By Dr. Jenni Zelin (Guest Opinion)
Editor: As an Island family physician, I have grave concerns about the potential impact of the Canada-EU CETA (Comprehensive Economic and Trade Agreement) on the cost of pharmaceuticals in P.E.I. Islanders are already struggling with the high costs of their prescription medications. In my practice, many are forgoing necessary medical treatment when they cannot afford these medications or they are forced to choose between paying for their medications or other basic necessities, such as healthy food.
According to a briefing paper by the Canadian Centre for Policy Alternatives, Canadian drug costs are already the second highest in the world on a per capita basis, with the fastest rising drug costs among OECD (Organization for Economic Co-operation and Development) countries. Drug costs make up a large proportion of Canadian health- care spending: in 2012, prescription drug spending in Canada was $27.73 billion, versus $29.96 billion spent on doctors. This is partially due to Canadaâ€™s generous pricing system for pharmaceuticals and protection of brand-name versus generic brand drugs. Under CETA, the situation will become far worse for patients.
CETA is designed to further protect the pharmaceutical industryâ€™s profits by committing Canada to a new system of patent term restoration, which will delay generic alternatives for up to two years. Generic medications are, in most cases, equally as effective as brand name drugs, but cost a great deal less. Delaying generic drug options by up to two years will delay the option for patients to receive equal treatment for a lower cost.
CETA will also lock in Canadaâ€™s current terms of data protection (the safety and efficacy research information provided by brand-name companies in order to get drug approval), making it difficult or impossible for future governments to reverse them. Generic drug companies are already restricted for a minimum of six years from using brand-name medication research data, data necessary to expedite their own approval applications. CETA will not extend data protection, but it will prevent any chance of shortening the protection period in the future.
The trade agreement will further delay the development and availability of generic medications by implementing a new right of appeal under the patent linkage system. This may lead to lengthy litigation between brand-name and generic drug companies, further delaying the introduction of a generic alternative medication in the market. Moreover, since the EU does not use patent linkage and CETA does not require it to do so, this Right of Appeal provision will only apply to Canada, an obvious inequity in the trade agreement.
These changes are estimated by the CCPA study to delay generic medication entry by from 1.05 to 2.03 years, leading to an increase in medication costs to Canadians of $850 million to $1.645 billion annually. P.E.I.â€™s share of this increase would be from $3.2 to $6.1 million annually. P.E.I. could, like other provinces have, demand federal compensation for these costs in the public drug plans (note that there would be no compensation for private insurance, co-payments, deductibles, or out-of-pocket drug costs). However, if the federal government agreed, taxpayers will still be footing the bill, but at the federal income tax level, rather than the provincial level. Either way, it is Canadian taxpayers and patients who will ultimately pay, while the pharmaceutical corporations profit.
What are our options if CETA inflates drug costs? In order to save health care spending under CETA, P.E.I. could choose to restrict the choice of medications that are offered to its citizens under its public drug plan, limiting our choices for health maintenance and disease treatment.
Alternatively, we could transfer the burden of costs onto the individual, often the elderly and our sickest Islanders, many already on fixed incomes. Or we could help pay for the increase in drug costs by using funds from other health-care departments, further straining a system near crisis. Ultimately, the health care of all Islanders will be compromised with any of these options. A sounder option is to reject CETA outright.
Dr. Jenni Zelin,
Charlottetown family physician