Posts Tagged ‘Canadian Politics’
Election Hangover in Ontario
The impact of the federal election is all but a formality.
The PM is calling back the House of Commons with more than a handful of new MPs and a handsome majority to ensure that a conservative agenda will dominate the Canadian body politic.
Many media, political observers and analysts believe that the PM’s Conservative government will define itself as good managers of the economy while being mindful of the needs of Canada’s growing cohort of seniors, those in need, minorities and New Canadians.
This scenario places the PM and his government squarely in the enviable political centre.
In Ontario, we’re almost five months away from a provincial election. The governing Liberals, once thought to be a spent force are defining the agenda for the election – good government, good social policies, good economic managers, good outreach, collaborative where it counts and tough and unafraid when they need to be. In effect, all the hallmarks of a centrist Party.
Notwithstanding the balance of power theory, which has always been alive and well in Ontario, the case cannot be made casually that the hangover from the federal election will permeate the outcome of the election soon to be fought in Ontario.
The media about and public images of the three Leaders in Ontario, the strategies to be employed during the campaign and math will all have an impact on this Ontario election in October of this year.
In as much as we need a provincial government in Ontario that has courage and knows the aspirations of its citizens – the winner of the election in Ontario will be the Party whose mission resonates successfully from the centre of the political spectrum – and I think we know what Party that could be this fall.
More of the same.
More of the same for this election. Is anyone following CBC’s horribly biased accounts of this election? No wonder people don’t want to vote!
Media Bias Continues
More of the same for this election. Is anyone following CBC’s horribly biased accounts of this election? No wonder people don’t want to vote!
Federal Election Update
Today federal Finance Minister Jim Flaherty confirmed that the federal government will table its latest budget on March 22, 2011.
The minority Conservative government must gain the support of at least one of the three opposition parties for the budget to pass. If the government is unsuccessful in passing the budget, the government will fall as it will have “lost the confidence of the House”.
Currently both the opposition Liberals and Bloc have indicated they will not support the budget. The Liberals sticking point is the issue of continuing corporate tax cuts which they oppose at this time. The Bloc under Duceppe has indicated that they could support the budget if $2 billion in HST compensation was included. It is somewhat unlikely that this will occur although “discussions are ongoing”.
This leaves the fate of the current government in the hands of Jack Layton and the NDP. The NDP has asked the Conservative government for four measures in the budget:
- Remove the HST from home heating bills and restore the EcoEnergy Retrofit program.
- Increase the Guaranteed Income Supplement for low-income seniors
- Expand & strengthen the Canada Pension Plan
- Increase the number of family doctors (5 million Canadians do not have access a family doctor)
Following the budget being tabled on March 22, there will be a vote in the House. If all three parties vote against the budget (vote to be held within the week following the budget) then the government will be defeated.
A likely Election Day is May 02, 2011.
Recent polls have the Conservatives on the edge of majority territory. Harper’s Conservatives have polled in the high 30’s through much of February, and in the most recent poll (yesterday) Conservative support is pegged at 43%.
The recent surge in Conservative support has occurred over the last few weeks so there is some debate regarding the “depth” and “staying power” of this level of support.
New seat projections have averaged the last few polls and show seat gains for both the governing Conservatives (+9), the Bloc (+5) and declines for both the NDP (-5) and Liberals (-4) from their current seat totals.
The Conservatives remain just shy of a majority under this model.
The question is whether or not the PM wants to roll the dice on a majority. This is likely his last chance to show the Conservative base that he can deliver. If he falls short, the leadership race will commence soon after.
However, if the polls are solid, the PM has never been this close before. It may prove too tempting to resist and if that is the case, the government will not work with the NDP or Bloc and will in fact engineer its own defeat.
Over the next few weeks, watch the polls and not Jack or Gilles…it really won’t be their call!
Marc Kealey with MP Justin Trudeau
At a recent event in Mississauga South, discussing policy issues with Federal MP Justin Trudeau.
Ein Prosit Mr. Turner!
You would probably never guess this, but every October John N. Turner officially opens Oktoberfest in Kitchener – Waterloo. This year was one of 30 yearly treks for him I think.
I went with him this year and in the usual rock star adoration he gets from the hundreds and hundreds of people at any event he attends, he delivered opening remarks in his usual precision and histrionics.
He recounted the time, years ago when he was invited by Helmut Kohl to open Oktoberfest in Germany, he recounted the words he used then, and in perfectly pronounced German, he offered greetings to the patrons of 2010’s Oktoberfest.
I’ve traveled with Mr. Turner to many parts of Canada and throughout the world. In every setting and at event he truly is treated like a rock star. And like finely brewed German ale, he gets better with age!
The Real Captain Canada
K&A was a proud corporate sponsor to a wonderful evening this week to celebrate Canada’s new Governor General David Johnston.
The event was in Kitchener Waterloo, and the crowd was as Canadian as they come. Former Prime Ministers, federal and Provincial Cabinet Ministers, provincial members of parliament, local politicians from across Canada, actors and myriad other celebrities made up some of the crowd of almost 1200 who came to honour the man who has inspired many Canadians.
David Johnston has touched the lives of so many in Canada and really is the essence of what a Head of State should be – selfless and for and of the people. The Prime Minister made a wonderful choice for certain and it was evidenced by the exuberance of those who attended the celebratory event this week marking it as an event for the ages.
Local businessmen Tim Jackson and Rob Caldwell dreamt up the event and in less than two months it was a sell out with a waiting list of another 400 people who wanted yet could not get tickets.
Celebrating David Johnston is easy – he is such a worthy candidate for accolades. More importantly, though, it’s his love of Canada and his remarkable energy towards young people that inspires them to strive to do the best that they can to make Canada a global powerhouse.
David Johnston is now the Governor General and I now know the Governor General. This is personal for me. David Johnston and I worked together on a Board, we conspired on fundraising efforts and we hang (or until recently hung) with the same crowd. He’s always been an inspirational role model to and for me.
To all of us, the Governor General will now be more than ceremonial. In fact, the role, in practice, has the constitutional gravity to allow the Governor General to weigh in on important issues framing how we are governed as Canadians. The Governor General is our link to our own history as a nation founded on a constitutional monarchy and ensures that as a constitutional monarchy, we can rely on appropriate advice by a learned head of state – the GG. David Johnston is an expert in these matters and, as such, is a choice we will all learn to appreciate given the fragile nature of our parliament today.
Captain Canada is a moniker we give to those who more than wrap themselves in the flag and who instinctively promote all the good Canada has to offer – and with Canada there is much to celebrate. David Johnston is a terrific choice, it’s a terrific honour for Canada and a terrific celebration of a Canadian who typifies all that IS Canada in the twenty first century. What a guy!
Drug Plan Reform in Canada – The new Rules and the Renewed Reaction
Canada contributes to the world significantly in terms of politics, comedians, natural resource management, innovation in health system design and, of course, the game of hockey. A G-20 nation, Canada often compares itself to and competes with its closest neighbor and trading partner, the United States.
However, when it comes to prescription drugs and their prices, Canada as a nation is compared to countries like Sweden — a bitter pill to swallow for Canadians, who represent 2% of the world’s population.
This article outlines the rationale behind and the reactions to prescription medication and drug plan reform currently underway in Canada. It also a provides a brief historical perspective on the reform environment and offers insights into opportunities for plan sponsors, designers and plan members to maximize reform outcomes.
A Perspective
Pricing for prescription medication in Canada is different from U.S. pricing.
The Canadian constitution gives provinces the power to create their own laws and regulations to manage and govern their health care systems, including prescription drug benefits. Each province has its own formulary and drug benefit plan and has regulatory colleges that govern the activities of health care providers like physicians, nurses and pharmacists.
The sum total of all provincial drug benefit programs is about $12 billion (Cdn) dollars per year.
In Canada, medications—both prescription and over the counter, and specifically those approved for human consumption—are granted approval through Health Canada.
Any pharmaceutical manufacturer wishing to “launch” a medication in Canada undergoes a rigorous approvals process. Patent laws govern the allowable time that a branded medication (like Lipitor™) can sell its product without competition—about 20 years. After the patent term expires, the law provides that generic manufacturers—those approved to manufacture a copy of the branded molecule—can produce and sell their version of the branded medication at a reduced price. Generic versions of any branded medication are sold and dispensed to patients through licensed pharmacies at a significantly lower price than that of the branded medication.
In the current environment of economic challenges, provincial drug benefit programs have little choice but to make changes to improve the financial position of their plans. The cost of drug programs is rising, and the public has little appreciation of those increases. Provincial drug benefit plans across Canada are making tough decisions. Generic drug prices, which seem unnecessarily high and are fueled by what are known as promotional allowances or rebates for retail pharmacies, are the targets of the reform. As frustrated private sector plan sponsors and designers experience similar rising costs, they also are undertaking this same assertive reform. Of course, this reform has created its own sense of frustration among pharmacy owners.
Canada spends about $25 billion (Cdn) dollars a year on prescription medicines. The split between public sector drug benefit plans (such as the Ontario Public Drug Program) and the private sector is about 45% public sector and 55% private sector.<1> It should be noted that rising costs in drug plans have largely accrued from increased drug utilization—for instance, more patients needing medications for chronic illnesses—and actual increases in the cost of medications. In the last ten years, provincial drug benefit programs have witnessed annual increases of anywhere from 8% to 15%.<2> Private sector drug plan sponsors have listed similar annual cost increases.
These issues are not endemic solely to the current economic climate; increases have been commonplace year over year for quite some time. While there appears to be no magic bullet for the future, with some innovative thinking, ingenuity and courage, they can be mitigated and managed.
An Historical Perspective
In the late 1960s, Canada’s federal government limited patent terms on brand medications and allowed for greater manufacture of generic medicines in Canada. Those broad-reaching legislative initiatives opened the door to realized savings for drug benefit plans as they allowed patented medicines to be copied by generic manufacturers when patents expired.
This legislation did not, by any stretch, threaten the existence of any brand manufacturer in Canada. The brand pharmaceutical sector remains a vibrant part of Canada’s socioeconomic fabric, providing clinical research for new therapies, clinical programs and education opportunities for patient groups, hospitals and medical providers including physicians, nurses, pharmacists and others. In fact, the 1990s and the early 2000s were good years for brand manufacturers with blockbuster medications to manage high cholesterol, hypertension, diabetes, mental health, sexual health issues and cardiovascular disease. Brand-named drugs were listed on formularies across the country.
Clinical research among brand manufacturers continues today for the next disease management tool, such as biologics, to combat cancer, rare diseases and genetic disorders.
The patent legislation of the late ’60s spawned a robust and vibrant generic manufacturing sector that continues to grow in Canada. Generic manufactured medicines account for over 50% of all medicines dispensed in plans across Canada.<3 >
The legislation giving generic manufacturers the right to copy the active ingredient in a previously branded medicine and sell to patients through a pharmacy has meant savings in drug plans. Generic medicines cost less because manufacturers do not incur the cost of drug discovery; that effort has already been done by brand manufacturers. Similarly, generic manufacturers do not have to incur the cost of what is commonly known in pharmaceutical industry parlance as safety and efficacy because brand manufacturers have already done these studies.
In the last five years, the patents on a number of blockbuster medicines—brand names sold at higher prices in pharmacies to patients—have expired. Generic versions of medicines such as Altace™, Biaxin™, Zyprexa™, Pantaloc™, Pariet™, Actos™, Pravachol ™and Vasotec™ are now for sale at a lower price. In the next three to five years it is expected that more branded medicines will hit the patent expiration cliff.
Prices for brand medicines, set in Canada by a panel known as the Patented Medicines Price Review Board (PMBRB), were about 30% to 40% higher than prices for their generic versions.
At the same time the movement from brand name to generic versions of drugs was taking place, community pharmacy, as a sector, began to consolidate. Throughout the 1970s and 1980s Canada witnessed the firm establishment of chains or banners or buying groups intended to ensure cost-effectiveness and profitability for the retail sector. As a consequence, there appear to be few real independent, community-based retail pharmacies in Canada. The retail community pharmacy universe, therefore, has become a significant force as a distribution channel.
This movement in pharmacy seems to have spawned a philosophical difference of opinion between pharmacy as retailer and pharmacist as health professional. The retail pharmacy, by virtue of its ubiquity and strength, appears to have emerged as the more powerful entity in this reform world.
Competition for shelf space in community retail pharmacy prescription medicine is fierce. Generic medicine manufacturers used to compete against each other for pharmacy’s business through programs aimed at pharmacists and small-ticket items like hand-held information technology devices. Now, they compete solely through cash rebates or free goods to the community pharmacy or chain head offices, which make the buying decisions and allow a manufacturer’s medicine to be dispensed at a local pharmacy or through a matrix established by the pharmacy chain.
This scheme produced the unintended consequence of making generic drug prices, although still cheaper than brand medicines, more expensive in Canada than in comparator countries. It’s widely noted that Canadians pay the highest drug prices for generic medications. Here’s why: Historically, as retail purchases of generic medications grew, so did the “allowances” to pharmacies from manufacturers to have pharmacies stock a particular manufacturer’s products. The prices that pharmacies charged to public and private plans did not take into account the rebates or allowances the retail pharmacy received from manufacturers. This practice inflated the price or the actual cost of the ingredient (not the fee) paid by the consumer and third parties.<4>
Public sector drug plans recognized that rebates or allowances to retail pharmacies ranged from 40% to 80% of the invoice price of medications. The provinces of Ontario and Quebec, convinced that this practice was having an impact on their plans, introduced legislation to curb the practice. In 2006, Quebec passed Bill 130, the Act Respecting Prescription Drug Insurance. The act introduced various cost-containment provisions, including establishing a set price for generic drugs (54% of the brand), and strived to limit allowances paid by manufacturers to retail pharmacy. The act did not affect private sector plans.<5>
In 2006, Ontario launched Bill 102, the Transparent Drug System for Patients Act, which introduced broad-ranging changes for manufacturers and pharmacy. The act went much further than Quebec’s Bill 130; it amended the Ontario Drug Benefit Act as well as the act that governed the private sector—the Drug Interchangeability and Dispensing Fee Act. It established a firm limit on “allowances” to be paid to retail pharmacies doing business with the Ontario Public Drug Program and set generic drug prices in the public sector at 50% of the brand. This 50% limit became the new price in Canada for generic drugs.
In other ways, the bill gave special recognition to the profession of pharmacist. It moved to increase the role of pharmacists as a part of the health team through commitments for increased scope of practice, the ability to advise the public drug program through the Pharmacy Council and a fee-for-service initiative known as Meds Check. <6>
Bill 102 was passed into law in late summer of 2006 amid a backlash from retail pharmacy, which was collectively upset over the impact of the act’s limit on allowances. One of the most significant and unintended consequences of the passage of Bill 102 was a shift in costs of prescription medications and fees for pharmacy service from the newly legislated public sector to the seemingly untouched private sector. Since the passage of Bill 102 in Ontario, drugs sold in pharmacies to consumers are sold under what is now referred to in Canada as a two-tiered drug-pricing system. Patients in the public program pay a lower price for drugs than patients in the private drug benefit sector.
Before the passage of Bill 102, there was little distinction between public sector drug plans and private sector drug plans regarding fees paid to pharmacy and ingredient costs. In fact, private sector plans often mimicked any changes that were realized by changes in public sector plans. Since the passage of Bill 102, however, private sector plans pay about 50% more for prescription and fees than plans in the Ontario Public Drug Program.<7>
Other provinces, watching closely what was transpiring in Ontario, soon followed suit with reform measures to protect their public drug plans. Most notable were the provinces of British Columbia and Alberta.
British Columbia (BC) established its Pharmaceutical Task Force and tried to address the issue of what it deemed “the hidden cost of generic medications” and what it viewed as a growing trend in “frequent prescribing.” After a protracted consultation period, the province reached an agreement with the BC Pharmacy Association with what it cited as “interim changes” to the province’s PharmaCare program.<8> It was interesting to note that the province gave appropriate recognition to the value of pharmacists and, in 2009, invested in patient care options.
In 2009, Alberta introduced its reform measures through its Pharmaceutical Strategy. This two-phased reform measure began in early 2009 with a legislated change to the price of any generic that would be newly introduced on the public drug plan from the previous 75% to 45% of the branded medicine’s price. The province committed to further lowering the cost of generics that were already on the plan. Early this year, the province announced a commitment to a price of 56% of the brand price for these medications.
The province also announced that it would invest in a fee mechanism for pharmacists to provide a cognitive service to patients similar to the program earlier described as Meds Check Ontario.<9> These announced reform measures in Alberta seemingly will not benefit private sector plans.
In the summer of 2009, the province of Ontario’s minister of health began consultations with pharmaceutical stakeholders to create longer term sustainability on its recently reformed public drug program. The minister recently announced that it would begin bilateral discussions with pharmacy on approaches to eliminating allowances or rebates altogether. The province will likely settle on a generic drug-pricing scheme similar to or perhaps lower than the province of Alberta’s scheme. At the same time, Ontario has further recognized the value of the pharmacist as a part of the integrated health team. Ontario offered the profession scope of practice enhancements, through proscribing authority and other clinical enhancements, to ensure greater access for patients in the health care system.
The Road Ahead
Private sector plan sponsors, designers and consultants have been keenly interested in the outcomes of recent reform measures introduced by provinces. Private sector sponsors are unhappy with the two-tiered drug cost system and have expressed concern and frustration about the practice of generic allowances to pharmacy. Plan sponsors have tried to instill some discipline in plan design to combat increases in prescription drug costs and fees associated with traditional community pharmacy.
Provinces in Canada remain bullish on the need for reform. The Competition Bureau in 2008 suggested that the practice of allowances or rebates to pharmacy from generic manufacturers resulted in $800 million dollars that could be used to reduce the prices Canadians pay for prescription medications, diverted into chronic disease management programs, or used to lower taxes or benefit plan costs.<10>
Pharmacy as a front has begun to agitate against these reform measures. In some provinces there are threats to withhold service to patients on public drug programs or there are threats to private plan sponsors where a pay-direct card, for example, would not be honoured by certain pharmacy chains.
Governments have moved to combat the animus through further recognition of the clinical value of the role of pharmacists and have amended scopes of professional practice to include them in their reforms.
No doubt pharmacy will try to resist these reform measures—the changes will impact their businesses directly. And they can play a tough game. It will take courage for private sector plans to fend against some of the tactics that pharmacy will employ. But leveraging the strength of the membership of any private sector plan will result in better pricing for those plans and, perhaps, bring to light a new pharmaceutical distribution model altogether.
Besides public efforts at reform, the private sector is seizing this opportunity to promote drug cost management. Many are looking closely at the prices of prescriptions and trying to find ways to direct plan members to opportunities for good outcomes at lower costs. Some are capitalizing on public sector reforms and implementing those changes. Others are considering innovative and alternative distribution of prescription medicines. Some are encouraging cooperatives with other plans. Most are calling for better drug prices, exclusive listing agreements on their formularies and clinical programs for their plan members.
Private sector plans are encouraged to engage more in the public sector reform debate and become knowledgeable about public policy initiatives underway on the sustainability of public sector plans.
Plan sponsors and plan designers may embrace alternative delivery mechanisms, a simplified prescription process, better interaction with pharmacists, lower dispensing fees, lower prices for drugs and optimization of the dispensing practice (from monthly to every three months for chronic medication regimens) when they witness the actual savings they can realize.
This transparency will maximize drug benefit plan efficiency and promote better outcomes for private sector plan sponsors and holders. This, in turn, will create greater access, greater benefit and, most of all, sustainability going forward.
Endnotes
<1> CIHI research
<2>Ontario Ministry of Health research, 2009
<3>IMS Canada
<4>Mercer Canada Report, October 2008
<5>Bill 130, the National Assembly
<6>Ministry of Health, Province of Ontario
<7>IMS Canada research
<8>Province of British Columbia Health Ministry
<9 >Province of Alberta
<10>Sheridan Scott, commissioner of the Competition Bureau, 2008.
The Liberal NDP merger.
Ask any young person about politics and they’ll say don’t care! Better than that they might say, “don’t care, don’t give a shit”! This is a sad commentary on politics today.
The reason why fewer that 55% of Canadians bothered to vote in the last federal election and why more and more Canadians are voicing displeasure with the politicians is because they (the voters) feel helpless and unengaged.
I joined the Liberal Party when I was 14 years old. In the past 35 years, I have enjoyed the experience of fighting no fewer than 15 provincial and federal elections combined, 7 leadership conventions, two leadership reviews and myriad policy conferences. Suffice to say, I am a child of MY Party. The sad fact today is that it means a hill of beans.
My political mentor John Turner, for whom I worked, laments that the democratization of parliament is an issue second only to the bolstering of policies and ingratiation of Party faithful. These people own the Party, NOT the bunch of appointed flacks who serve the Leader of the Party. The recent private discussions that have been undertaken by old flacks in some secluded spots in Ottawa are a symptom of a larger problem for the Liberal Party how to re-engage Liberals or attract new ones.
Instead of a re-evaluation of this option, these wiley old timers seek to merge the oldest political brand in Canada with a left wing rump. Let’s face it the NDP will never assume power in Canada’s federal parliament, nor were they ever expected to – they were, however, a Party who’s philosophies and policies embraced that of a true perpetual opposition. Not so with the Liberals. This is a Party that bore most of the social policy reforms that have made Canada a tour de force internationally.
A discussion of a merger at this juncture should be taken for what it really is a cynical attempt to wrest power through mathematics. The Liberal Party on its own has neither the leadership nor the voter appeal at this point to become government. Perhaps a deal with the NDP to gain power now might be a possibility but ask Bob Rae if this benefitted him in Ontario in 1985.
The simple fact is this – the appointed flacks in the Leaders office, the unelected Senate members who claim to be the conscience of the Party, the advisors and consultants who skulk around Ottawa are NOT the Liberal Party. It is the hundreds of thousands of Party faithful across this great land who believe in the philosophies of Wilfrid Laurier, MacKenzie King, Louis St. Laurent, Mike Pearson, Pierre Trudeau, John Turner, Jean Chretien, Paul Martin and others. It is also the Party of great thinkers like Vincent Massey, Norman Lambert, Gordon Fogo, Gordon Dryden, Boyd Upper, Walter Gordon, James Scott, Keith Davey, Al Graham, Norm Macleod, Martin Connell, Maurice Sauvé, Paul Desrocher, Iona Campagnolo and many other great Liberal thinkers across Canada who have perfected the Liberal brand.
There is no cross road here, the silly talks about a merger should be outed for what they are a frustration at the current prospects of a Party in disarray, with little attraction from voters. If the attempt is to increase a paltry 25% voter approval for a leader no one wants – then following that logic, what does a Conservative PM do at 32% – who does he merge with???
Let¹s get smart all you Liberals say something!
