38 40 Clinical leadership is essential; however, an evidence-based national formulary can help to stem overuse and inappropriate use of prescription medications. 41 , 42 Furthermore, improved integration of medications into Canadas universal public health care system should increase not decrease incentives and opportunities to promote their appropriate use. We were unable to account for confidential rebates paid by drug manufacturers to public drug plans in comparator countries or to existing provincial drug plans. 27 However, private insurers and patients without insurance in Canada generally do not negotiate discounts with manufacturers. 43 Thus, our assumption that a universal public drug plan would expand the negotiating power of the public drug plans in Canada and the scope of sales on which negotiated rebates would apply is reasonable, and our estimates of the decline in prices of brand-name drug are probably conservative. Conclusion Universal health coverage is first and foremost about providing appropriate care to patients on the basis of need, not ability to pay. Canadas system is unique insofar as such access is assured for medical and hospital care but not for prescription drugs. A long-time barrier to the implementation of universal prescription drug coverage in Canada has been the perception that it would necessitate substantial tax increases. Our analysis shows that this need not be the case. Universal public coverage of prescription drugs can achieve access and equity goals while also achieving considerable economies of scale that stem from better pricing and more cost-conscious product selection under a single-payer system. Footnotes CMAJ Podcasts: author interview at soundcloud.com/cmajpodcasts/drug-coverage Competing interests: Michael Law reports receiving personal fees from Health Canada outside of the submitted work.
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