A Canadian essential medicines list must be evidence-based

An essential medicines list in Canada should be evidence-based and independent of conflicting interests, found a study of decision-makers and policy-makers that is published in CMAJ (Canadian Medical Association Journal).

Prescription drug coverage in Canada is a patchwork system, with about 21% of Canadians covered by provincial or territorial government drug plans, 3% by federal public coverage and 70% by private employer-based coverage. About 20% of Canadians are uninsured or underinsured.

A national essential medicines list has been proposed to reduce inequitable access and improve health, ensure quality and safety of care, and improve efficiency of spending on medicines.

"Decision-makers and key stakeholders in Canada had different and sometimes skeptical views on the suitability of an essential medicines list in Canada," writes Jordan Jarvis, lead author of the study and a researcher at the London School of Hygiene & Tropical Medicine, London, United Kingdom, with coauthors. "Nonetheless, there was consensus on three important factors that would need to feature in the policy process of a possible approach to an essential medicines list."

The three factors are

• an independent, arms-length decision-making body
• selection criteria to list medications based primarily on clinical and cost-effectiveness
• clear communication with the public and other stakeholders, such as clinicians and policy-makers, on the purpose and evidence-based focus of the essential medicines list.

After the study was completed, the Federal Advisory Council on the Implementation of National Pharmacare announced recommendations for universal public pharmacare with coverage for a list of essential medicines to be implemented with federal leadership working with provinces and territories.

The authors suggest that engaging all provincial and territorial governments, patients, the public and clinicians in understanding and developing an essential medicines list is necessary.

"Acceptability and feasibility of a national essential medicines list in Canada: a qualitative study of decision-makers and policy stakeholders" is published October 7, 2019.