On November 16, 2007, the Ministry of Health announced the appointment of a pharmaceutical task force to "…provide advice to government on how best to maximize value for patients and value for money as well as examine ways to continuously improve the pharmaceutical approval process." The Task Force's report is dated April 10, 2008, but it was released to the public on May 21st, at the same time as a government news release in which Health Minister George Abbott announced that: "Government has accepted all of the recommendations from the Pharmaceutical Task Force …" Normally such reports are received by government for study; the quick endorsement of all of the recommendations confirms suspicions that the fix was in from the start.

Nowhere in the Task Force's report can you find any indication of how full implementation of its recommendations will impact costs for the Pharmacare program, not even so much as to say whether costs would go up or down under the recommendations. It looks like the recommendations are the wish list of "Big-Pharma", and that far from realizing maximum value for money, they will increase costs which the government will accommodate by increasing user fees and co-payments, i.e. shifting more costs from the public purse to individuals who are sick enough to need a lot of drugs. Much of the Task Force's report undermines what the Ministry of Health's Pharmaceutical Services Division (PSD) has done to try to control costs while maximizing benefits for British Columbians.

When Pharmacare was established in 1974 pharmacies signed a participation agreement which stipulated that they would bill Pharmacare for the actual acquisition cost of pharmaceuticals plus a dispensing fee. In recent years it came to light that pharmacies regularly pad their billings by making a profit on the ingredient costs on top of what they make through their dispensing fees. Rather than criticizing that practice, the Task Force said: "The PSD has reasonably resisted increases to the current level of $8.60 per prescription in an environment where it was understood that the costs of these services were offset by generic rebates and other indirect sources of revenue. In effect, the rebates provided by the generic industry to pharmacy have subsidized the provision of services provided to patients by pharmacy …" In other words, the Task Force acknowledged that pharmacies are not charging the actual acquisition cost of drugs as they are getting various kickbacks, rebates or other "indirect sources of revenue", but the Task Force laid that fault entirely at the feet of the generic drug producers, not saying a word about the pricing and marketing practices of so called "research-based pharmaceutical companies". Note that members of the Task Force included the chief executive officer, Pharmasave Drugs (National) Ltd. and the president of Canada's Research-based Pharmaceutical Companies. No apparent conflict of interest there!

The Task Force devoted a substantial portion of its report to strategies for controlling the cost of generic drugs, while criticizing the government's approach to using tendering as a method of cost control for not considering patient choice. Throughout the report, including in the terms of reference, the concept of "patient choice" is used. Most health economists would argue that patients are not qualified to self-prescribe, and that the term "patient choice" is a euphemism for complying with marketing by drug companies. The government should not hesitate in its efforts to minimize the acquisition costs of generic drugs, and it should not be sidetracked by the Task Force's confusion over the concept of patient choice.

In 1994 the province started funding the Therapeutics Initiative at UBC, a collaboration of the Department of Pharmacology and Therapeutics in cooperation with the Department of Family Practice. The Therapeutics Initiative is an effort to counteract the millions of dollars the pharmaceutical industry spends in its efforts to influence the prescribing patterns of physicians. Much of what the industry reports as "research" is actually marketing expenditures aimed at trying to influence the prescribing patterns of physicians. The Therapeutics Initiative is aimed at effecting : "an immediate and long term change in physician prescribing habits that will result in improved health care in the province of British Columbia." Obviously, there is an inherent conflict between the marketing aims of the drug companies and the goals of the Therapeutics Initiative.

According to the Campbell government's Pharmaceutical Task Force: "The Therapeutics Initiative is regarded by most who participated in this process, other than the PSD leadership, as narrow, insular and resistant to meaningful stakeholder engagement." In other words, the professional civil servants who are charged with resisting cost pressures from the drug companies (stakeholders) support the effort to counteract drug company marketing, but those who made submissions to the government's effort to undermine its own staff view the watchdogs as narrow and insular.

BC has been particularly successful in resisting Big-Pharma. The Canadian Institute for Health Information (CIHI) recently reported that in 2007: "Total drug expenditure per capita is forecast to have ranged from $660 in British Columbia to $910 in New Brunswick." The government has a role to play in controlling drug costs whether they are publicly or privately paid. BC has been particularly successful in that effort, with the Therapeutics Initiative playing an important role. The Campbell government shouldn't get away with rewarding the drug companies by re-organizing the Therapeutics Initiative out of existence.

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PS: Thirty-four years ago, I wrote the original Pharmacare participation agreement when the late Pat Tidball and I put the 1974 Pharmacare program together.