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Advocates of pharmacare were alarmed to see Canada's federal health minister attend a gathering billed as a "national pharmacare forum" that was dominated by groups that oppose universal drug coverage.

Ginette Petitpas Taylor gave the opening keynote address at the event last Tuesday that brought together industry groups that have a lot to lose if the original vision of a public drug plan paid for by governments is ever realized. Doctors who support such a system say they were not included.

In attendance were representatives from the Canadian Life and Health Insurance Association (CLHIA) and Innovative Medicines Canada (IMC), which represents Canada's pharmaceutical industry, as well as drug companies AstraZeneca and Ipsen.

Petitpas Taylor is no stranger to these groups: the CLHIA and IMC have together lobbied the federal government more than 160 times in the past 12 months, according to the lobbyist registry.

The patient lobby group Canadian Organization for Rare Diseases (CORD), which receives funding from more than 40 drug companies , was also there.

'One-sided'

The event was hosted by Canada 2020, an organization Maclean's magazine referred to as " the progressive think-tank that really runs Canada ."

IMC is a donor to Canada 2020.

Dr. Danyaal Raza, chair of Canadian Doctors for Medicare, has no issue with the health minister talking to the industry just as it consults other stakeholders such as doctors, patients, labour groups and employers.

"But to participate in such a one-sided forum where there are clearly business interests at play, I think it's problematic."

Earlier today, <a href="https://twitter.com/Canada2020?ref_src=twsrc%5Etfw">@Canada2020</a> hosted <a href="https://twitter.com/GinettePT?ref_src=twsrc%5Etfw">@GinettePT</a>, for a <a href="https://twitter.com/hashtag/Pharmcare?src=hash&ref_src=twsrc%5Etfw">#Pharmcare</a> panel stacked with pharma & insurance industry insiders. 1/3 <a href="https://twitter.com/hashtag/cdnpoli?src=hash&ref_src=twsrc%5Etfw">#cdnpoli</a> <a href="https://twitter.com/hashtag/cdnpoli?src=hash&ref_src=twsrc%5Etfw">#cdnpoli</a> <a href="https://t.co/MIFkutGgQi">pic.twitter.com/MIFkutGgQi</a> —@DanyaalRaza

Canadian Doctors for Medicare, which says it represents physicians across the country, strongly backs a single-payer system in which the provinces alone would pay for drugs as they do for doctor visits and essential hospital stays. His group was not invited to the forum, and Raza said that perspective was clearly missing.

Also absent were academics who could present any of the large number of independent, peer-reviewed research papers published on the subject of pharmacare.

Canada 2020 executive director Alex Paterson told CBC News the event was not one-sided.

"We always strive for good balance and debate. I feel this event lived up to that commitment," he said in an email.

Paterson said there were approximately 80 people in attendance, including "physician representation and research from CHEO [Children's Hospital of Eastern Ontario]."

But that physician, Dr. Alex MacKenzie, who's a senior scientist at CHEO Research Institute, told CBC News he didn't present any research and simply acted as a moderator.

He considered Raza's criticism "legit."

"It was pretty industry-represented. It did not have a lot of patient involvement, nor health economists, academics or physicians," MacKenzie said.

Petitpas Taylor responds

Petitpas Taylor's office suggested she was at the meeting to advance the cause of pharmacare.

"I will continue to speak about our government's plan to lower drug prices for Canadians and work toward pharmacare on as many occasions as possible, to present it to people from all horizons that sometimes agree with it and sometimes don't," she said in a statement.

But Dr. Joel Lexchin, who has published extensively on the power and influence of Canada's pharmaceutical industry, said Petitipas Taylor's appearance at the industry-dominated pharmacare forum is a problem.

"The optics are that by agreeing to appear she's saying, 'Yes, I think that you guys ... your position is valid,'" he said.

Plans for universal drug coverage were in the blueprints for Canada's original Medicare plan 55 years ago. But political promises came and went. Those blueprints were dusted off again in February 2018 with the Trudeau government's creation of the Advisory Council on the Implementation of National Pharmacare, headed by former Ontario health minister Dr. Eric Hoskins.

Last year, a Liberal Party policy convention called for " a universal, single-payer, evidence- based and sustainable public drug plan " — although it would have to be with "provincial and territorial co-operation."

But Lexchin worries that Petitpas Taylor's presence at the forum might signal the government's willingness to consider a limited pharmacare plan that the industry endorses, known as the "fill in the gaps" approach.

In this model, existing provincial drug insurance would simply be extended to the 20 to 30 per cent of Canadians who don't have their own coverage and normally wouldn't qualify for a public plan because they earn too much or aren't seniors.

Academics and advocates for universal single-payer coverage have long warned that continuing with parallel private and public drug plans will do nothing to rein in Canada's drug prices, which are the highest of any country with a universal health care system.

"If you want to control drug prices, one of the strategies is to have a single bargaining agent. When you're doing 'fill in the gaps' you don't get that," Lexchin said. "The literature is pretty clear."

Opponents of a single-payer system warn it would be a huge financial burden for governments and may result in new drugs not being covered as quickly as they would by private insurers, the way many of them are now.

The federal government said in its 2019 budget it is taking steps to make prescription medications "more affordable and more accessible" but stopped short of announcing a universal drug plan.

What happens next will become clearer after Hoskins releases his final report, due next month.

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