The proposal for a system of catastrophic drug insurance fails to deal with both equity and cost issues in a comprehensive manner and will still leave many Canadians without adequate drug coverage. Retaining features of current provincial plans that give near first-dollar coverage to the poor and the elderly is a step forward. The idea of tying first-dollar insurance to drugs that are used for prevention and in disease management programs is worth exploring, but there are still many unanswered questions about disease management. A full public pharmacare plan with first-dollar coverage will increase public expenditures but reduce overall drug costs and distribute benefits more equitably.

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