Abstract
Among all categories of health expenditure in Canada, spending on drugs is the fastest growing. The factors at play in the increase in expenditure on drugs are essentially those related to the volume of use and the arrival of new drugs on the market. Some of these new drugs are very expensive. In fact, the costs of certain drugs threaten the continued existence of the Québec Prescription Drug Insurance Plan. In Québec, the Conseil du médicament (Drug Board) is responsible for recommending drugs to the Ministry of Health and Social Services to be put on the formulary of drugs covered by the public plan. In spite of pressure by various stakeholders, we believe that the rationing of drugs that are too expensive can achieve political legitimacy if it is based on a transparent justification that includes not only evidence-based criteria, but also ethical principles and values. For egalitarians, fairness in the supply of health care should be accomplished as a function of health care needs. But this concept of justice should also be extended to future generations. The balance of current and future needs should be achieved by determining what would be "reasonable access" through public consultations among experts and citizens.