Ottawa says pharmacare is coming - here's what you need to know

The federal government's latest budget sets aside $1.5 billion to implement pharmacare - a major fi‐ nancial commitment with the potential for a wideranging impact on the country's health-care sys‐ tem.

The program, long de‐ manded by the government's supply-and-confidence part‐ ners in the NDP, will start small by covering just two categories of drugs.

For the program to get off the ground, the provinces and territories also will have to be on board.

Ottawa has made a com‐ mitment to expand pharma‐ care - it's standing up a panel of experts to provide advice on how best to implement a universal, single-payer pro‐ gram sometime in the future.

CBC News has received a number of questions about the program. Here are some answers.

What is pharmacare?

The Pharmacare Act pro‐ poses a publicly-funded, na‐ tionwide health-care insur‐ ance program to subsidize the cost of prescription drugs in Canada.

The stated purpose of the act is to improve the accessi‐ bility and affordability of pre‐ scription drugs for all Canadi‐ ans, with a goal of eventually introducing a national, uni‐ versal pharmacare program.

Canada is the only coun‐ try in the developed world with a universal health-care program that does not in‐ clude universal coverage for prescription drugs. Instead, we have a mix of private, public and out-of-pocket in‐ surance plans.

According to the Parlia‐ mentary Budget Office (PBO), total prescription drug spending in Canada in 202122 amounted to roughly $36.6 billion. Of that total, 46 per cent was covered by pub‐ lic sources, 40 per cent was covered by private insurance, and 14 per cent was paid for out-of-pocket.

Legislation has been lay‐ ing the groundwork a phar‐ macare-type program for decades.

The Medical Care Act, passed into law in 1966 but not fully implemented until 1972, established a costsharing arrangement be‐ tween the federal govern‐ ment and the provinces to ensure universal public health insurance for hospi‐ tals and physician services.

The Canada Health Act, passed in 1984, enshrined in law the core principles of the public health-care system that it be publicly adminis‐ tered, comprehensive, uni‐ versal, portable and accessi‐ ble to all.

The missing piece - uni‐ versal prescription drug cov‐ erage - is what pharmacare is meant to provide.

What's in Bill C-64, the Pharmacare Act?

In its current form, the proposed legislation would provide universal access to a wide variety of contracep‐ tives and diabetes medica‐ tion.

If C-64 passes Parliament, Health Minister Mark Holland will begin negotiating with the provinces and territories on a funding commitment that would cover the cost of providing these medications to people for free.

According to Health Cana‐ da, nearly 10 per cent of the population lives with diag‐ nosed diabetes. A quarter of those diabetics say their treatment plans are affected by the cost of drugs.

Bill C-64 would subsidize access to diabetes medica‐ tions that lower blood glu‐ cose levels, such as insulin and metformin.

The full list of diabetes medications the government is suggesting will be covered can be found here. They in‐ clude Glulisine, Detemir, Saxagliptin and metformin, among others.

The bill also would cover access to contraceptives for roughly nine million Canadi‐ ans of reproductive age. The federal government says the coverage will reduce unplan‐ ned pregnancies and lower costs for health-care systems nationwide.

The full list of contracep‐ tives to be covered can be found here. They include a variety of oral birth control pills, copper and hormonal IUDs and emergency contra‐ ceptives.

That's it for now. The fed‐ eral government says it's planning to introduce univer‐ sal pharmacare incremental‐ ly. This first phase will be

evaluated before the govern‐ ment looks to expand to a nationwide single-payer model.

When will Canadians get access to pharmacare?

The short answer is ... it depends.

Holland has said he hopes to have the first phase imple‐ mented with the provinces by the end of the year. That timeline depends on the fed‐ eral government reaching agreements with the provinces.

That means residents of some provinces might have access to pharmacare sooner than others.

If the bill passes, the Canadian Drug Agency will then develop a national pur‐ chasing plan and a national formulary of prescription drugs.

It's not clear how this pro‐ cess might affect the federal government's timeline.

What are the provinces saying?

So far, both Alberta and Quebec have said they plan to opt out of pharmacare if it's enacted. Both provinces say they want to invest their share of the program's fund‐ ing in their own health sys‐ tems.

The Ontario government has yet to commit and has said it wants to see more de‐ tails before backing the legis‐ lation. The government of B.C. has reacted favourably to the legislation.

The other provinces and territories have signalled they are open to taking part in the program but want to see more details before com‐ mitting.

The pharmacare pitch comes after the federal gov‐ ernment last year offered the provinces and territories $196 billion over 10 years for their health systems.

How much is this going to cost?

Federal officials have yet to confirm the exact cost of the first phase of the phar‐ macare program.

Without finalized agree‐ ments with the provinces, it's hard to say exactly how much the program will cost. Estimates released in the fed‐ eral budget indicate that the first phase will cost $1.5 bil‐ lion over five years.

The cost of a fully imple‐ mented, universal, nation‐ wide, single-payer prescrip‐ tion drug program is esti‐ mated at $33.2 billion in fis‐ cal 2024-25, climbing to $38.9 billion in fiscal 2027-28, according to the PBO.

The projected cost to the federal government would range from $11.2 billion in 2024-25 to $13.4 billion in 2027-28.

Despite expected growth in prescription drug use, the PBO predicts that lower drug prices would help contribute to economy-wide savings of about $1.4 billion in 2024-25, incrementally rising to $2.2 billion in 2027-28.

What are pro-pharma‐ care advocates saying?

According to Statistics Canada data, one in five Canadians "remain unin‐ sured and pay out-of-pocket for prescription medica‐ tions."

Pharmacare advocates al‐ so note that Canadians pay some of the highest individ‐ ual prescription drug prices among OECD countries.

Nikolas Barry-Shaw of the Council of Canadians, an in‐ dependent progressive advo‐ cacy group, said the cost of the "status quo" is more than the cost of a national univer‐ sal prescription drug pro‐ gram.

Barry-Shaw said that such a program would help reduce the strain on hospitals - be‐ cause if more people have access to prescription drugs, fewer of them are likely to be hospitalized.

What are others saying? Critics of pharmacare claim the program would re‐ duce the variety of drugs available to Canadians and say the funding could be put to better use elsewhere in the health-care system.

Dr. Bettina Hamelin, presi‐ dent of Innovative Medicines Canada - which represents pharmaceutical companies said that "moving provinces and territories towards a single-payer pharmacare sys‐ tem would ultimately reduce the quality of drug coverage for most Canadians."

Opponents of the legisla‐ tion point to the wide range of coverage already available to the vast majority of Cana‐ dians. Roughly 88 per cent of Canadians already have com‐ prehensive prescription drug coverage.

The Canadian Association of Pharmacists, which repre‐ sents over 45,000 pharma‐ cists across Canada, is calling for a mixed-payer model that builds on public and private insurance programs.

What does the future look like?

Assuming the bill passes through Parliament, much depends on whether the fed‐ eral government can get enough support from the provinces. And there's a fed‐ eral election coming next year.

Conservative Leader Pierre Poilievre has not said whether he would scrap pharmacare. He has criticized the idea by suggesting that it would "ban" private insur‐ ance plans. (The proposed legislation would not ban pri‐ vate plans.)

Poilievre also has ham‐ mered the Liberals over their deficit spending, casting doubt on the future of new Liberal social programs un‐ der a government led by him.

"It is imperative for this to get rolled out as quickly as possible," said Barry-Shaw.