Health Minister Mark Holland released the long-awaited details of the federal government’s pharmacare plan on Thursday, with a commitment to cover some diabetes treatments and contraception.
If the bill, C-64, passes Parliament, 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.
He said he hopes people can access the program sometime this year, although a lot of uncertainties make an actual start date hard to pinpoint.
The federal government says it also will establish a fund to support Canadian diabetics who need access to syringes and glucose test strips to manage their condition but struggle to afford them.
The government says one in four Canadians with diabetes — about 3.7 million people have the condition — have reported they’re not following their treatment plans due to the cost.
The “first-dollar” coverage for these drugs — an insurance industry term which means the government foots the bill entirely — will help those diabetics in particular.
The pharmacare plan also will give the nine million Canadians of reproductive age better access to contraception to ensure “reproductive autonomy, reducing the risk of unintended pregnancies and improving their ability to plan for the future,” the government said in its media release.
The exact types of contraception covered by this program have not yet been chosen but the government is promising that “a comprehensive suite” of drugs and devices eventually will be covered in the provinces and territories that sign on.
This is the first step in what could be a much more robust regime in the years ahead, although its future is uncertain. Some provinces are already demanding the chance to opt out of the federal program, or are rebuffing Ottawa’s efforts entirely.
The federal government says that, beyond diabetes treatments and contraception, it intends eventually to implement more coverage for other medications.
Bill C-64 calls for the creation of a national formulary — a list of essential drugs that could be eventually covered by the government — and develop a national bulk purchasing strategy.
The government says it will strike a committee of experts to advise it on how to establish a universal, single-payer program and will then pursue bilateral deals with each of the provinces and territories before proceeding to that sort of larger pharmacare plan.
The goal is ‘full coverage,’ Holland says
The government said it wants to take a “step-by-step,” incremental approach to implementing universal pharmacare, which could come with a multi-billion dollar price tag and upend the country’s existing drug coverage network.
Most Canadians already have coverage for prescription drugs through a patchwork of public and private insurance plans. It’s not immediately clear what effect a national, universal program might have.
Holland said Ottawa will evaluate how the first phase of coverage for diabetes treatments and contraception pans out before deciding to fund something more extensive like a single-payer model. Canada’s existing medicare program is a single-payer system where most costs are borne by government.
But Holland insisted Ottawa is committed to pursuing “full coverage so that everybody can afford their medication.”
Holland has cited the high cost of a truly universal and single-payer pharmacare system as a barrier at a time when the federal government is trying to rein in spending after years of big pandemic-era budget deficits.
The Parliamentary Budget Officer (PBO) has pegged the cost of a single-payer program for all medications at nearly $40 billion a year.
Another option may be a more tailored approach that provides pharmacare coverage to people who don’t already have insurance, or expanding provincial drug coverage schemes to include more people.
Cost uncertain
Federal officials speaking to reporters during a background briefing said the government does not know how much this first phase of the pharmacare program will cost taxpayers.
The final price tag for diabetes treatments and contraception will be determined after negotiations with the provinces and territories, the officials said.
Pressed to provide some sort of cost estimate, Holland said the first phase will cost roughly $1.5 billion.
He said that figure could change depending on what the uptake is among the provinces and territories.
Reporters pressed Mark Holland on the cost of pharmacare as he announced the launch of the program on Thursday. Holland says it will take time to work out the cost of the new service.
Holland said the funds won’t be included in the upcoming federal budget because the pharmacare legislation has to pass both houses of Parliament — and he still has to broker deals with his provincial counterparts before the money can flow.
Some sort of national pharmacare program has been a long-time demand of pharmacists, health-care professionals and progressive activists who say Canada’s single-payer health-care system should be paired with coverage for drugs and other treatments to improve population health.
The details were announced after months of protracted negotiations with the NDP, which demanded the government launch pharmacare as a condition of the supply-and-confidence agreement that keeps the minority Liberal government in power until 2025.
Holland said Thursday was an “important day” in Canada’s history.
“Today is a giant step forward for our health system,” he said.
Canadians won’t have to lie awake at night worried about the cost of their diabetes treatment, and women and girls will be able to control their own bodies with free contraception, he said.
“Cost remains a barrier. Today, we’re taking action to remove that barrier,” Holland said.
Women and Gender Equality Minister Marci Ien called the government’s plan to cover things like birth control and the morning-after pill “a concrete step toward true and lasting gender equality.”
NDP MP Don Davies, the party’s health critic, negotiated with Holland for months and helped draft the pharmacare bill. He said this legislation is “a pathway to ensure no Canadian will be forced to suffer because they can’t afford their medication.”
“For the first time ever, insulin, diabetes medications and devices and contraception will be available as a matter of right and not privilege,” he said. “This is a game-changer for millions of people.”
Davies promised his party won’t stop advocating for the implementation of a national, universal, single-payer program for other medications.
NDP Leader Jagmeet Singh took credit for forcing the Liberals to act on the issue.
“If you want to see more pharmacare, you’re going to need New Democrats. It’s not going to be Liberals that deliver more of this,” Singh said.
Conservative Leader Pierre Poilievre told reporters his party will closely review what’s being proposed before taking a position.
Christina Warner, the executive director of the Council of Canadians, an advocacy group that has long pushed for pharmacare, said the federal government’s announcement is a “major win.”
“For too long, wealthy corporations have stood in the way of progress on a public pharmacare plan. But today, patients have finally prevailed. Now, the government must rapidly fund, implement, and expand the program to fully meet the needs of Canadians and bring drug prices down,” she said.
Canadian Life and Health Insurance Association (CLHIA), an industry group that represents major players like Manulife and Sun Life, panned the legislation as a threat to existing private insurance.
In a media statement, Stephen Frank, the president and CEO of the CLHIA, said the government’s pharmacare program and its planned expansion “will spend billions of dollars unnecessarily on drugs for people who already have coverage.”
“It will replace what is working with a government program that will become more burdensome and expensive over time. And it will put at risk the workplace benefit plans that 27 million Canadians count on, making life less affordable for millions of families,” Frank said.
He said private insurance plans cover twice the number of drugs covered by even the best public plans.
Frank claimed Canadians do not want the federal government “picking and choosing which drugs get covered and which don’t.”
