Negotiations with provinces could slow pharmacare

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This article was published 24/03/2025 (207 days ago), so information in it may no longer be current.

Despite Canada’s commitment to universal health care, one in 20 Canadians cannot afford their prescribed medications, with people from Alberta, New Brunswick and British Columbia being the most likely to say they’re missing doses due to costs.

When people skip medications, it leads to more emergency room visits, costly hospital stays and worse health.

Ensuring people have coverage for essential medications is crucial. In October 2024, Canada took a step forward when Bill C-64, or the Pharmacare Act, received royal assent and became law.

The act will cover contraceptives for nine million Canadians, helping with family planning and managing conditions like endometriosis and polycystic ovary syndrome.

It will also cover diabetes medications for the 3.7 million Canadians living with the disease — critical for managing blood sugars and preventing complications like blindness, kidney failure, heart attacks and strokes.

Despite this historic passage of pharmacare legislation, its rollout remains uncertain. The next steps are complicated by the Constitution Act of 1867, which gave provinces jurisdiction over health care.

The federal government must now negotiate agreements with each province to implement the plan — a task made more difficult because medication coverage varies widely across Canada. Without full co-operation, pharmacare’s impact could be limited, with coverage gaps persisting for millions of Canadians.

Conservative Leader Pierre Poilievre has also said he’ll scrap pharmacare.

COVERAGE DIFFERS AMONG PROVINCES

In many provinces — including B.C., Saskatchewan, Manitoba, Ontario, Nova Scotia, P.E.I. and Newfoundland and Labrador — pharmacare coverage is provided universally with income-based deductibles. Provincial coverage only kicks in after an individual reaches a spending threshold on medications. This threshold varies by age and income level.

Alberta and New Brunswick use premium-based systems, requiring monthly membership fees.

Most provinces also use co-payments, meaning people must cover part of the cost of each prescription — for example, 20 to 30 per cent of the full cost, or a flat fee of $5 to $10. Only Québec mandates prescription insurance coverage, either privately or through its public plan.

Currently, a major driver of how much Canadians pay for their medications is arbitrary — it’s about where one lives. For example, a young Albertan living with diabetes and heart disease who earns $14,000 would need to pay $1,000 annually for medications. In Ontario, that same person would pay just $100.

Such differences can influence where people choose to live and hinder interprovincial labour mobility. It’s a driving force behind the push for pharmacare — to ensure free access to the most important medications, regardless of where someone lives.

AN OPPORTUNITY FOR NATIONAL PHARMACARE

Pharmacare could have been implemented nationally, like it was for the Canadian Dental Care Plan, offering federal coverage for essential medications like contraceptives and diabetes medications, while insurers and provincial plans cover the rest.

This would have been a simple approach that would have allowed for future changes, and could have been implemented by provinces much like vaccines are — paid for using people’s provincial health numbers, sidestepping the difficulty of enrolling people in a new plan.

But in the waning days of the current Liberal federal government, it appears the chosen direction has been to negotiate separate agreements with each province and territory to establish a minimum standard.

Movement in this direction has already been seen in B.C., Manitoba and P.E.I. where deals have already been made with the federal government, while other provinces remain in talks.

The pace of these agreements remains uncertain, and it’s unclear when — or if — all the provinces and territories will sign on.

PHARMACARE FIGHT NOT OVER

As Canada takes its first steps toward pharmacare, many questions remain. For provinces with income-based deductibles, would the deductible simply shift to other drugs, meaning people with other health conditions won’t really save on their overall medication costs each year?

For those with premium-based coverage, how would those who don’t enrol in the public plan access coverage? How would this be rolled out in Québec where some form of medication coverage is already mandatory?

The push for universal drug coverage in Canada dates back decades. When medicare was first recommended in 1964 by the Hall Commission, it included a proposal for universal drug coverage that was ultimately never implemented.

Over the decades, multiple reports, including the 1999 Kirby Report and the 2019 Pharmacare For All Report, have called for its implementation.

Organizations like the Canadian Medical Association and the Canadian Nursing Association have similarly stressed its importance. Yet, despite decades of advocacy, Canada has remained the only country with a universal health-care system that doesn’t provide comprehensive drug coverage.

With negotiations on pharmacare officially underway, its success will depend on federal-provincial co-operation, which has been increasingly strained in recent years. Advancing pharmacare is in Canadians’ best interest — especially for the 7.5 million people who cannot afford the medications their doctor prescribes.

The question now is whether governments will act swiftly to implement pharmacare, or if political roadblocks will delay access to life-saving medications even further.

» Jane Fletcher is a PhD candidate in Community Health Sciences, University of Calgary. Braden Manns is a professor of Medicine and Health Economics, University of Calgary. David Campbell is an associate professor of Medicine, University of Calgary. Reed F. Beall is an associate professor of Community Health Sciences, Cumming School of Medicine at the University of Calgary. This column was originally published at The Conversation Canada: theconversation.com/ca.