Moving a national pharmacare plan
Canada’s “universal” healthcare coverage may step toward becoming more universal
In 2019, the Canadian government released A Prescription for Canada: Achieving Pharmacare for All, the final report from the advisory council on plans to implement national coverage for prescription drugs.
“If the promise of universal health care is that Canadians are there for each other when we’re sick, by not including prescription drugs we’re placing a limit on that commitment,” wrote the chair of the advisory council, Dr. Eric Hoskins, in the report.
Hoskins continued, “The time for universal, single-payer, public pharmacare has come. This is our generation’s national project: better access to the medicines we need, improved health outcomes and a fairer and more sustainable prescription medicine system.”
According to the 2019 report, Canadians spent approximately $34 billion on prescription medicines in 2018. According to a 2021 study published in the Journal of Pharmaceutical Policy and Practice titled “Trends in Canadian prescription drug purchasing: 2000-2020,” prescription drug spending was estimated to increase from 4.2 per cent to 4.6 per cent per year from 2021 to 2023, representing a total spending of approximately $37.2 billion in 2023.
Drugs are the second largest expenditure in health care after hospitals, and the Canadian healthcare systems spends more on pharmaceuticals than they do on doctors. At the time of the 2019 report, approximately 3 million Canadians could not fill their prescriptions due to unaffordability.
As it stands, Canada is the only country in the world that has universal health care but does not include universal coverage for prescription drugs. Instead, Canada relies on more than 100 government-run insurance programs and over 100,000 private drug insurance plans.
On Feb 29, 2024, Minister of Health Mark Holland introduced Bill C-64, An Act respecting pharmacare, which proposes the underpinning principles of the first phase of a national universal pharmacare plan.
“Each and every Canadian should have access to the prescription drugs they need. That’s why we’re working with our partners towards the first phase of national universal pharmacare. This important next step will provide universal access to contraception and diabetes medication that will be transformational in improving health outcomes in Canada,” said Holland.
Covering contraception will increase the access of nine million Canadians of reproductive age and is expected to promote reproductive autonomy. This is of major significance, as cost has largely been identified as the single most impactful barrier in accessing these medications. Moreover, the cost of such medications is unevenly felt by women and gender-diverse Canadians.
Conversations around universal contraception in Canada have intensified in recent years, most notably following U.S. legislation impacting abortion rights. Such conversations in Canada have highlighted major gaps in healthcare policy that must be addressed.
Those who live in rural or remote communities, who belong to Indigenous communities, or are newcomers to Canada may have increased barriers in accessing contraception warns Dr. Vivian Tam, an emergency physician based in Ottawa. “What we really want to do is to protect and prioritize the reproductive freedom and health of people with a uterus,” said Tam.
She continued: “The first thing that we need to do as a country, collectively, is to reject the idea that just because you’re poor or living in a rural part of the country or Indigenous, that you need to accept a lower standard of health care and wellbeing.”
According to a CTV News article, “One U.S. study found that a publicly funded contraceptive plan resulted in major cost savings, with every dollar spent on IUDs resulting in seven dollars saved in other health-care costs. Tam noted that in countries like the U.K. and Australia where contraception is covered, there are clear downstream cost savings with respect to averted unwanted pregnancies, constituting STIs and infertility.”
Following the announcement of the national Pharmacare plan, the Alberta government announced it wants to opt out of the plan covering diabetes medication and contraception. Alberta Health Minister Adriana LaGrange shared how the province is unhappy with the way the deal was reached without consulting with the provinces first.
LaGrange claimed that Alberta already has “robust” coverage of medications and would rather Ottawa give Alberta per-capita funding to strengthen its own programming instead of forcing the province to sign into the national program.
Alberta’s unwillingness to adopt the Pharmacare Act raises concerns around whether other provinces will follow suit. In Saskatchewan, an email statement was released that claimed the government needs more information about the program. “Our residents are currently being provided protection from high drug costs through several provincially operated programs. At this time, the cost to the province for a national pharmacare program being implemented in Saskatchewan is unknown,” the statement said.
However, the Saskatchewan provincial government also said the province is “not interested in reducing the scope of its existing drug plan to align with a new national plan if the new plan will result in reduced benefits.”
