Progress, but more work is needed

June 20, 2024
Pharmacist wiht patient.
The Pharmacare Act proposes a framework as the first step toward universal, single-payer pharmacare, but if, how and when this will happen remains unknown.

Pharmacare legislation introduced in February is a positive step and is significant for Canadians who need diabetes medication and contraception. 

Among the commitments in the agreement between the Liberals and NDP was passing a Canada Pharmacare Act by the end of 2023. The parties agreed to extend to March 1, 2024, and while there were questions about the likelihood of a deal, legislation was introduced the day before the deadline. 

The government calls it the “first phase” of national, universal pharmacare in Canada. The Pharmacare Act (Bill C-64) proposes a framework for universal, single-payer national pharmacare and the government’s intent to work with the provinces and territories to provide universal, “first dollar” coverage — meaning no co-payments or out-of-pocket expenses — for certain diabetes medications and contraception. 

Although it’s not in the bill, the government said it also intends to support access to diabetes supplies, such as syringes and glucose strips. Details will follow, after discussions with the provinces and territories. 

The government has reported that this coverage will support affordable access to diabetes medication for 3.7 million Canadians and contraception for 9 million Canadians who are of reproductive age. 

It also reports, “one in four Canadians with diabetes have reported not following their treatment plan due to cost. Eliminating cost barriers of medications will help improve health of people living with diabetes and reduce the risk of serious health complications.” 

The bill proposes the Canadian Drug Agency develop a national formulary, a national bulk purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications within a year following royal assent. 

The health minister will establish an expert committee to make recommendations “respecting options for the operation and financing of national, universal, single-payer pharmacare in Canada.” 

The 2024 federal budget proposes $1.5 billion over five years to support the national pharmacare plan. 

It isn’t yet clear when this limited coverage will commence. The bill still has to move through the House of Commons and Senate, and the government needs to finalize negotiations with the provinces and territories. Some provinces have already said they’ll opt out. 

In the press conference, the minister called the diabetes and contraception coverage under a universal, single-payer model a “proof of concept opportunity.” The bill proposes the first step with a framework, though if, how and when universal, single-payer pharmacare expands is unknown. 

What are the impacts to private insurance, such as the PSHCP? Normandin-Beaudry, a consultancy, reported in March that it estimates private plans will see 15 to 20 per cent of costs for treatment of diabetes shift to the national plan, and almost 80 per cent of contraception costs. The consultants estimate this could represent a three per cent reduction in drug expenses for plans. 

They estimate that the effects on premiums of an average private plan would be roughly one per cent, with a complete shift of drugs listed in the bill and more limited in post-retirement plans, given the rare use of contraceptives. 

Canada is the only country in the world with a universal health-care system that does not also provide universal prescription drug coverage. The Pharmacare Act is an important beginning for advocates, including Federal Retirees, who have been calling for action for decades. 

Federal Retirees will continue to monitor the progress of the bill and its impact on the PSHCP and it will ensure governments remain focused on helping Canadians age in health and dignity. 

This article appeared in the summer 2024 issue of Sage magazine as part of our “Health Check” series, which addresses timely health questions and health-related policies with a focus on issues affecting older Canadians. While you’re here, why not download the full issue and peruse our back issues too?