Why is Canada’s national pharmacare legislation such a head-scratcher?

Published on
May 16, 2024
Written by
Jason Grier
Read time

Just 1,384 words.  That, apparently, is all it takes to fundamentally transform Canadians' access to pharmaceuticals, whether better or for worse. 

Bill C-64,an Act Respecting Pharmacare was introduced on February 29, 2024, all 1,384 words of it.  Yep, on Leap Day.  But, frankly, you’d be forgiven if you’re reminded instead of Groundhog Day, specifically Bill Murphy’s 1993 movie of the same name. In that classic film, weatherman Phil Connnors (played by Murray) is forced to relive the same day over and over again in an endless loop, kind of like pharmacare itself. 

You see,pharmacare has been a favourite bauble dangled in front of Canadians for as long as I can remember (indeed, I was there when a National Pharmacare Strategy was written into the 2024 Health Accord twenty years ago).  As Yogi Berra famously quipped, “it’s déjà vu all over again.”

In another way, you could say that national pharmacare is a topic much like the weather:  everyone likes to talk about it, but nobody ever does anything about it. The problem is that national pharmacare is one of those things that is easy to promise, yet difficult to define and deliver. 

An examination of Bill C-64 illustrates this in spades. Indeed, instead of providing clarity, the bill raises even more questions.  And, to top it off, yesterday’s cost estimate released by the Parliamentary Budget Officer(PBO) has now spawned even further questions.  You see, not only does the PBO peg the cost at $400M higher than the government’s recent  budget,their calculation was not based on a universal, single-payor model.That’s right, the PBO assumes the new program would cover these costs for “those who currently do not have public or private drug plan coverage”.  

While the government has prioritized diabetes medications and some diabetes supplies,along with “a comprehensive suite” of contraception drugs and devices, the proposed legislation priorities funding “beginning with those for rare diseases.”  While definitely worthy of attention, particularly given the out-of-pocket costs many living with diabetes face, it would seem to stretch the definition of rare disease given that it is, sadly, one of the most prevalent disease conditions in Canada, which Diabetes Canada says impacts more than 5 million Canadians. Similarly, access to contraceptive options may also be worthy of support, but you’d be forgiven to wonder which rare “disease”contraceptives are intended…

But, the legislation raises even bigger questions, particularly where it comes to the government’s intention to roll-out a single-payor, universal, system in a country where the vast majority of people already have broad pharmaceutical coverage, many through private drug plans that cover far more products than on public formularies. If the government is providing first-dollar coverage of diabetes medications under a single-payor phamacare plan, what will this mean for those who are currently getting their medications through their private plan?  Will patients be assured that they will continue to be able to access the medications they have today? 

There are many areas where the legislation – all 1, 384 words of it – leaves ambiguity,questions, concerns, and contradictions in its wake.  And, sure, some of these will be cleared up in time, particularly in the context of agreements that need to be negotiated with each province.  However, in the absence of that clarity – clear answers to clear questions – , Canadian patients have every right to be uncertain and concern. The Government of Canada would do well to endeavor to provide more details and more answers as quickly as possible.

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