Opinion: It’s now or never to negotiate a national pharmacare plan

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The passing of Bill C-64 opens the door for the federal government to negotiate agreements with each province and territory so that all Canadians would pay nothing when they fill prescriptions for contraceptives and diabetes medications.

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The federal government has celebrated this win as a first step towards national pharmacare. The Government of Alberta came out quickly noting that the federal
government has yet to share its vision for the future of national pharmacare and that meaningful consultation and collaboration are required.

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Both are right.

Removing financial barriers to contraceptives results in higher use and in cost-savings to the public purse. It also allows people to control when they get pregnant, empowering them to become parents when they feel ready to take on this important role. In addition, contraceptives are effective treatments for many health issues including regulation of abnormally long or heavy menstrual cycles, reduction of menstrual pain, symptom management for endometriosis and polycystic ovary syndrome, preventing anemia during menstrual blood loss, decreasing the risk of ectopic pregnancies and decreasing the risk of hysterectomy. Fundamentally, access to contraception supports gender equality and increases women’s participation in all aspects of society.

The evidence assessing removing financial barriers for diabetes medications is a little less clear-cut but generally suggests the same result: increased use of effective medications that can prevent the need for hospital visits. Ensuring Canadians face no financial barriers when using these two types of medications is an evidence-based good thing.

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For well over 60 years, national pharmacare has been commonly understood as a program that would be publicly funded and administered and that provides a comprehensive set of medications ensuring all Canadians have equal access based on medical need, not ability to pay. Its establishment has been called for in numerous reports over the decades, from the 1964 Hall Royal Commission on Health Services to the final report of the Advisory Council on the Implementation of National Pharmacare in 2019. The exact details of the plan may be slightly different in each report but the fundamental goal has not changed: public coverage of a broad list of effective medications for all Canadians.

If coverage of contraceptives and diabetes medications is Step 1 towards this vision of national pharmacare, what is Step 2?

If the vision for national pharmacare drawn out in any of the previous Canadian reports and commission doesn’t fit the bill for the federal government, it’s easy to find other places to draw inspiration from to articulate a longer-term vision. Our neighbours to the south started with expanding Medicare drug coverage through private drug plans that contract with the federal government.

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The World Health Organization recommends starting any public drug coverage plan in the context of limited resources with a list of essential medications, expanding as more resources become available. In each of these cases, the steps were clear about how to move towards more comprehensive pharmacare; Canadians deserve the same here.

Perhaps most importantly, and a major stumbling block for national pharmacare, is that the provinces and territories already have their own public plans that cover different populations in different ways. These plans have generally been developed over time in response to specific policy needs but in all jurisdictions, through a complex patchwork of plans, all residents are eligible for at least one publicly funded plan. This means that implementation in each province will look different.

For example, in B.C., where Fair Pharmacare covers everybody with different levels of financial support, removing financial barriers to contraceptive and diabetes medications is relatively easy (they already did it for contraceptives proving it can be done). However, in provinces like Alberta where the publicly funded plan for adults under age 65 who are above the low-income threshold has monthly premiums, many residents are not on the publicly funded plan. Instead, they are covered by private insurance. Twenty per cent of Albertans are uninsured.

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Instead of going through the public plan, there are other implementation options. For example, pharmacies could be directly reimbursed from the government for medications after providing them at no charge to patients.

Due to the complex nature of each province’s landscape, the implementation of this important funding will not be straightforward and time is short. If agreements aren’t reached with this federal government, there is a high likelihood they never will be. Thoughtful, collaborative policy development is what is
required — something we will not get unless both the federal government and provincial and territorial governments come to the table, with the interest of Canadians at the centre, to engage in conversation.

Fiona Clement is a professor in the Dept. of Community Health Sciences, Cumming School of Medicine and a member of the O’Brien Institute for Public Health, University of Calgary.

Amity Quinn is an assistant professor in the Departments of Obstetrics and Gynaecology and Community Health Sciences, Cumming School of Medicine, and member of the Centre for Health Policy, O’Brien Institute for Public Health, University of Calgary.