Canada’s pharmacare bill has officially become law, aiming to broaden access to essential medications like treatments for diabetes and contraception, which can cost Canadians hundreds or even thousands of dollars annually. However, provincial agreements are still being negotiated, meaning that coverage under Bill C-64 will only be available in provinces that finalize deals with the federal government.

The legislation promises universal access to most contraception and diabetes medications, with plans to expand the list of covered treatments over time. It introduces universal first-dollar coverage, meaning that the government—funded by Canadian taxpayers—will cover costs upfront, potentially saving insurance companies millions.

For diabetes, the plan covers treatments like insulin for Type 1 and Type 2 diabetes, metformin, and other medications for Type 2 diabetes. Contraception coverage includes oral contraceptives, and morning-after pills. However, it’s important to note that many of these medications were already covered by provincial governments or private insurance for most Canadians. The real beneficiaries of this new plan may not be individuals but private insurance companies that will no longer have to bear the cost of these medications. It remains to be seen whether insurance premiums will decrease, though corporate profits are likely to rise.

Prime Minister Justin Trudeau has called on provinces and territories to start negotiating pharmacare deals as soon as possible. These agreements are crucial to the plan’s implementation, although it’s puzzling that legislation was passed without first negotiating with provincial governments and pharmacists—the very key parties responsible for implementing it. Despite these concerns, this marks the beginning of Canada’s journey toward a universal pharmacare system. The government plans to convene an expert panel within the next month to outline the next steps, with recommendations due within a year.

Here are two things you might want to ask your MP:

1. Ensure pharmacists are included in the expert panel.
2. Advocate for the government (and Canadian taxpayers) to be the “Payer of Last Resort,” not the “Payer of First-Dollar Coverage.” This would mean the pharmacare plan would only “top up” existing coverage or provide coverage to those without any, rather than offering blanket coverage to everyone, regardless of their current insurance status (which for most Canadians is already robust).

As pharmacists, we support universal coverage for essential medications but only in a way that is financially sustainable and fair to taxpayers. Right now, the biggest beneficiaries of this plan aren’t patients with diabetes or women needing contraception (since many already have coverage)—the main winners are the insurance companies, who will no longer have to pay for these medications.

So, what’s wrong with the federal government being in charge of this pharmacare plan and paying first?

1. It’s not within their constitutional jurisdiction.
2. The provinces likely won’t agree, and much like the daycare strategy, we’ll see a patchwork of plans across the country, especially in Quebec.
3. The costs will likely become unsustainable, and as expenses rise, the plan may eventually cover fewer people and fewer medications to stay within budget.

Instead, the pharmacare plan should:

1. Be federally funded but provincially administered, like current health and drug plans.
2. Act as the “Payer of Last Resort,” covering only those without existing insurance.
3. Focus on essential medications not normally covered by provincial or private plans, such as orphan drugs and non-formulary medications.
4. Involve pharmacists in making sure that the plan remains relevant, cost effective and sustainable for the Canadian Taxpayer and not simply become an expensive superfluous piece of bureaucratic political propaganda.

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