Earlier this month, federal pharmacare legislation was enacted, including provisions for contraception, various diabetes medications, and supplies. However, many details remain unclear, particularly regarding who will be covered and how the coverage will work.

The next step is for Health Minister Mark Holland to appoint a committee to make recommendations on the program’s implementation. Both the Neighbourhood Pharmacies Association of Canada and the Canadian Pharmacists Association (CPhA) are urging for pharmacy representatives to be included. “Pharmacists should ideally be involved throughout the entire process,” they stated, emphasizing that these healthcare professionals will be on the front lines of implementing the program.

One of the primary questions revolves around the system’s structure: Will it cover all Canadians or just those without existing insurance? Will a government insurance plan be used, excluding private insurance, or will a mixed-payer model allow people to utilize both private and public coverage? 

Holland previously described the plan as “universal, single-payer, first-dollar coverage.” However, he also suggested that individuals might have a choice between their private insurance and the federal plan.

“The government has committed to a single-payer approach for these medications, but how that will be achieved remains complex,” one representative remarked, adding, “Will people lose their private coverage? Will there be dual coverage? There are many questions still to be answered.”

Pharmacies Advocate for a Mixed-Payer System

Both the CPhA and Neighbourhood Pharmacies are in favor of a mixed-payer approach, arguing it offers several advantages, especially including reduced government costs. According to Neighbourhood Pharmacies’ estimates, covering all uninsured Canadians for diabetes and contraception would cost around $300 million annually, while extending coverage to all Canadians would raise the cost to $900 million, three times as much!  Pharmacists suggest prioritizing uninsured individuals across various disease groups while allowing those with private coverage to maintain it. This approach, they argue, is more cost-effective and simpler to implement.

Past changes, such as Ontario’s OHIP+, serve as cautionary tales. One example on many is during that transition, a child cancer patient losing access to chemotherapy initially covered by a parent’s private plan. The medication wasn’t covered under OHIP+, resulting in an eight-week delay until exceptional access could be granted.

Neighbourhood Pharmacies is also concerned that a public formulary would offer fewer choices than private ones, potentially leading to shortages and limiting medication options.

Canadians’ Preferences

Surveys show most Canadians are satisfied with their current drug coverage. A 2020 poll conducted by Neighbourhood Pharmacies found that 80% of Canadians were content with their coverage, and 75% did not want their benefits replaced.

“There’s a system that works well for many Canadians now. Public plans are generally less comprehensive, and we shouldn’t aim to bring everyone down to a basic level; we should aim to elevate everyone’s coverage,” they noted.

The practical details will be ironed out through agreements between the federal government and the provinces, with negotiations expected to wrap up by the spring. B.C. is leading the way, having already signed a memorandum of understanding with the federal government. However, Alberta’s Health Minister Adriana LaGrange has expressed a preference to opt out in favor of the province’s Alberta Blue Cross program. Quebec, which already has its own pharmacare system, also seeks compensation rather than participation.

We hope that pharmacists are included in the discussions to provide valuable insights on the benefits and challenges of implementation decisions. Our hope is that this process prioritizes enhancing access to healthcare and medications for Canadians, while establishing a cost-effective, sustainable program built to last. It’s essential that this effort goes beyond a rushed, short-term solution driven by political interests and instead focuses on genuinely benefiting the majority of Canadians and taxpayers.

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