National Pharmacare: A prescription for change

Canada is the only developed country with universal health care but no national pharmacare program.  In the recent throne speech, the federal Liberals pledged to change that.  But Canadians have heard this before from our government with little action to date. It is time that we hold them to their promise.

Drugs account for the second largest component of health system expenses (behind hospital care) and are the fastest area of cost increase.  Currently, prescription drug coverage in Canada remains an incomplete patchwork of federal, provincial, territorial and private plans that leave a significant number of Canadians with no insurance.  Approximately 1 in 10 Canadians cannot afford to take their medications as prescribed.  

Public plans pay for 42% of drug expenditures and private drug plans account for 36%, leaving 22% percent of prescription drug costs to be covered out-of-pocket by patients.  Approximately 11 percent of Canadians have no prescription drug coverage whatsoever, while many with private or public coverage face significant deductibles or other user fees.  

Public support is also overwhelmingly in favour of a national pharmacare program with 91% of Canadians supporting universal prescription drug coverage. 

When people cannot access the prescription medications they need, studies show that they are at risk of getting sicker or dying prematurely.  Without prescription drug coverage, people report worse overall health status, more people with HIV infections die and the number of premature deaths from diabetes increases. 

Other health care costs such as hospitalizations or emergency department visits also go up.  Lack of comprehensive prescription drug coverage leads to increased financial burden on patients, difficulties with access to lifesaving drugs and higher overall costs to the health system.

These are not new insights.  Numerous commissions since the 1960s have recommended a national pharmacare program to provide coverage for medically necessary drugs for all Canadians. 

Experts in the medical field including physicians, nurses, and academics have endorsed national pharmacare for decades.  Public support is also overwhelmingly in favour of a national pharmacare program with 91% of Canadians supporting universal prescription drug coverage.  

So why do we not have a national pharmacare program today? 

Some think it is because the costs of a universal prescription drug program will be prohibitive.  However, the weight of evidence suggests that universal prescription drug coverage will in fact save Canadians money.  With a single-payer universal system, administrative costs are reduced, purchasing power is increased through bulk procurement and Canadians will stop paying some of the highest prices for medications in the world.  

Costs to governments are estimated to increase by $1 billion with national pharmacare, while the private sector (i.e. you, me and our employers) would save $8.2 billion, resulting in estimated net savings of $7.3 billion or 32% per year. 

There is good news for governments too, because increased costs to them will be offset by improvement in health outcomes and reduced demand on other health services which have not been included in the above calculation.

Some fear that the profits and livelihoods of private insurance and pharmaceutical companies may be threatened by a national pharmacare program.  But private insurance companies have showed us their resilience before when Canada adopted universal coverage for hospital and physician services.  They pivoted, diversified and expanded into other areas of health benefits and remained a viable industry. 

Similarly, evidence from other countries shows that pharmaceutical companies will not abandon Canada as a place to do business or decrease their important contributions to research and development.

A national pharmacare plan is essential to the health of Canadians and in ensuring that everyone can access life-improving and life-saving medication. Federal, provincial and territorial governments must collaborate to fill this prescription for change.

By Vamini Selvanandan© 2020. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on October 15, 2020. Photo credit: Miguel Á. Padriñán on

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