Debate begins on a universal, single-payer pharmacare

On June 12, the federally appointed Advisory Council on the Implementation of National Pharmacare recommended a universal, single-payer, public pharmacare system in Canada. However, it is far too soon to know what, if anything, will be implemented.

So far, only the New Democratic Party (NDP) has released its election platform in anticipation of the October federal election. The NDP echoes the Advisory Council’s recommendation for a universal, single-payer public pharmacare program, and further states that implementation would begin sooner (in 2020 rather than 2022) and at a lower cost ($10 billion annually rather than $15 billion annually upon full implementation).

The Liberal government has yet to provide a detailed response to the Advisory Council’s recommendations. In media reports, federal Health Minister Ginette Petitpas Taylor has said the recommendations will be reviewed over the coming months.

The Advisory Council suggested that the national formulary build upon the World Health Organization’s Model List of Essential Medicines (which contains approximately 450 drugs, each with multiple products or Drug Identification Numbers [DINs]) and the CLEAN Meds list developed by St. Michael’s Hospital in Toronto (with 136 drugs and their respective DINs).

In the months leading up to the report, the House of Commons Standing Committee on Finance had indicated that a fill-the-gaps approach for pharmacare, which maintains the current blend of private and public plans, would be preferable to a universal, first-payer approach. However, the Advisory Council’s report specifically recommends against a fill-the-gaps approach. On page 10 the report states: “We came to understand that a ‘fill the gaps’ approach was unrealistic since, like our current mixed public/private system, it would do little to lower drug prices or create fairness or uniformity in access across the country.”

Two of the Advisory Council’s 60 recommendations do, however, suggest a continued role for private insurance:

• Recommendation 3 (page 17 of report) – “The council recommends Canadians be allowed to purchase private insurance to supplement coverage under national pharmacare.”
• Recommendation 55 (page 22) – “The council recommends private insurers be allowed to provide coverage for copayments, as well as for drugs not on the national formulary.”

The coming months leading up to and following the federal election will determine which of the recommendations are adopted and bring further clarity on implications for private insurers, provincial governments and Canadians.