Question Period Note: Pharmacare

The Government has committed to implement national universal pharmacare, including a Canadian Drug Agency, a national formulary, a national strategy for drugs for rare diseases, and a Canada Pharmacare bill.

No Canadian should have to choose between paying for prescription drugs and putting food on the table.
The Government of Canada is committed to continue working with willing provinces and territories towards national pharmacare, which includes introducing a Canada Pharmacare Act.
We have established a Canadian Drug Agency Transition Office and are taking steps to develop a national formulary, while moving forward with developing a national strategy for drugs for rare diseases in collaboration with provinces, territories, stakeholders, and the public.
IF PRESSED ON THE GOVERNMENT’S COMMITMENT TO IMPLEMENT NATIONAL PHARMACARE …
The mandate letter from the Prime Minister reiterated the Government of Canada’s commitment to continue engaging with willing provinces and territories towards national universal pharmacare, while proceeding with a national strategy for drugs for rare diseases and advancing the establishment of the Canadian Drug Agency.
The agreement to bring forward a Canada Pharmacare bill builds on this commitment.
IF PRESSED ON THE CANADA PHARMACARE ACT …
We look forward to working with all Parliamentarians to ensure that Canadians have better access to the drugs they need.
IF PRESSED ON THE DEVELOPMENT OF A NATIONAL FORMULARY AND BULK PURCHASING PLAN …
Work is already underway to develop a national formulary. Following broad consultations, a multidisciplinary national panel established to develop a draft formulary framework released its final report in June 2022. The panel’s work was overseen by the Canadian Agency for Drugs and Technologies in Health (CADTH), at the request of Health Canada.
We will continue to work with all provinces, territories, and stakeholders to lower costs and improve access to the safe, high-quality drugs and vaccines Canadians need.
IF PRESSED ON PRINCE EDWARD ISLAND INITIATIVE…
Progress has already been made to improve the affordability and accessibility of needed prescription drugs for Prince Edward Island residents.
Since January 23, 2023, PEI expanded access to a total of 85 new medications to treat a variety of conditions including cancer and heart disease.
Effective June 1, 2023, PEI expanded its provincial drug coverage to reduce co-pays to $5 for almost 60% of medications regularly used by Islanders and removed barriers to the High-Cost Drug Program making it available to all income levels. As of August 16, 2023, Islanders have saved over $675,000 in out-of-pocket costs on more than 77,000 prescriptions under the $5 co-pay program.
PEI also lowered the cap on the amount of money a household spends on eligible medications under the Catastrophic Drug Program as of July 1, 2023.

Private Member’s Bill on Pharmacare
On February 24, 2020, NDP MP Peter Julian introduced Private Member’s Bill C-213, An Act to Enact the Canada Pharmacare Act, in the House of Commons. This bill would provide for a legislative framework for a public single-payer drug coverage system in Canada, which was defeated. On March 13, 2020, the House of Commons unanimously adopted a motion from NDP MP Don Davies that called on the government to negotiate with the PTs to establish a dedicated fiscal transfer for universal, single-payer, public pharmacare.
On June 13, 2023, NDP MP Don Davies introduced Private Member’s Bill C-340, An Act to Enact the Canada Pharmacare Act. This bill is similar in text to the previously defeated Bill C-213.
Supply and Confidence Agreement
The agreement announced on March 22, 2022, committed to continuing progress towards a national pharmacare program by passing a Canada Pharmacare Act by the end of 2023 and then tasking the National Drug Agency [Canadian Drug Agency] to develop a national formulary of essential medicines and bulk purchasing plan by the end of the agreement (June 2025). This commitment was reflected in Budget 2022.
Advisory Council on the Implementation of National Pharmacare
In Budget 2018, the Government announced the creation of the Advisory Council on the Implementation of National Pharmacare, chaired by Dr. Eric Hoskins. The Council engaged with Canadians, patients, provincial, territorial and Indigenous leaders, health care experts, and stakeholders through regional roundtables, town halls, an online questionnaire, and written submissions. On June 12, 2019, the Council’s final report was tabled in Parliament, recommending the implementation of national universal pharmacare over seven years, starting in 2020 and achieving a comprehensive national formulary under pharmacare by 2027. This report recommended universal, single-payer, public pharmacare in Canada through step-by-step progress including the establishment of the Canadian Drug Agency (CDA), implementing a National Strategy for Drugs for Rare Diseases, and the development of a national formulary funded by pharmacare.
Under these recommendations, this formulary, developed by the CDA, will start with an initial list of essential medicines that provinces would cover with incremental federal funding. Hoskins’ estimated that the initial net incremental public cost to cover essential medicines in 2022 would be about $3.5 billion. In addition, the council recommends out of pocket costs for all products listed on the national formulary not exceed $5 per prescription, with a copayment of $2 for essential medicines, and an annual maximum of $100 per household per year to ensure that patients face few barriers to access.
Over the subsequent five years, additional prescription drugs would be added to the national formulary as prices and supply arrangements are negotiated with manufacturers leading to a comprehensive national formulary available under pharmacare. Hoskins’ estimated that the incremental public cost once national pharmacare is fully implemented in 2027 would be $15.3B.
Parliamentary Budget Officer: Cost Estimate of a Single-payer Universal Drug Plan
In response to parliamentary interest in implementing a single-payer universal drug plan, on October 12, 2023, the Parliamentary Budget Office (PBO) released a report entitled Cost Estimate of a Single-payer Universal Drug Plan. The report estimates that the incremental public cost to implement single-payer universal drug plan based on Quebec’s Régie de l’assurance maladie du Québec (RAMQ) formulary to be $11.2B in 2024-25, increasing to $13.4B in 2027-28. The RAMQ formulary was used given that the drugs it lists represent the largest share of system-wide spending of any PT formulary. The PBO costing is based on the framework proposed by the House of Commons Standing Committee on Health (HESA) in 2016 and used by the PBO to prepare pharmacare costing in 2017 (Federal Cost of a National Pharmacare Program). In its 2017 report, the PBO estimated full implementation of national pharmacare in 2015-16 would have required $7.3B in incremental public spending.
pan-Canadian Pharmaceutical Alliance (pCPA)
The pan-Canadian Pharmaceutical Alliance (pCPA) has been leading the way for negotiating drug prices for public plans. As of April 1, 2023 savings from pCPA activities to participating drug plans are estimated to be $3.89 Billion annually ($3.14 Billion from Brand Letters of Intent; $750M from Generic Drugs). Cumulative savings to public plans are estimated to be $19.4 Billion since inception of the pCPA.
Prince Edward Island Improving Affordable Access to Prescription Drugs Initiative
On August 11, 2021, the Government of Canada announced the signing of the first agreement with the Government of Prince Edward Island (PEI) to inform the advancement of national universal pharmacare. Through this agreement, PEI will receive $35 million over four years in federal funding. The Government of Canada will use early lessons from PEI’s efforts to inform its ongoing work to advance national universal pharmacare.
A first drug coverage improvement was announced May 25, 2022. As of June 1, PEI has increased formulary coverage of opioid and alcohol dependency medications to provide to residents at no cost through its Substance Use Harm Reduction Program. In addition, PEI is strengthening community mental health services with second generation long-acting antipsychotic medications to the Community Mental Health program. Other improvements include changes to special authorization requirements for 23 medications on the Pharmacare formulary that will allow greater ease of access for physicians seeking to provide medications to Islanders. As of January 23, 2023, PEI expanded access to a total of 85 new medications to treat a variety of conditions. Effective June 1, 2023, PEI expanded its provincial drug coverage to reduce copays to $5 for residents covered in the Seniors Drug Program, the Family Health Benefit Program, the Generic Drug Program and the Diabetes Drug Program. The medications identified in this list represent about 60% of prescriptions that Islanders use on a regular basis. PEI also increased access to the provincial High-Cost Drug Program as of June 1, 2023, making it available to all income levels, and PEI also made adjustments to the Catastrophic Drug Program as of July 1, 2023, by lowering the annual cap on the amount of money a household needs to spend out of pocket on eligible medications.

In Budget 2018, the Government announced the creation of the Advisory Council on the Implementation of National Pharmacare, chaired by Dr. Eric Hoskins. On June 12, 2019, the Council’s final report was tabled, recommending the implementation of national universal pharmacare.
Budget 2019 announced $35 million over four years, starting in 2019-20, to establish a Transition Office to support the creation of a Canadian Drug Agency and national formulary. It also announced an investment of up to $1 billion over two years, starting in 2022-23, with up to $500 million per year ongoing, to help Canadians with rare diseases access the drugs they need.
On August 11, 2021, the federal government announced an agreement to provide Prince Edward Island with $35 million over four years (from 2021-22 to 2024-25) to support the province’s efforts to provide its residents with more affordable access to prescription drugs.
Budget 2022 announced that the federal government will continue its ongoing work towards a universal national pharmacare program. This will include introducing a Canada Pharmacare bill, and then tasking the Canadian Drug Agency to develop a national formulary of essential medicines and bulk purchasing plan.