Question Period Note: Pharmacare

N/A

• 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.
KEY MESSAGES
• 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. This will include tabling a Canada Pharmacare bill and working to have it passed by the end of 2023.
• 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.
• We are making progress with the Government of Prince Edward Island to improve access to medications for Island residents and inform the advancement of national universal pharmacare.
• Through this partnership, the Government of PEI is aiming to make further improvements to their drug programs, such as increasing coverage and simplifying access. Under the Improving Affordable Access to Prescriptions Drugs Program, those who experience the most vulnerability, including uninsured Island residents, seniors, and families with high burden of medication cost will benefit from improved access to medications.
• As of January 23, 2023, PEI expanded access to an additional 23 medications, bringing the total to 61 new medications to treat a variety of conditions including cancer, heart disease, migraine, multiple sclerosis, pulmonary arterial hypertension, and psoriasis.
• In the coming months, PEI will also make changes to reduce the copay eligible Islanders spend on many prescription medicines, expand access to the Catastrophic Drug Program and increase access to the provincial High-Cost Drug Program.
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 PILOT…
• Drug coverage and the health system should respond to the needs of Canadians.
• Progress has already been made to improve the affordability and accessibility of needed prescription drugs for Prince Edward Island residents.
• As part of the Improving Affordable Access to Prescription Drugs initiative supported by the Government of Canada, PEI is adding new medications to its provincial formulary under their growing public pharmacy program.
• As of January 23, 2023, PEI expanded access to an additional 23 medications, bringing the total to 61 new medications to treat a variety of conditions including cancer, heart disease, migraine, multiple sclerosis, pulmonary arterial hypertension, and psoriasis.
• This builds on previous formulary additions made by PEI to improve access to medications, as well as changing requirements on dozens of medications to allow greater ease of access for physicians seeking to provide these medications to Islanders.
• In the coming months, PEI will also make changes to improve access and affordability. This includes reducing the copays for eligible medications to $5 for residents covered in the Seniors Drug Program, the Family Health Benefit Program, the Generic Drug Program and the Diabetes Drug Program.
• PEI will also lower the cap on the amount of money a household spends on eligible medications under the Catastrophic Drug Program. Finally, under the High-Cost Drug Program, PEI will remove barriers for those in the lowest income brackets, avoid duplication of income testing and remove the exclusion of households earning over $150,000 from coverage.
• This partnership between the Governments of Canada and Prince Edward Island will significantly reduce the out-of-pocket costs of eligible PEI residents to access a wide range of medication.

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.

Private Member’s Bill on Pharmacare
On February 24, 2020, NDP MP Peter Julian tabled 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. On February 24, 2021, Bill C-213 was defeated on second reading with a vote of 295 against and 32 for.

Opposition Motion on Pharmacare
On March 13, 2020, the House of Commons unanimously adopted a motion from NDP MP Don Davies (Vancouver Kingsway, BC) that called on the government to negotiate with the PTs to establish a dedicated fiscal transfer for universal, single-payer, public pharmacare. The motion was passed with the Government’s support.

Text of the motion:
(a) acknowledge the government’s intention to introduce and implement national pharmacare;
(b) call on the government to implement the full recommendations of the final report of the Hoskins Advisory Council on the Implementation of National Pharmacare, commencing with the immediate initiation of multilateral negotiations with the provinces and territories to establish a new, dedicated fiscal transfer to support universal, single-payer, public pharmacare that will be long term, predictable, fair and acceptable to provinces and territories;
(c) urge the government to reject the U.S.-style private patchwork approach to drug coverage, which protects the profits of big pharmaceutical and insurance companies, but costs more to Canadians; and
(d) recognize that investing in national pharmacare would help stimulate the economy while making life more affordable for everyone and strengthening our health care system.

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 several years.

Budget 2019 Commitments
Guided by the recommendations of the Advisory Council, Budget 2019 announced federal investments to move forward on three foundational elements of national pharmacare:
o Creation of a Canadian Drug Agency to take a coordinated approach towards assessing effectiveness and negotiating drug prices;
o As part of the work of the Agency, development of a national formulary to promote more consistent coverage across the country; and,
o Creation of a national strategy for drugs for rare diseases to help Canadians get better access to the effective treatments they need.

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.

These commitments were reiterated in the Speech from the Throne, Fall Economic Statement and Budget 2021.

Prince Edward Island 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 to add new drugs to its list of covered drugs, and lower out of pockets costs for drugs covered under existing public plans for Island residents. 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 under this program was announced May 25, 2022. As of June 1, PEI has increased formulary coverage of opioid and alcohol dependency medications to provide residents with no cost access to these addiction treatments through its Substance Use Harm Reduction Program. In addition, PEI is strengthening community mental health services with the addition of second generation long-acting antipsychotic medications as requested by local care providers, 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 December 28, 2022, PEI expanded access to 38 medications, including two important medications, Zejula® (niraparib tosylate) and Lynparza® (olaparib), for treating ovarian cancer. As of January 23, 2023, PEI expanded access to an additional 23 medications, bringing the total to 61 new medications to treat a variety of conditions including cancer, heart disease, migraine, multiple sclerosis, pulmonary arterial hypertension and psoriasis. On March 3, PEI also announced their intention to make the following changes over the coming months:
• Reducing copays for commonly prescribed, eligible medications 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 list includes medications used in the management of mental health, cardiovascular disease, and diabetes. The medications identified in this list represent about 60% of prescriptions that Islanders use on a regular basis.
• Adjustment to the Catastrophic Drug Program to lower the cap on the amount of money a household spends on eligible medications, based on a percent of household income.
• Adjustment to the High-Cost Drug Program to remove barriers for those in the lowest income brackets, avoid duplication of income testing and remove the exclusion of households earning over $150,000 from coverage.

• 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 tabling a Canada Pharmacare bill and working to have it passed by the end of 2023, and then tasking the Canadian Drug Agency to develop a national formulary of essential medicines and bulk • purchasing plan.