Bill C-64, aiming to establish a national pharmacare plan, continues to advance in Ottawa, reaching the second reading stage. During a recent debate in the Commons, there was scant discussion about private insurers and their exclusion from the future single-payer program.
In her latest budget, Federal Finance Minister Chrystia Freeland announced that $1.5 billion over five years is being allocated for the future pharmacare plan. In its initial phase, the federal government will cover the costs of contraceptives and diabetes medications.
Next steps
Once Bill C-64 passes second reading, it will be referred to the health committee, where various groups can present their perspectives. This second stage will culminate in a report, after which C-64 will return to the House of Commons for adoption. Then, it will be sent to the Senate, where senators are not bound by the Commons' vote.
If it survives this lengthy process, negotiations will begin with the provinces to implement it nationwide, another phase that could take months. Quebec, which has a mixed public-private system, has already indicated its willingness to accept federal funding without conditions.
Why contraceptives and diabetes medication?
Why prioritize contraception and diabetes medications first? Liberal MPs explained the government’s view in the House of Commons.
Providing this coverage is a first step towards a universal, single-payer pharmacare plan stated MP Chandra Arya. “Diabetes affects a vast number of people. Coverage for contraceptives is available to about nine million Canadians, and diabetes coverage is available to about 3.7 million,” he pointed out.
“When a person does not have access to their diabetes medication, it means they risk heart attack, stroke, kidney failure, blindness and amputation," said Federal Health Minister Mark Holland. "Oral contraceptives cost $25 a month and have a 9% failure rate. The IUD costs about $500, lasts five years and has a failure rate of 0.2%. What it means is that a person who does not have money ends up choosing the birth control option that is cheaper, which has a 9% fail rate.”
In the Commons, a Liberal MP hinted that phase two would cover heart medications.
The NDP, allies of the Liberals in this matter, believes that establishing this national plan will reduce drug costs.
“With a universal pharmacare system, we can tell the pharmaceutical companies what prices we are going to pay,” stated NDP MP Peter Julian. “When New Zealand reduced the cost of some of its medications by 90%, that was due to bulk purchasing being the best practice.”
The role of insurers underestimated
During the discussions in the House of Commons on April 16, there was little mention of the contribution of private insurers and employer-sponsored group benefits plans. Liberals and New Democrats largely overlooked their role. Comments about insurance companies came from the ranks of the Conservatives led by Pierre Poilievre.
"More than 27 million Canadians benefit from private plans offered by their employers," stated Conservative MP Todd Doherty. "I spoke with insurers who have no idea how this pharmacare plan would work. Are they to scrap their plans altogether? What happens to those 27 million Canadians who already have a plan?”
His colleague, Conservative MP and family physician Stephen Ellis, stated that “the NDP-Liberal coalition wants to create federated programs that are going to reduce choices for Canadians and push those who do have access to the beloved care they now have into programs that will cover much fewer medications.” He asked, "What incentive will there be for employers to continue to provide plans for their hard-working employees in the future if a federated plan with a few old medications on it is what is being offered ‘for free’ on the backs of all Canadians?”
The Health Minister did not react or provide clarification on these statements. In a message to the Insurance Portal in response to our inquiries, his Ministry stuck to general remarks regarding the role of private insurers.
"The bill does not reference private prescription drug insurance and does not legislate any of its activities...Until agreements are reached with the provinces and territories, it is unlikely that employers and employees will want to make changes to their prescription drug plans."
"Canadians with private prescription drug insurance would also be covered for a broader range of drug categories, beyond the contraceptives and diabetes medications described in the bill," the statement added.
How many drugs will be covered?
The bill stipulates that the Canadian Drug Agency will work on creating a national list of insured medications no later than one year after the law is enacted and will also be tasked with establishing a national bulk buying strategy.
The Bloc Québécois says it is not opposed to a federal prescription drug plan, but is concerned about its impact on the Quebec system managed by the Régie de l'assurance maladie du Québec (RAMQ).
Bloc Québécois MP, Luc Thériault, asked how many drugs will be covered by the national pharmacare plan while noting that Quebec’s public plan’s list contains 8,000 medications. “Will Quebec's list be used? Will Quebec have to take any prescription drugs off its list? Will INESSS (Institut national d'excellence en santé et en services sociaux) be made redundant, or will it be able to continue doing its good work?
MP Stephen Ellis noted that Ozempic, a leading diabetes treatment medication, is not on the initial list of insured medications for this condition under the future national regime. “There is no surprise there," he commented. “The other difficulty that Canadians are also very aware of is that the newest medications, a class of medications called “biologics”, which account for 2% of claims, are now accounting for 30% of spending. Of course, none of these biologics are included on any of the proposed fantasyland formularies from the NDP-Liberal coalition.”
Quebec pharmacists' proposed plan
The Association québécoise des pharmaciens propriétaires (AQPP), which is concerned about Bill C-64, proposes a three-point solution involving the private sector. They intend to present this plan in committee in Ottawa.
- A national formulary, which could include a list of essential medications that all Canadians must have access to through public or private regimes.
- Financial support to provinces to ensure they can provide all medications listed on the national list of insured medications through their public regimes.
- Collaboration between public and private regimes to ensure Canadians can benefit from lower medication prices.
