National pharmacare plan is in limbo as health minister calls pending deadline ‘arbitrary’

Health Minister Mark Holland signalled Tuesday the government is unlikely to meet the end-of-the-year deadline imposed by the NDP for passing pharmacare legislation — a condition of the supply-and-confidence agreement that was struck to keep the Liberals in power until 2025.

Holland said talks are ongoing with NDP MP Don Davies, the party’s health critic, who has been working with the government to craft legislation to implement some sort of national drug coverage plan.

Davies also suggested the long-awaited bill may not materialize by year’s end.

“We’re going to keep working diligently in the weeks that follow to meet the spirit of our confidence and supply agreement,” Davies said, adding that his party’s deadline is “artificial.”

The supply-and-confidence agreement is clear about what the NDP wants in exchange for propping up the government in this minority Parliament: a Canada Pharmacare Act passed “by the end of 2023” to create a framework for “universal national pharmacare.”

No such act has been introduced — and time has nearly run out.

It’s highly unlikely that such contentious legislation would get through both houses of Parliament before MPs and senators depart for the Christmas break.

Holland reframed the NDP’s demand when asked about it at a press conference.

“This an extremely complicated space and trying to find areas of common ground certainly takes time,” Holland said of the discussions with Davies.

“These markers were set in the supply-and-confidence agreement as guidelines,” Holland added, referring to the “end of 2023” stipulation in the agreement.

“They are arbitrary. They really are about the spirit of what we’re trying to achieve.

“We have a few days left. Getting it right is more important than getting it done fast.”

Price tag a sticking point

The sticking point could be the cost of a universal, single-payer pharmacare system — a program that would shift the financial burden from employers and people with out-of-pocket private plans to a government-run program.

Canada’s system of pharmaceutical coverage is divided between public insurance (44 per cent of prescription spending) and the privately insured/funded (56 per cent), according to the Canadian Institute for Health Information (CIHI).

Major changes to that regime would be costly for federal and provincial governments, according to a recent report from the Parliamentary Budget Officer (PBO).

The PBO found a single-payer system would cost the public sector (the federal and provincial governments combined) $11.2 billion more a year starting in 2024-25, before increasing to $13.4 billion a year in 2027-28.

The PBO also concluded that implementing such a program would save relatively little money.

There would be economy-wide savings of about $1.4 billion in 2024-25, rising to $2.2 billion in 2027-28, said the PBO.

The federal government is trying to rein in spending after years of outsized budget deficits incurred during the COVID-19 health crisis.

The country’s debt load has more than doubled to about $1.3 trillion. The cost to borrow all that money has spiked from $20.3 billion in 2020-21 to $46.5 billion in this fiscal year.

Holland has cited the cost of a single-payer program in the past, telling reporters in October that the “fiscal framework is tight” and the government has to be “responsible with dollars.”

“We are in a situation where we have to act prudently, that we don’t have the ability to spend, you know, what could be $40 or $45 billion,” Holland said, referring to a PBO report that said total drug expenditures under pharmacare would be about $38.9 billion.

Delays frustrating for patients who do without: activist

Nikolas Barry-Shaw is a pharmacare campaigner at The Council of Canadians, an advocacy group that has long demanded universal drug coverage. He said the additional delays are “frustrating for the millions of Canadians who have been waiting for and expecting a pharmacare program.”

He said the Liberal government has been studying the issue for more than five years.

“It’s really hard to understand why it’s taken so long. Every day of delay means more people are going without their medication,” Barry-Shaw told CBC News.

“There doesn’t seem to be that much urgency on the side of the government when we know how important this is for so many Canadians who are struggling with high drug costs.”

Barry-Shaw said the government doesn’t have to stand up a $40-billion public pharmacare plan right away.

It can start by covering the most commonly prescribed essential medications. Later, he said, the list of covered drugs — known as a formulary — could be expanded.

That’s what the government’s pharmacare rapporteur, Eric Hoskins, has also recommended.

Drug companies call universal pharmacare ‘unrealistic’

Barry-Shaw pointed to the frequent meetings pharmaceutical and insurance industry lobbyists have had with the minister, his staff and Health Canada officials as one possible explanation for the delay.

Innovative Medicines Canada, the group that represents pharmaceutical companies like AstraZeneca, Lilly, Pfizer and Sanofi, has said “single-payer options are unrealistic.”

The group says the vast majority of Canadians already have access to pharmaceutical coverage and the government should focus on filling “insurance gaps” that are “concentrated in a small number of provinces” rather than push ahead with a single-payer system that would dismantle what they call “higher quality employer-based insurance plans.”

But New Democrats have made it clear where they stand on the issue.

At the party’s October policy convention in Hamilton, members passed an emergency resolution that calls on the party to withdraw its support for the government if the Liberals do not commit to “a universal, comprehensive and entirely public pharmacare program.”

Davies addressed that ultimatum Monday, saying there are “very exciting and creative possibilities to make progress towards universal national pharmacare.”

“What’s very important is that we get it right — if that takes a little bit more time, then so be it. We think what’s more important is we get such a fundamentally important advance in our public health system correct, rather than meet an artificial deadline.”