The governing Liberals took their first major step toward national pharmacare Thursday as the health minister tabled a bill that paves the way for a universal drug program and secures NDP support in the House of Commons.
But Health Minister Mark Holland made clear there is still a long way to go before all drugs in Canada are covered under a federal program.
The bill allows the government to negotiate with provinces and territories to cover birth control, along with diabetes drugs and supplies, for anyone with a health card.
Holland said the cost is likely to be in the realm of $1.5 billion, but he said that estimate is very likely to change over the course of his talks with provinces.
There will be some money set aside in the Liberals’ spring budget, Holland said, but the full cost of the program won’t be reflected until 2025.
“This is a proof-of-concept opportunity to try (providing) two drugs on a universal, single-payer model,” Holland said at a press conference Thursday.
“We’re going to have an opportunity to evaluate the effectiveness of that model.”
He said he believes the government will be able to show significant cost savings in fairly short order.
Making sure contraception and diabetes medications are covered is really important, Prime Minister Justin Trudeau said Thursday at a press conference in Thunder Bay, Ont.
“We know there’s far too many people who find themselves in worse and worse situations because they can’t quite afford to take the medications they need,” he said.
In addition to testing the waters on universal coverage, the bill also fulfils a promise made to the New Democrats, who touted the legislation Thursday as the fulfilment of a long-held dream.
“This is historic. This is the dream of our party since the conception of our party,” NDP Leader Jagmeet Singh said Thursday morning.
“It is happening not by coincidence, it is happening because New Democrats fought and we forced the government to do this.”
Pharmacare is a central pillar of the political pact between the two parties, which has the NDP helping the Liberals stave off an election in exchange for progress on a list of shared priorities.
Its future had seemed uncertain amid a months-long stalemate over the wording of the legislation and the number of drugs they planned to launch with.
The NDP announced they clinched the negotiations late last week, in the lead-up to a negotiated March 1 deadline to table a bill.
Health critic Don Davies, who led the negotiations for the New Democrats, said the final pieces were put in place over the weekend.
“The Liberals fought us every step of the way. They resisted, they delayed, they opposed, but New Democrats persisted,” said Davies.
The legislation makes reference to a single-payer, universal model — something Davies said he insisted on.
And it includes universal coverage as a binding principle that must guide the implementation of a future pharmacare program.
Holland, however, said the legislation merely requires the government to “consider” those elements when designing the full drug plan.
Conservative Leader Pierre Poilievre spoke to the media in the foyer of the House of Commons Thursday, but walked away when reporters asked him for his position on the government’s pharmacare plans.
As it stands, Canada is the only country in the world with a universal health-care system that does not also have universal coverage for prescription drugs outside of hospitals.
In December, the NDP and Liberals agreed to push back the original timeline, which would’ve seen legislation fully passed by the end of last year.
The reticence on the Liberals’ part largely came down to cost.
A full fledged pharmacare program would cost the government nearly $40 billion a year by the time it is fully up and running, the parliamentary budget officer estimates.
Singh threatened to pull out of the deal if the March 1 deadline wasn’t met with legislation that earned his approval, though he was open about a desire to keep the deal alive and see a pharmacare bill debated in the Commons.
The bill calls for the minister to put together a committee of experts to make recommendations about how to pay for a national, universal, single-payer plan within 30 days of the act receiving royal assent.
Alberta and Quebec have already said they want to opt out of the program and would rather put the money toward their existing drug plans.
“We were not consulted about the federal government’s plan and, although information available to us is limited, we have concerns about the proposed limited scope,” Alberta Health Minister Adriana LaGrange said earlier this week.
LaGrange said Alberta intends to opt out of the program, but still wants to receive its per-capita share.
On the other hand, British Columbia already covers many contraceptives as part of its provincial pharmacare program, and Manitoba’s government has already pledged to do so as well.
“I have to admit I’m a bit perplexed by the reaction of some provinces about this announcement,” said British Columbia Premier David Eby.
“It feels like good news to me.”
Ontario also provides many contraceptives for people under the age of 25 who don’t have private insurance, and has existing programs to support people with diabetes.
The provincial government says it wants more information about what the bill will mean for those programs.
“I was very clear with the minister when we spoke that I’m not writing off anything, but I’m also not buying into something where I don’t know exactly what’s there,” Ontario Health Minister Sylvia Jones said Thursday.
Singh called it disappointing that provinces would dismiss the program out of hand, without seeing the details.
Despite the immediate concerns from Alberta and Quebec, Holland said he is “very optimistic this is a plan we can deliver across the country.”
In addition to the initial plans for diabetes and birth control drugs, the bill lays out several next steps and deadlines designed to nudge the government toward a bigger pharmacare plan.
Those steps include asking the new Canadian Drug Agency to develop a list of essential medicines within a year of royal assent, which would inform which drugs are covered in the future.
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