Their pharmacare plan and ours

This piece appears in the 2022 issue of Canadian Perspectives, the Council of Canadians’ annual magazine. Read other featured articles from the issue.

Back in March, news of a pharmacare deal between the Liberals and the NDP was announced with much fanfare from both parties, despite the agreement’s lack of both detail and ambition.

Months later, the specifics of the agreement remain fuzzy. Although the government has committed to a Canada Pharmacare Act by the end of 2023, it has offered few details on what the law will actually look like. The agreement is, importantly, not a promise to implement pharmacare. Rather, it’s a promise to “continue progress” towards a universal national pharmacare program.

With so little detail, and no actual blueprint for how progress will be made, there is only one true measure of the strength of this pharmacare pledge: the reaction from Canada’s Big Pharma lobby.

A day after the new deal was signed, Innovative Medicines Canada—the country’s most powerful pharmaceutical lobby, whose primary objective has been to delay, deter, and obstruct universal public pharmacare—released a statement applauding the plan.

Why isn’t Big Pharma screaming bloody murder? Because the deal is so vague that it almost resembles a blank canvas—a canvas onto which pharmaceutical companies are undoubtedly keen to paint their own version of pharmacare.

For the pharma lobby, that means pulling out all the stops to prevent a public pharmacare plan from ever being realized.

“A national pharmacare program must build on the strengths of our current dual-market system and focus on improving access for the Canadians who need it most: the uninsured and underinsured,” Pamela Fralick, the president of IMC, said in the statement.

In non-lobby speak, that means: keep our current patchwork system while throwing a few bones to people who’ve fallen through the cracks, but don’t touch drug prices (or Big Pharma profits).

Critically, the Liberal-NDP agreement is mum on whether the pharmacare program in the works will be a public one.

Currently, rather than universal, single-payer prescription drug coverage, Canadians have access to either public plans with province-specific eligibility criteria, private insurance plans that vary by employer, age, and other factors, or nothing at all.

This patchwork system has unsurprisingly had its biggest defenders in the pharmaceutical and insurance industries. For years, they’ve funneled billions of dollars into lobbying campaigns in support of a “fill in the gaps” approach that combines both public and private insurance—keenly aware that a single-payer public pharmacare program would endanger their profits by driving down drug prices.

That the government’s announcements make no explicit promise to implement a public pharmacare program should be of grave concern.

For too long, our elected representatives have been playing political football with pharmacare—scoring points by appearing to move the needle on its implementation. It’s no surprise why. The idea of pharmacare is overwhelmingly popular in Canada. Poll after poll suggest super-majority support.

But despite this public support, we’ve seen mostly empty gestures by the ruling federal Liberals, whose support for the program ebbs and flows with little in the way of real progress. The party included pharmacare as a key campaign plank in the 2019 federal election. In his 2020 Throne Speech, the Prime Minister promised to “accelerate” progress on pharmacare but then committed no new spending in the fall economic plan that followed. In 2021, the Liberals dropped pharmacare from their election campaign altogether.

The new deal with the NDP continues that tradition, including only a “pharmacare pantomime,” as Dr. Nav Persaud, family physician and Canada Research Chair in health justice, so poignantly described it. The real barometer of success, then, is not the March announcement, but whether or not the Liberals can turn this political dance into an actual race to the finish line: a universal, single-payer, public, national pharmacare program.

Turning pharmacare from political gimmick to reality will depend, ultimately, on our elected leaders’ willingness to stop kowtowing to powerful corporate lobbyists—and for this to happen, we must be relentless in pressuring them to deliver for us instead.

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