Far from a utopian idea, pharmacare is a policy that’s both practical and urgently needed

More Canadians report being unable to afford medication even as the government sits on a report that offers a way out

Imagine walking into a pharmacy and filling your prescription with nothing more than your medicare card and small co-payment. Just $3 for essential medicines, $5 for everything else, with annual payments capped at $100 – and no copayments at all for low-income individuals.

In the midst of an ongoing cost-of-living crisis, it must sound more like something out of a utopian science fiction novel than a serious policy proposal.

But in fact, Canada does have just such a plan. For two years, Justin Trudeau’s Liberal government has been sitting on the report of an expert panel (the Hoskins report) that lays out in great detail how the federal government could extend medicare to cover to prescription drugs and eliminate the excessive out-of-pocket costs that many Canadians experience.

“The plan outlined by the Advisory Council of Implementing National Pharmacare led by Dr. Eric Hoskins was supposed to come into effect by January 2022. It was nearly buried by a lobbying barrage spearheaded by Big Pharma – an industry whose influence in Ottawa (and in countries around the world) has been supercharged by the pandemic – only to be revived by the Liberal-NDP supply-and-confidence deal.”

If it had been brought into effect as planned, we could expect to be making headway towards ensuring affordable access to medicines for all and bringing an end to the shameful reality of “cost-related non-adherence” in Canada. The phenomenon of patients who can’t afford their medication is two to five times more prevalent in Canada than in other OECD countries.

Instead, we are seeing disturbing signs that as inflation persists, growing numbers of Canadians are losing access to their medicines. Elected representatives report constituents urging them to do something about drug costs not currently covered by inadequate provincial plans. Pharmacists have seen a growing number of low-income seniors that have resorted to skipping doses and deferring prescriptions because their fixed incomes have been eaten away by inflation. Anti-poverty groups have witnessed more and more families making impossible trade-offs between paying rent, buying groceries, and taking medications.

More than half of Canadians report health care costs threaten their finances

It is hard to know exactly many people find themselves in this situation, but it undoubtedly is affecting millions of Canadians. In September, for instance, 52 per cent of Canadians reported feeling their financial situation was “threatened” by health care costs (admittedly, a wider category than just prescription drug costs) – including 15 per cent who felt “very threatened.” When inflation was gathering steam, many Canadians told pollsters that rising prices were forcing them to take “drastic actions” to cope, including not taking their medications. An April 2022 Ipsos poll showed that one in twelve Canadians (8 per cent) had delayed or not renewed a medical prescription because of inflation, rising to 14 per cent among those aged 18-34.

Of course, all of these problems were present before prices began their steep – and seemingly unending – rise. As the Hoskins report documented, millions of patients across Canada were suffering from the high drug prices and yawning gaps in insurance coverage that characterize our current “non-system.” Low-wage, precarious workers, immigrants and racialized people, the elderly, and others disproportionately at the bottom of the income distribution are those that most prone to experiencing these injustices.

The Advisory Council found that one in ten Canadians are, at any given time, skipping taking their medications because of the cost, and more than one in five could easily find themselves unable to fill their prescriptions because of inadequate coverage. That’s 7.5 million people across the country who are either uninsured or underinsured, and don’t have the drug coverage they need. The proportion of Canadians in this situation is undoubtedly higher now due to the cost-of-living crisis, with possibly grave consequences for their health.

What does “cost-related non-adherence” look like, in the flesh? Cancer patients told the Hoskins panel about organizing GoFundMe campaigns to pay for their oncology treatments. Type 1 diabetics recounted how they were stretching doses of insulin because their employer’s insurance plan doesn’t cover “pre-existing conditions.” Families related how they were plunged into “medical poverty” by the cost of drugs following their child’s diagnosis with a rare disease.

“Look, I work hard, I do my bit,” said Dave, an electrician with type 1 diabetes, to the Advisory Council. “I don’t understand why access to medication doesn’t work like our access to doctors or hospitals.” That incomprehension is widely shared by Canadians, whose support for pharmacare is “near universal.” In poll after poll, nine out of ten Canadians say that prescription drugs should be covered by medicare. Even among Conservatives, 61% say they would support adding pharmacare to our public health system.

“With the possible exception of a few drug company executives,” notes Bob Hepburn in the Toronto Star, “Canadians overwhelmingly support universal pharmacare — and they have for years.” The trouble, of course, is that those drug companies executives currently hold more political sway over decision-making in Ottawa than the overwhelming majority of Canadians.

Big Pharma is Right: Pharmacare would be a radical change – for the better

Big Pharma and its think tank allies insist that pharmacare is “too radical.” Rather than a public, single-payer insurance plan that would cover everyone and contain excessive drug prices, as outlined by Hoskins report, they propose that we merely tinker around the edges. They warn that “nationalizing” drug insurance is “a sweeping policy reform” and a “radical change” with uncertain outcomes. “We shouldn’t so incautiously discard the status quo in an elusive search for technocratic utopianism,” admonished Sean Speer, a fellow for the pharma-funded Macdonald Laurier Institute, after Hoskins’ report was released.

Of course, pharmacare is hardly utopian – extending medicare to include medications you get at the pharmacy would simply bring Canada up to speed with virtually every other OECD country, all of which instituted some kind of universal drug insurance long ago.

And there is nothing mysterious or elusive about how we could achieve this. In places like the U.K., New Zealand and many E.U. countries, it is simply how things work. Prescription drugs are covered as a matter of course by the public health system, through one form or another of public, single-payer drug insurance. Giving people access to essential medicines on the basis of need rather than income isn’t just some post-scarcity fantasyland. The real obstacle to pharmacare is not practicality, but politics.

It’s understandable, though, that Big Pharma’s defenders should try to tar pharmacare as some pie-in-the-sky social experiment. It does feel a bit utopian to imagine everyone having access to essential medications for as little as $3 per prescription, with no copayments at all for low-income people. Given how badly served Canadians are by the current status quo, a comprehensive, single-payer pharmacare program would indeed mark a radical departure – one that would change things radically for the better, for millions of Canadians.

As the Hoskins report laid out, and as the example of numerous other countries shows, it is both eminently doable and well past time we did it.

TAKE ACTION! Let the Trudeau government and our elected representatives know that pharmacare can’t wait. We need it, and we need it now.

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