Today we’re celebrating a major win for people power! The federal government introduced pharmacare legislation that lays the foundation for a universal, single-payer system that will begin by covering contraception and diabetes medications.
For too long, wealthy corporations have stood in the way of progress on a public pharmacare plan. This program is an affront to the power of Big Pharma and the insurance industry and their decades-long effort to stymie pharmacare in Canada. The program that this legislation lays out is a good start that will need to expand in order to fully meet the needs of people in Canada and realize the full cost-saving potential of bulk-buying medications.
This analysis lays out what this legislation includes, what could be improved, what comes next, and how it will impact people, patients, and our movements.
What is the program?
This legislation (read it here) lays out a publicly-funded, single-payer, universal pharmacare program that will offer coverage for two broad classes of medications: diabetes drugs and devices and contraceptives. The program will provide “first dollar” coverage for all Canadians with a health card, meaning there will be no out-of-pocket costs, no income cut-offs, and no restrictive eligibility conditions. And unlike the Canadian Dental Care Plan, it will be publicly administered through existing provincial plans, not through a private insurance company.
This is broadly in line with what was leaked last week when the deal was announced. It is a major rebuke to Big Pharma and the insurance industry, which were lobbying the Health Minister and his aides almost daily. These corporate interests wanted a program that would be neither universal, nor public, nor single-payer. On all three counts, they lost.
The legislation also lays out steps for expanding coverage to essential medicines and developing a bulk buying plan, within a year of the passage of the Pharmacare Act.
It also calls for a committee to be struck within 30 days of royal assent that will be tasked with presenting options for the financing and operation of national, universal, single-payer pharmacare. This is a panel of five members that will be continuously involved as the program rolls out.
What does this mean for people who need diabetes and contraceptive meds?
When this program comes into effect, and people can get these classes of medications free of charge, it will be nothing short of life-changing.
There are 3.7 million people in Canada with diabetes according to Statistics Canada, and managing this disease can cost more than $18,000 a year. This is due to the high cost of the devices needed to check blood sugars and administer insulin, as well as the skyrocketing cost of insulin and other medications. This program will cover both the meds and the devices.
“We hear a lot about the insulin crisis in the U.S., where people are dying because they can’t afford insulin and do not have access to diabetes devices; we assume that it isn’t happening here,” wrote Rebecca Redmond, a patient advocate living with T1 diabetes who was also a panelist at our London pharmacare town hall. “That couldn’t be further from the truth.”
With the price of diabetes medications and devices soaring year after year, pharmacare will make a huge difference for millions of people like Rebecca living with diabetes. “All Canadians deserve to feel as healthy as possible and that means universal access to medications and devices.”
For people who need contraceptives, autonomy over one’s sexual and reproductive health is an essential step towards gender justice and personal freedom. Being able to access birth control pills, rings, patches, intra-uterine devices, and emergency contraception regardless of one’s employment status or income, and without relying on a partner’s insurance plan, will be an incredible improvement in nearly 9 million people’s lives – for cis and trans women, and for gender non-conforming people.
What needs to be improved or expanded?
The legislation makes reference to the Canada Health Act and explicitly refers to pharmacare in various places as “public, universal and single-payer.” The fact that it will be publicly-administered is positive, but as we noted in our previous analysis, working through the provinces is a double-edged sword.
Rollout for pharmacare will depend, in part, on the willingness of provinces to negotiate funding agreements quickly. While provinces like Manitoba, British Columbia, and Newfoundland have expressed interest, Alberta and Quebec indicated they would seek to opt-out – even before seeing the legislation.
The legislation’s commitment to a universal, single-payer model is not water-tight, at least when it comes to adding drugs to the program beyond diabetes and contraceptive medications. Big Pharma and insurance industry players will undoubtedly try to weaken this language in the legislation or pervert its principles.
For instance, the bill says pharmacare must be designed “considering” the Canada Health Act. This is not a strong legal word and it leaves room for the possibility that principles of the Canada Health Act – universality, public funding, and comprehensive care – could be pushed aside in the future.
The legislation calls for a committee of experts to be struck to present options for “the operation and financing of national, universal, single-payer pharmacare.” Who is on this committee will matter a lot, as it is likely that they will have long-term oversight on the program. If these members are committed to serving people and improving access to medications, that’s good. But if industry representatives sit on that committee, it could be challenging to ensure this program is as strong as possible in the future.
What’s next?
We will continue to press for the best possible pharmacare program through the legislative process. The bill has only just been introduced, so there are several steps and points of intervention before the legislation gets royal asscent. Throughout this process we will be working to tighten the wording to ensure the program is stronger and ensures single-payer model on expansion.
It’s important that we work to get funding secured as soon as possible for diabetes and contraceptive medications so people can start benefiting from pharmacare. Today Minister Holland said that covering the two drug classes would cost about $1.5 billion – not even half a per cent of the federal budget. We know that drug prices are too high and people are suffering across the country, and they can’t wait any longer. We also know that this legislation is fragile, and what will make it stronger is its implementation and expansion. Once people start receiving their medications free of charge, folks won’t want to see that benefit taken away again.
This victory shows that social movements can win real gains
This is an incredible win not only for the people who rely on these medications to live and live well, but for everyone who contributed to this decades-long effort to win pharmacare.
It’s no small feat that, together, we pushed back against the incredible power of the pharmaceutical and insurance industries to secure this program.
At this time last year, things were less hopeful. Pharmaceutical and insurance lobbyists were meeting with Health Canada about three or four times a week about pharmacare, pushing their agenda against a public universal program. Evidence from The Breach showed that the health minister at the time had delayed drug price reform due to meddling by industry lobbyists. Several members of the Patented Medicines Price Review Board quit due to excessive industry influence over Health Canada’s decisions.
Even a few weeks ago, things on the pharmacare front did not look bright. Through December and January, the Liberal government was showing support for a fill-the-gaps program that wouldn’t cover all people in Canada. This is really a demonstration that collective efforts and campaigning with a clear focus can overcome the sometimes-debilitating degree of corporate control over things that should be democratically managed.
In the face of these incredible odds, our collective work to push back against this corporate lobby and demand that our elected officials deliver for us worked! This changes the playing field for the next fight: not only do we know our movements are powerful and can deliver change, if this pharmacare program can be implemented fully, it will cut into industry profits in Canada by lowering the currently exorbitant drug and insurance prices. With less money to throw around, industry lobbies will weaken overtime.
So let’s take this win and let it buoy us through the next phase of the work to secure access to medicines for everyone in Canada.
Pharmaceutical and insurance corporations have billions, but we don’t
Can you help fund the next steps of this fight so we can secure the strongest pharmacare program possible? The Council of Canadians is independently funded by people like you. We don’t take money from the government or corporations, and this helps us retain the independence we need to run effective campaigns like this one.
Nikolas Barry-Shaw
Nikolas is the Trade and Privatization Campaigner for the Council of Canadians and author of the book “Paved with Good Intentions.”
