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What you didn’t know about the Liberal-NDP Pharmacare plan

There is one true measure of the strength of the pharmacare pledge contained in the new Liberal-NDP “supply and confidence” agreement. That measure is to be found in 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 and welcoming it.

If Big Pharma isn’t screaming bloody murder, we should all be concerned.

But why would Innovative Medicines Canada have applauded this new pharmacare promise? It’s because the deal is so vague that it almost resembles a blank canvas – a canvas onto which Big Pharma is undoubtedly keen to paint its 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).

But blank as it may be, the new deal is as much our canvas to paint onto.

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 for the idea, and pandemic hardships have only heightened the urgent need for equitable access to life-saving medications.

But despite this public support, we’ve seen mostly empty gestures by the ruling federal Liberals, devoid of concrete, meaningful actions. The new deal with the NDP continues that tradition, including only a “pharmacare pantomime,” as poignantly coined by Dr. Nav Persaud, family physician and Canada Research Chair in health justice.

Turning pharmacare from political gimmick to reality will depend, ultimately, on our elected leaders’ willingness to stop kowtowing to powerful corporate lobbyists – and on our continued pressure on them to deliver for us instead.

What we know about the Liberal-NDP deal (Spoiler: not much)

Despite the fanfare, the clause on pharmacare contained in the new Liberal-NDP agreement lacked in both detail and ambition.

Here is the little that we do know about the deal. The agreement is, importantly, not a promise to implement pharmacare by 2025 (at which point the deal expires and a fall federal election is likely). Rather, it’s a promise merely to “continue progress” towards a universal national pharmacare program. What happens to pharmacare after the 2025 election is anyone’s guess.

The deal is also not a concrete blueprint for how progress will be made. The government has committed to a Canada Pharmacare Act by the end of 2023. But by the Health Minister’s own admission, there are few details as of yet on what the law will actually look like.

The deal also tasks the National Drug Agency with developing “a national formulary of essential medicines” by an unspecified timeline. This, too, is hardly cause for celebration.

The Advisory Council on the Implementation of National Pharmacare, appointed by the Liberals themselves, had already recommended drawing up a list of essential drugs back in 2019 – as the first milestone in its suggested roadmap for a national, universal, single-payer, public pharmacare program. In fact, that list was due to be released months ago, by January 1, 2022.

Not only have the Liberals failed to meet that timeline, but they’ve also failed to match the financial commitment needed for delivering on the promise. The Advisory recommended a minimum of $3.5 billion in funding towards essential medicines coverage. But this commitment has been absent in all subsequent federal budgets – including the most recent one.

Will the Liberals work towards a public pharmacare plan?

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, Big Pharma and the insurance industry in Canada have advocated for 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, they’ve funneled billions of dollars into lobbying campaigns to prevent its realization.

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

Will drug prices finally come down?

Another important litmus test in the road ahead to pharmacare will be the price of patented drugs.

Canadians pay the highest drug prices of any country with a universal health care system. In 2019, the Liberal government proposed new guidelines to lower the price of patented medicines – the biggest reform to the country’s drug price regime in more than 30 years and a crucial step in laying the groundwork for a public national pharmacare program.

But, after a targeted and aggressive campaign by the pharma lobby, the government has now postponed those reforms four consecutive times. At the height of the pandemic, Big Pharma lobbyists even resorted to veiled threats about the availability of COVID-19 vaccines if the government were to move forward with its drug pricing reforms.

The new Liberal-NDP deal includes a promise to establish a bulk drug purchasing plan by the end of the agreement in 2025. But absent reforms for regulating the price of patented drugs, a bulk purchasing plan will not necessarily lower the price of medicines.

Their pharmacare plan and ours

Fundamentally, the federal government’s success in the road towards a universal, single-payer, public, national pharmacare system will depend on one thing alone: the political will and courage to face down Big Pharma and defend the interests of Canadians instead.

Sadly, the federal Liberal party has yet to demonstrate that will. The Trudeau Liberals 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.

While the reiteration of their previous commitments in the new deal with the NDP at least gets pharmacare back on the policy agenda, the real barometer of the Liberals’ success will be their ability to finally take their political dance with pharmacare to the finish line.

As vague as its commitments are, the NDP-Liberal deal also sharpens the focus of our campaigns for pharmacare and clarifies the nature of the political battle ahead.

In the wake of the agreement, some political strategists suggested that it could provide “a golden ticket” for progressive advocacy organizations to be heard by the federal government on what the details of a pharmacare plan should look like.

With the minority Liberals more or less guaranteed the next three years in government, and with little leverage left for a progressive opposition party to hold them to account, our voices may be all we’ve got.