In June 2018, the Advisory Council on the Implementation of National Pharmacare (the Council) was created by the federal government to advise the government on the design of a public insurance program for prescription drugs, commonly referred to as Pharmacare. The Council was tasked with answering three questions:
1. Who should be covered and under what circumstances?
2. What should be covered (essential or most often prescribed drugs)?
3. Who should pay?
The Canadian federal government was seeking practical solutions to the perceived problems that had a reasonable chance of being accepted by a majority of stakeholders. The key problems related to both access and cost of prescription drugs. Prescription drugs outside of hospital are not included in Canada’s universal health coverage program referred to as medicare. The majority of working age people have drug coverage through their employer, and some population subgroups, such as older adults, people with specific health conditions and people receiving social assistance, are covered by provincial drug plans. In addition, spending on prescription drugs is higher in Canada than most other high-income countries; the problem of prescription drug spending became a political concern upon reaching 16% of total health care spending in the early 2000s (CIHI 2017).
In June 2019, the Council finished its mandate and put forward a list of 58 recommendations. To summarize, the Council recommended that the federal government work with all provincial and territorial governments to establish a universal, single-payer, public system of prescription drug insurance in Canada upheld by the five fundamental principles of medicare, embodied in the Canada Health Act; but funded through a new transfer that is separate from the Canada Health Transfer currently used for medicare. The Council recommended that provinces and territories must meet or exceed the agreed-upon national standards for funding and will have flexibility to offer coverage beyond the national pharmacare standards. Some of the other recommendations included creating a national formulary, caps on out-of-pocket spending, developing a strategy for expensive drugs and rare diseases, allowing private insurance to supplement national pharmacare, and ensuring portability of coverage across the country.
The creation of the Council was an exercise in demonstrating political goodwill and improving federal-provincial-territorial relationships by seeking agreement before committing to any substantial action or planning (Grignon et al 2019). Implementing the Council required minimal monetary resources, and only a moderate time investment taking three and a half months to appoint the seven total members of the Council who accurately represent the different viewpoints of Canada’s provinces and stakeholders. The implementation of the recommendations of the Council will depend on the outcomes of the October 2019 federal election.