It’s Time to Finally Kill the Zombies; Comment on “Universal Pharmacare in Canada”

Document Type : Commentary


1 School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada

2 University Health Network, Toronto, ON, Canada

3 Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada


The movement for a national pharmacare plan in Canada is growing, but at the same time the multinational pharmaceutical companies and their supporters are critical of such a move. The three major arguments that they make are that all that is needed is to “fill in the gaps,” ie, cover those who currently are uninsured or underinsured, that private drug plans are superior to public ones because they cover a larger number of drugs and that Canada cannot afford pharmacare. This commentary examines each of these arguments and makes the case that none of them is valid and that it is time to get on with implementing pharmacare.


  1. Hajizadeh M, Edmonds S. Universal pharmacare in Canada: a prescription for equity in healthcare. Int J Health Policy Manag. 2019; In Press. doi:10.15171/ijhpm.2019.93
  2. Lewis S. It won’t be easy: how to make universal pharmacare work in Canada. Int J Health Policy Manag. 2019;9(1):1-5. doi:10.15171/ijhpm.2019.82
  3. Boothe K. Ideas and the Pace of Change: National Pharmaceutical Insurance in Canada, Australia, and the United Kingdom. Toronto: University of Toronto Press; 2015.
  4. Trudeau J. Minister of Health Mandate Letter.  Accessed January 4, 2020. Published 2019.
  5. Gibson V. Premiers offer tepid words about feds’ pharmacare pledge.  Accessed January 4, 2020. Published December 3, 2019.
  6. Evans R, McGrail K, Morgan S, Barer M, Hertzman C. APOCALYPSE NO: population aging and the future of health care systems. Canadian Journal on Aging. 2001;20:160-191.
  7. Dore G. Australia leads the world in hepatitis C treatment - what’s behind its success? The Conversation. July 31, 2017.  Accessed November 16, 2019.
  8. Lexchin J. Health Canada’s use of expedited review pathways and therapeutic innovation, 1995–2016: cross-sectional analysis. BMJ Open. 2018;8:e023605. doi:10.1136/bmjopen-2018-023605
  9. IMC responds to final report of Advisory Council on the Implementation of National Pharmacare.  Accessed November 16, 2019. Published June 12, 2019.
  10. Skinner B. Voters beware: national pharmacare is unnecessary, bad for privately insured Canadians and costly for taxpayers. National Post. October 18, 2019.
  11. Lietaer J. Canada already has a pharmacare system - and it’s working. National Post. June 17, 2019.
  12. Stratton T. 90% of Canadians don’t want pharmacare jeopardizing their drug coverage. But it could. National Post. February 6, 2019.
  13. Canadian Life and Health Insurance Association. Submission on the 2019 federal budget to the House of Commons Standing Committee on Finance. Toronto, 2019.
  14. Law M, Cheng L, Dhalla I, Heard D, Morgan S. The effect of cost on adherence to prescription medications in Canada. CMAJ. 2012;184(3):297-302. doi:10.1503/cmaj.111270
  15. Morgan S, Gagnon M-A, Charbonneau M, Vadeboncoeur A. Evaluating the effects of Quebec’s private-public drug insurance system. CMAJ. 2017;189(40):E1259-E1263. doi:10.1503/cmaj.170726
  16. Stabile M. The role of tax subsidies in the market for health insurance. International Tax and Public Finance. 2002;9(1):33-50.
  17. Cassels A, Law M. The impact of the introducton of a formulary into a large Canadian private drug plan: in interrupted time-series analysis. CMAJ Open. 2019;7(3):E472-E477. doi:10.9778/cmajo.20180124
  18. Law M, Kratzer J, Dhalla I. The increasing iniefficiency of private health insurance in Canada. CMAJ. 2014;186(12):E470-E474. doi:10.1503/cmaj.130913
  19. Stevenson H. An end to blank cheques: getting more value out of employer drug plans. Toronto (ON): Reformulary Group; 2011.
  20. Canadian Life and Health Insurance Association (CLHIA). Submission on the national pharmacare discussion paper to the Advisory Council on the Implementation of National Pharmacare. Toronto: CLHIA; 2018.
  21. Millson B, Thiele S, Zhang Y, Dobson-Belaire W, Skinner B. Access to new medicines in public drug plans: Canada and comparable countries. 2016 annual report. Innovative Medicines Canada;2017
  22. Lichtenberg F. Are the benefits of newer drugs worth their cost? Evidence from the 1996 MEPS. Health Aff (Millwood). 2001;20(5):241-251. doi:10.1377/hlthaff.20.5.241
  23. Law M, Grépin K. Is newer always better? Re-evaluating the benefits of newer pharmaceuticals. J Health Econ. 2010;29:743-750.
  24. Zhang Y, Soumerai S. Do newer prescription drugs pay for themselves? A reassessment of the evidence. Health Aff (Millwood). 2007;26(3):880-886. doi:10.1377/hlthaff.26.3.880
  25. Baker D, Fugh-Berman A. Do new drugs increase life expectancy? A critique of a Manhattan Institute paper. J Gen Intern Med. 2009;24(5):678-682. doi:10.1007/s11606-009-0954-4
  26. Grootendorst P, Piérard E, Shim M. Life-expectancy gains from pharmaceutical drugs: a critical appraisal of the literature. Expert Rev Pharmacoecon Outcomes Res. 2009;9(4):353-364.
  27. Lichtenberg F. Do new drugs save lives? J Gen Intern Med. 2009;24(12):1356. doi:10.1007/s11606-009-1101-y
  28. Lichtenberg F. Effects of new drugs on overall health spending: Frank Lichtenberg responds. Health Aff (Millwood). 2007;26(3):887-890. doi:10.1377 /hlthaff.26.3.887
  29. Prescrire Editorial Staff. Drugs in 2018: a brief review. Prescrire International. 2019;28:105-107.
  30. Kratzer J, McGrail K, Strumpf E, Law M. Cost-control mechanisms in Canadian private drug plans. Healthcare Policy. 2013;9(1):35-43.
  31. Nelson J. Manulife begins program to scrutinize coverage of pricey drugs. Globe and Mail. November 15, 2015.
  32. Focus update: group benefit news.  Accessed November 16, 2019. Published August 31, 2017.
  33. Office of the Parliamentary Budget Officer (PBO). Federal cost of a national pharmacare program. Ottawa: PBO; 2018.
  34. National Prescription Drug Utliization Information System (NPDUIS). Alignment among public formularies in Canada – Part 1: General overview. Ottawa: NPDUIS; 2017.
  35. OECD. Health at a glance 2019: OECD indicators. Paris: OECD; 2019.
Volume 9, Issue 12
December 2020
Pages 528-530
  • Receive Date: 17 November 2019
  • Revise Date: 04 January 2020
  • Accept Date: 05 January 2020
  • First Publish Date: 01 December 2020