Understanding the Battle for Universal Pharmacare in Canada; Comment on “Universal Pharmacare in Canada”

Document Type : Commentary


School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada


Drug coverage in Canada is a patchwork; an inequitable inefficient and unsustainable patchwork with no coherence or purpose. Some people think that we can solve the problem by adding more patches, but the core of the problem is that it is a patchwork. For the working population, access to medicines is still organized as privileges offered by employers to their employees. Universal pharmacare would not only provide better access to needed prescription drugs, but also eliminate waste, ensure value-for-money and help improve drug safety and appropriate prescribing. Opponents fear that a universal pharmacare plan would ration drugs, and impede drug access for some patients. However, these claims misunderstand the reality of drug coverage, pricing and access. Opponents propose, instead, to “fill the gap” of current drug coverage by implementing catastrophic coverage, which would serve commercial interests without maximizing health outcomes for the Canadian population. In spite of overwhelming evidence and consensus in the academic community in favour of universal pharmacare, the battle is far from over.


  1. Advisory Council for the Implementation of National Pharmacare. A Prescription for Canada: Achieving Pharmacare for All. Ottawa: Government of Canada; 2019.
  2. Hajizadeh M, Edmonds S. Universal pharmacare in Canada: a prescription for equity in healthcare. Int J Health Policy Manag. 2020;9(3):91-95. doi:10.15171/ijhpm.2019.93
  3. Lewis S. It won’t be easy: how to make universal pharmacare work in Canada. Int J Health Policy Manag. 2020;9(1):1-5. doi:10.15171/ijhpm.2019.82
  4. Morgan SG, Martin D, Gagnon MA, Mintzes B, Daw JR, Lexchin J. Pharmacare 2020: The Future of Drug Coverage in Canada. Vancouver: Pharmaceutical Policy Research Collaboration, University of British Columbia; 2015.
  5. Canadian Institute for Health Information (CIHI). How Canada Compares: Results from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa: CIHI; 2017.
  6. OECD. Health at a Glance 2019: OECD Indicators. Paris: OECD Publishing; 2019. doi:10.1787/4dd50c09-en
  7. Gagnon MA. A Roadmap to a Rational Pharmacare Policy in Canada. Ottawa: Canadian Federation of Nurses Unions; 2014.
  8. O'Brady S, Gagnon MA, Cassels A. Reforming private drug coverage in Canada: inefficient drug benefit design and the barriers to change in unionized settings. Health Policy. 2015;119(2):224-231. doi:10.1016/j.healthpol.2014.11.013
  9. Face to Face in Drug Plan Management - Research results. Benefits Canada website. https://www.benefitscanada.com/conferences/face-to-face-drug-plan-management-forum.  Published 2015.
  10. Canadian Agency for Drugs & Technologies in Health CADTH Canadian Drug Expert Committee Recommendation for Vortioxetine (Trintellix – Lundbeck Canada Inc.) (Final). CADTH; 2020.
  11. Express Scripts Canada. Prescription Drug Trend Report. Express Script Canada; 2019. https://www.express-scripts.ca/sites/default/files/Express_Scripts_Canada_2018_Prescription_Drug_Trend_Report_FINAL.pdf.
  12. Patented Medicine Prices Review Board (PMPRB). Annual Report 2017. Ottawa: PMPRB; 2018.
  13. Advisory Council for the Implementation of National Pharmacare. Interim Report of the Advisory Council for the Implementation of National Pharmacare. Ottawa: March 5, 2019. https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/interim-report/interim-report.pdf.
  14. In support of universal pharmacare. Pharmacare 2020 website. https://pharmacare2020.ca/our-letter.
  15. Morgan SG, Law M, Daw JR, Abraham L, Martin D. Estimated cost of universal public coverage of prescription drugs in Canada. CMAJ. 2015;187(7):491-497. doi:10.1503/cmaj.141564
  16. Office of the Parliamentary Budget Officer. Federal Cost of a National Pharmacare Program. Ottawa: PBO; 2017.
  17. GlaxoSmithKline's Patient group funding disclosure. https://ca.gsk.com/en-ca/responsibility/responsibility-reports-and-additional-data/patient-group-funding/best-medicines-coalition-bmc/.
  18. Batt S. The Big Money Club: Revealing the Players and Their Campaign to Stop Pharmacare. Ottawa: Canadian Federation of Nurses Unions; 2019.
  19. Rawson NSB. National pharmacare in Canada: equality or equity, accessibility or affordability comment on “Universal pharmacare in Canada: a prescription for equity in healthcare.” Int J Health Policy Manag. 2020; In Press. doi:10.15171/ijhpm.2019.146
  20. Acri KML. The Unintended Consequences of National Pharmacare Programs: The Experiences of Australia, New Zealand, and the UK. Vancouver: Fraser Institute; 2018.
  21. Sutherland G, Dinh T. Understanding the Gap: A Pan-Canadian Analysis of Prescription Drug Insurance Coverage. Ottawa: The Conference Board of Canada; 2017.
  22. Canadian Pharmacists Association. A Prescription for a Healthier Canada; Rx: PharmAccord. Ottawa: CPhA; 2019.
  23. Sun Life Financial. National Pharmacare: Getting it Right. Sun Life Financials; 2018.
  24. Macdonald K. Employer-Sponsored Drug Plans Becoming Risky Business. Benefits Canada website.  https://www.benefitscanada.com/benefits/health-benefits/employer-sponsored-drug-plans-becoming-risky-business-76793. Published 2016.
  25. Charbonneau M, Gagnon MA. Surviving niche busters: main strategies employed by Canadian private insurers facing the arrival of high cost specialty drugs. Health Policy. 2018;122(12):1295-1301. doi:10.1016/j.healthpol.2018.08.006
  26. Bourassa Forcier M, Noël F. Product listing agreements (PLAs): a new tool for reaching Quebec's pharmaceutical policy objectives? Healthc Policy. 2013;9(1):65-75.
  27. Olson M Jr. The Logic of Collective Action: Public Goods and the Theory of Groups, With a New Preface and Appendix. Harvard University Press; 1971.
  28. Gagnon MA, Hébert G. The Economic Case for Universal Pharmacare. Ottawa: IRIS and CCPA; 2010. 
Volume 10, Issue 3
March 2021
Pages 168-171
  • Receive Date: 20 February 2020
  • Revise Date: 04 March 2020
  • Accept Date: 05 March 2020
  • First Publish Date: 01 March 2021