National Standards for Drug Coverage

Summary#

This bill, the Canada Pharmacare Act (C-340), sets national standards for provincial drug insurance plans. Provinces that meet these standards can receive federal cash contributions made under other Acts. The standards mirror the five pillars used in health care: public administration, comprehensiveness, universality, portability, and accessibility. The bill also allows creation of an independent drug agency and requires annual public reporting.

• Provinces must run drug plans on a non-profit, public basis and provide full coverage for insured drugs and dispensing fees (ss.7-8).
• Coverage must be for all residents on uniform terms, with limits on waiting periods and rules for travel and moves (ss.9-10).
• Plans must not use charges that block reasonable access; provinces must pay using an authorized tariff or system (s.11).
• The federal government may reduce or withhold transfers if a province does not meet the standards (ss.14-15).
• The federal Cabinet may set, by regulation, which drugs and supplies must be insured (s.17(a)).
• The Minister may establish an independent drug agency to assess effectiveness, advise on coverage, negotiate prices, and monitor safety (s.16).

What it means for you#

• Households and patients

  • If your province complies, insured drugs would be fully covered at the pharmacy, including dispensing fees. You would not pay out-of-pocket for insured drugs (s.8, s.11(a)).
  • Coverage would apply on uniform conditions for all residents who meet provincial eligibility rules (s.9).
  • The list of insured drugs and supplies would be set by federal regulation and provincial plan design; details would follow in regulations (s.17(a)).

• People traveling or moving

  • While temporarily in another province, your drugs would be paid at the rate approved by the host province, unless provinces agree otherwise (s.10(b)(i)).
  • While outside Canada, you could be reimbursed based on what your home province would have covered for similar drugs (s.10(b)(ii)).
  • When you move, your old province must cover you during any waiting period in your new province, up to 3 months (s.10(a), s.10(c)).

• People excluded from provincial plans

  • Members of the Canadian Forces and people serving sentences in federal penitentiaries are excluded and are covered by separate systems (Definitions: “insured person”).

• Health care practitioners

  • You continue to prescribe. An independent drug agency, if created, may issue advice on best use of medicines and safety (s.16(d)-(e)).

• Pharmacists and pharmacies

  • Provinces must pay for insured drugs under a tariff or authorized payment system. Your reimbursement would come from the public authority that runs the plan (s.11(b), s.7).

• Employers and private insurers

  • The bill requires a public, non-profit plan that fully covers insured drugs. It does not address private supplemental insurance. Changes to workplace drug benefits would depend on provincial decisions and the federal list of insured drugs (ss.7-8, s.17(a)). Data unavailable.

• Provinces and territories

  • To receive federal cash contributions, your plan must meet the five criteria throughout the fiscal year and provide required data to the federal Minister (ss.7-12).
  • If non-compliant, contributions may be reduced or withheld after notice and consultation (ss.13-15).

Expenses#

Estimated net cost: Data unavailable.

• No direct appropriation in the bill. “Cash contribution” means money provided under another Act of Parliament; this bill sets conditions for such contributions (Definitions; s.5; s.6).
• Amounts of any future contributions are not stated. Data unavailable.
• The Minister may create an independent drug agency, but the bill sets no budget for it (s.16). Data unavailable.
• No official fiscal note identified. Data unavailable.

Proponents' View#

• It would remove financial barriers at the pharmacy for insured drugs by requiring full coverage of drug costs and dispensing fees, and by barring user charges that impede reasonable access (s.8; s.11(a)).
• It establishes clear, national standards for public, non-profit administration and uniform eligibility, improving fairness across provinces (ss.7-9).
• Strong portability rules protect people who travel or move so they do not face gaps in drug coverage (s.10).
• A drug agency could make evidence-based coverage decisions, advise prescribers, negotiate lower prices, and monitor safety (s.16(a)-(e)).
• Federal leverage to reduce or withhold transfers creates accountability for meeting the standards (ss.14-15).

Opponents' View#

• Federal conditions may limit provincial flexibility in designing drug plans and could be seen as intruding on provincial health jurisdiction (ss.7-11; ss.14-15).
• Requiring full coverage on uniform terms may raise provincial spending or force trade-offs with other services if the insured list is broad (s.8; s.17(a)). Data unavailable.
• A federally prescribed list of insured drugs might be narrower than some existing private plans, reducing patient choice relative to current coverage (s.17(a)).
• Transition could disrupt existing employer-sponsored or private plans as provinces shift to public administration and payment rules (ss.7-8). Data unavailable.
• Using transfer withholdings to enforce compliance could create intergovernmental disputes and risk service instability during disputes (ss.14-15).