New pharmacare framework bill includes plan to cover diabetes medications, contraceptives

The federal government has presented a much-anticipated piece of legislation, broadly laying out the Liberals' plans to implement a national pharmacare framework, satisfying a core commitment to the NDP.

Presented in the House of Commons on Thursday morning by Health Minister Mark Holland — one day ahead of the March 1 deadline agreed to by both parties—the six-page bill outlines the "foundational principles" of a national universal drug coverage plan, but does not directly implement one.

"This is fundamentally an important day for Canada. It is one for which I am so deeply proud," Holland said, at the announcement held at a community health centre minutes away from Parliament Hill alongside NDP MP and lead negotiator for his party on the file, Don Davies.

"There will be a debate about who gets credit here today… This debate entirely misses the point," Holland said. "Today is a giant step forward for our health system. It was made possible by two adversaries asking what we have in common, rather than what separates us… I hope that it represents the politics of our future, it certainly made the history of today."

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As the NDP confirmed ahead of the bill being tabled, the legislation includes a commitment to first launch diabetes medication and birth control coverage for Canadians, through a single-payer system, contingent on provincial and territorial agreement. This first phase is being seen as an opportunity to evaluate "the effectiveness" of the model, as Holland put it. 

"If the minister enters in a bilateral agreement with a willing province or territory, the minister may provide funding… to increase any existing pharmacare coverage, allowing the province or territory to provide universal, single-payer, first dollar coverage," for these two kinds of medications, according to the government's briefing material.

Specifically, the government says it will be establishing a fund to improve access to supplies that Canada's 3.7 million diabetics require to manage, monitor, and administer their medication in addition to improving the access to diabetes medications, including insulin.

As for contraceptives, the government will be working on cross-Canada deals to provide access to a suite of options for the more than 9 million people of reproductive age, including oral contraceptives, copper and hormonal IUDs, injections, implants, rings, and morning-after pills.

"Everyone in our country will get free diabetes medication. To women who have seen, south of the border, direct attacks on women's rights… We can say very clearly now that in our country, everyone will have access to free birth control because of New Democrats," NDP Leader Jagmeet Singh said Thursday. "This is historic. This is the dream of our party since the conception of our party."

What does the pharmacare bill say?

In paving the way for a full-fledged pharmacare program, Bill C-64, "An Act Respecting Pharmacare," indicates the Liberals' "commitment to consulting widely about the way forward," and intent to establish a committee of experts to make recommendations "on the operation and financing," within 30 days of the bill becoming law.

The committee would then have an entire year from the bill's passage to provide a report to the health minister with its recommendations.

The legislation also includes a series of underlining guiding factors for a future pharmacare program, including improving the accessibility, affordability and appropriate use of pharmaceutical products, as well as providing "universal coverage… across Canada."

It also provides for the Canadian Drug Agency announced in late 2023 to work on developing a national formulary and bulk purchasing strategy. Should the bill pass, this agency would have to also provide a list of essential prescription drugs within a year. 

The legislation comes as recent survey data indicated some Canadians are resorting to cost-cutting means to save on critical prescriptions. Nearly one in four Canadians have reported splitting pills, skipping doses or deciding not to renew or fill their prescriptions due to high costs, according to a recent poll. 

A core Liberal-NDP pledge 

Reaching the deal by the already-extended March 1 deadline came down to the wire, with Singh threatening for weeks to pull out of the deal if the Liberals didn't come through. 

Setting up a framework for a national drug plan was one of the core planks of the two-party agreement meant to provide the minority Liberal government parliamentary stability until June 2025, in exchange for progress on progressive policies.

After saying he put Prime Minister Justin Trudeau "on notice," late last week, Singh broke the news that the two sides had come to an agreement on "historic" draft legislation that specifically refers to single-payer delivery, a key demand of the New Democrats.

Funding questions remain 

A key sticking point through the talks has been the Liberals' fiscal prudence preoccupation, with Holland previously indicating the government "can't afford this to be a massively expensive program." The Parliamentary Budget Officer has estimated a full universal national pharmacare program would cost billions, annually.

Over the weekend, Finance Minister Chrystia Freeland indicated the new drug coverage approach won't impede on her plans to keep the federal deficit below one per cent of gross domestic product, according to The Canadian Press.

And, while no specific funding has been committed yet, the legislation includes a vow that if the federal government inks a deal with a province or territory, the feds would maintain "long-term funding … beginning with those for rare diseases."

Asked by reporters, Holland would not provide a clear cost estimate. He said he had a "quantum" range in his head that could be on either side of $1.5 billion. 

"We're hopeful to sign agreements this year. And so, the point that I'm making is there will be some expenditure this year I hope, if we can get to agreements and we can see people getting access to drugs in this fiscal year," Holland said, noting the legislation needs to still make its way through the Parliament first.

"So that's going to take some period of time. And obviously, not all the provinces are going to come online at once, so that's very hard to forecast." 

Political, provincial buy-in? 

At a town hall during last month's Edmonton caucus retreat, Singh and his MPs heard pleas to pin down the—as Singh characterized them—at-times "slippery" Liberals on pharmacare.

Davies told reporters at the January retreat that there has been some back-and-forth on some "creative" and "bold" proposals to see an agreeable version of the legislation materialize, after the initial draft was rejected by Singh as offering "insufficient" coverage for Canadians.

"Today, we lay the foundations of public pharmacare in Canada," Davies told reporters on Parliament Hill Thursday. "It's the result of decades of hard work by New Democrats and progressive Canadians, and allied organizations for years, who believe that every Canadian should get access to the prescription medication they need to stay healthy with their health card, not their credit card."

While the agreement originally required the federal government to pass a "Canada Pharmacare Act" by the end of 2023, the Liberals and New Democrats agreed to an extension, after being unable to even table a bill by that deadline. 

The bill comes just as both Quebec and Alberta have said they want to opt out of the new federal offering, which could have knock-on effects for the federal government's bulk purchasing power. Others, such as New Brunswick and Nova Scotia, say they want to hear the details of the plan before saying whether they're in favour.

While signalling a need to still sort out the logistics and details, both Manitoba Premier Wab Kinew and British Columbia Premier David Eby welcomed the legislation on Thursday.

Asked repeatedly by reporters on Thursday whether a potential future Conservative government would dismantle pharmacare, Conservative Leader Pierre Poilievre did not answer.

With files from CTV News' Spencer Van Dyk and Annie Bergeron-Oliver