What is Pharmacare in Canada?

Pharmacare is the federal-provincial-territorial framework to provide universal public coverage of prescription drugs to all Canadians. Unlike hospital and physician services, prescription drugs outside hospitals have traditionally been covered through a patchwork of provincial drug plans, employer-sponsored private insurance, federal plans for First Nations and Inuit and the military, and out-of-pocket payments. About 7.5 million Canadians have inadequate or no drug coverage according to the Hoskins Advisory Council on the Implementation of National Pharmacare.

Federal pharmacare commitments built up gradually through the 2010s and 2020s. The 2018 Hoskins Advisory Council, chaired by former Ontario Health Minister Eric Hoskins, recommended a single-payer national pharmacare system covering an essential medicines list. The 2019 federal-provincial National Strategy for Drugs for Rare Diseases provided $1.5 billion over three years for orphan drug coverage. The Canadian Drug Agency was established in 2024 to assess drug effectiveness and value. The Patented Medicine Prices Review Board regulates prices of patented drugs sold in Canada.

The Pharmacare Act, Bill C-64, received Royal Assent on October 10, 2024, establishing the federal framework for universal public pharmacare. The Act commits the federal government to negotiate bilateral agreements with provinces and territories starting with universal coverage of diabetes medications (insulin, glucagon, oral hypoglycemics, and related supplies) and contraception (oral, injectable, IUDs, and emergency contraception). British Columbia signed the first bilateral agreement on September 24, 2024.

Future expansion of pharmacare coverage is contested. The federal NDP and provincial governments including British Columbia, Manitoba, and Quebec support expanded universal coverage. Critics including the Canadian Life and Health Insurance Association argue that supplementing existing public-private hybrid coverage would deliver similar outcomes at lower cost. The 2024 federal Budget provided $1.5 billion over five years for the diabetes and contraception phase. Provincial drug plans include Ontario's OHIP+, British Columbia's PharmaCare, Quebec's RAMQ drug plan (which has been universal since 1997), and similar plans in every province and territory.