Filling the Gaps: A Prescription for Universal Pharmacare

Pharmacare is currently a much-debated issue in Canada. Drugs are an increasingly important treatment for many medical conditions. Though most Canadians have some form of pharmaceutical coverage, a substantial minority either have no coverage or incomplete coverage, leaving them exposed to substantial risk. However, healthcare costs are rising faster than GDP and governments must be cautious about further expansions. In addition, differences in existing provincial insurance programs and health systems present a significant barrier to creating a single national formulary. There are, however, ways to close the gaps in prescription drug coverage and protect households from excessive costs when in acute need through the expansion of public insurance. This Commentary investigates current prescription drug insurance in Canadian provinces, evaluates options for achieving universal coverage and estimates their cost. These estimates suggest that providing prescription drug insurance coverage to the uninsured population would increase total provincial government spending across the country by about $2.2 billion to $5.4 billion in 2020, depending on the option chosen. The estimated cost of implementing catastrophic drug insurance ranges from about $340 million to $890 million, to cover drug costs above a threshold of 9 percent of income or 6 percent of income, respectively. Extending prescription drug insurance to those currently not covered in an already fiscally strained system is a significant challenge. Policymakers should carefully consider the structure, costs and benefits of existing programs and reform them as they are expanded to the currently uninsured population. Further, premiums and copayments should remain a feature of any universal prescription drug insurance policies. One advantage of the public drug insurance model in Quebec – currently the only province with universal prescription drug insurance – is that it includes a funding mechanism: enrollees pay an annual premium. Adopting a prescription drug insurance model that includes a funding mechanism would reduce the potential for short-term strain on government budgets. Significant progress towards improving access to prescription drugs and harmonizing coverage across provinces has already been made, and with careful expansion and revision of public programs, prescription drug insurance for all Canadians is within reach.