When the topic of national pharmacare made a resurgence in 2018, the Canadian Breast Cancer Network (CBCN) continued advocacy for an equitable and comprehensive approach to national prescription drug coverage. We have advocated that a national plan should provide Canadians with better access to life-saving medications than they currently have and improve equity of access nationally, so the newly announced legislation for a universal, single-payer, phased approach is a welcomed first step. The Act (Bill C-64 An Act Respecting Pharmacare) was introduced on February 29, 2024, but must still go through the legislative process before coming into effect.
What does the Pharmacare Act say?
By now, it is well known that contraceptives and diabetes medicines will be covered under the Act, with “first dollar” funding. This insurance term simply means that the full cost of the prescription will be covered for these two types of medicines. While this is the most publicized aspect of what pharmacare will look like, it also references the Canada Health Act’s principals and recognizes that being unable to afford medicines creates strain on the healthcare system. To address these concerns, pharmacare will take a step-by-step approach under a single-payer system that focuses on collaboration among provinces, territories, Indigenous peoples, and the federal government. The federal government has already committed to long-term funding for pharmacare, committing $1.5 billion dollars over three years in March 2023 towards a rare disease strategy.
What is the future of pharmacare?
It is still very early to know what the exact future of pharmacare will be and which provinces will adopt the legislation first. Although provinces have the right to opt-out, it’s important to remember that at the time of writing this article, nothing has been agreed on. This means that only as negotiations progress can we get a better sense of what it means for Canadians if provinces do in fact opt-out. Next to this, the newly formed Canadian Drug Agency (CDA) is likely to have a significant role in pharmacare. They may be tasked with giving advice to the Health Minister and providing evaluations of the progress of pharmacare, but critics warn that the language used in the Act does not commit the Minster to involving the CDA on these points. Similarly, although the federal government commits itself to requesting a bulk purchasing strategy, essential medicines list, and pan-Canadian strategy for appropriate use of medicines from the CDA, the CDA can choose how to respond to that request.
What does pharmacare mean for people diagnosed with breast cancer?
Although not directly related to oncology, covering the cost of diabetes medication and contraceptives is still a win for Canadians affected by breast cancer. For example, diabetes management can be an important part of breast cancer treatment because patients with diabetes are more likely to develop breast cancer, and some breast cancer treatments may increase the risk of type 2 diabetes. What’s more, universal access to paid contraceptives represents a significant milestone in women’s health. However, in CBCN’s calls to action regarding pharmacare, it has always been with the intention of bolstering equity and improving access to breast cancer treatments – two things the Pharmacare Act fails to do. In 2019, CBCN identified equity, delays, eligibility, and un- or under-insured as the biggest issues facing cancer treatment, and these concerns still hold true. Experts continue to point to a requirement that more timely access to therapies be a key outcome of pharmacare, and advocates insist that pharmacare should not leave anyone with less coverage than they currently have.
With the announcement of pharmacare legislation, Canadians have the chance to consider whether to view access to medicines as a pillar of healthcare, or simply an add-on service. CBCN remains hopeful that the legislation will rekindle Canadian values of affording people access to healthcare based on need, not ability to pay. At the same time, considering how some provinces such as Quebec and Alberta have already made statements on opting out of the national plan, it appears that Canada’s current patchwork of coverage still needs to be truly addressed.
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