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Santis’ Take on a National Pharmacare Commitment


November 30, 2023- In 2022, as part of the Liberal-NDP Supply and Confidence Agreement, the federal government committed to “continuing progress towards” a universal national pharmacare program and passing a Canada Pharmacare Act by 2023.

The Parliamentary Budget Officer released new estimates in October showing total spending on prescription drugs under a single-payer universal drug plan would be cost $33.2 billion in 2024-25, rising to $38.9 billion in 2027-28. Despite this commitment, there are divisions between the NDP and Liberals, with the former insisting on a single-payer public pharmacare system.

Shifting Timelines

With only three weeks left in the sitting calendar, the window for tabling and passing pharmacare legislation in the current session has passed, something that Liberal House Leader Karina Gould acknowledged. Health Minister Mark Holland also expressed the government’s continued goal of tabling pharmacare legislation by the end of this year, with the expectation of passing it in 2024. The NDP has further stated that they are comfortable with a delay, especially in the situation that the pharmacare commitment is further enhanced and advanced.  

This is all still under the guise of the government’s focus on fiscal restraint, underscored in the Fall Economic Statement, where Minister Freeland emphasized spending tightening with no mention of new health commitments. The government also continues to highlight the cost of a single payer system, as costed by the Parliamentary Budget Office and based on the work completed by the Advisory Council on National Pharmacare 

Key Takeaways

  • Coordinated Media Campaign: It appears that there is coordination between the Liberals and the NDP in thea media campaign surrounding pharmacare. Based on the supply agreements provisions to have no surprises, both parties have maintained a positive tone and continue to highlight collaborative conversations for a pharmacare bill to be passed in 2024.
  • The Supply and Confidence Agreement Remains Healthy: Despite speculation, the NDP remainremains positive around the Supply and Confidence Agreement, with Jagmeet Singh and the NDP pointing to dental care as a significant win. The program will cost the government $13 billion over five years, an increase from the initial estimate of $5.3 billion when the program was first announced. Coupled with the positive traction around the future of pharmacare, the agreement continues to hold and seemingly be appearseemingly mutually beneficial.
  • Sweetening the Deal: In exchange for a delay, the NDP has publicly stated their expectation of a more favourable pharmacare. Though not having mentioned what would be sufficient to the NDP, it is likely that it would pertain to the two other aspects of the agreement that are often overlooked with the focus on pharmacare, namely, a national formulary and bulk purchasing by a national drug agency.
  • Who is Paying?: The NDP favors a universal, single-payer system, while the Liberals lean towards a mixed-payer model. Minister Holland highlighted that the federal government does not currently have the fiscal capacity to shoulder the estimated $40 billion annual cost of a single-payer system. This difference likely continues to drive discussions at the negotiating table between the government and NDP.
  • Provinces & Territories (PTs): As of yet, it does not appear that PTs have been formally engaged on the government’s plans – as the focus continues to be on finding common ground with the NDP. Following legislation, the path forward with PTs would likely be through individual bilateral agreements with willing jurisdictions.