Canadians are one step closer to national pharmacare. The Trudeau government and the NDP recently introduced the first piece of the plan. Reportedly, this first piece will cover contraceptives (including birth control pills) and treatments for diabetes, although the government must still work out many details including the extent of coverage.

Canadians are right to ask—how will national pharmacare affect me?

Currently, because health care is a provincial jurisdiction, coverage for pharmaceutical drugs varies widely from coast to coast. According to Statistics Canada, in 2019 more than 81 per cent of Canadians were covered by at least one type of drug insurance including 20.6 per cent by government-sponsored plans, 54.7 per cent by employer-sponsored plans, 5.2 per cent by association-sponsored plans and 5.7 per cent by private plans. According to the Trudeau government’s plan, national pharmacare would replace these options.

And according to the criteria put forward by the NDP, the proposed new pharmacare law would likely prohibit Canadians from purchasing supplemental insurance to cover drugs not covered (or only partially covered) by pharmacare. Patients who rely on these drugs would then have two choices—pay out-of- pocket for their drugs or go without.

This prohibition, which would effectively prevent many Canadians from purchasing prescription drugs outside the pharmacare plan, is particularly problematic because private insurance covers more drugs than the public insurance plans of provincial governments. Specifically, between 2018 and 2021, private plans reimbursed (on average) 51 per cent more unique medications than public plans. This difference grows to 59.6 per cent in Quebec, the province with the most generous public coverage.

In other words, if pharmacare becomes the law of the land, the 25 million Canadians who currently have private drug insurance plans will suddenly find themselves with significantly less coverage. And all Canadians will be limited to the list of drugs selected by the government. Although traditional “reference drugs,” which would be widely covered by a public plan, may work well for most patients, other drug options may not be available through pharmacare. Patients, of course, will pay the price. Canadians need only look to the United Kingdom where cancer survival rates are low compared to other industrialized countries, an outcome likely exacerbated by lack of access to medicines regarded as effective in other European countries.

Moreover, a recent study by Innovative Medicines Canada found that while 44 per cent of new drugs launched on the global market (between 2012 and 2021) are distributed in Canada, only 20 per cent are covered by the public plans. Access is problematic, and so are approval delays. In Canada, the average approval delay for coverage of a new drug by private insurers is 226 days after its approval by Health Canada compared to 732 days for public plans (which is double the average wait in peer OECD countries).

Clearly, national pharmacare would be bad news for some patients in Canada. It’s important that physicians have therapeutic options to address the wide variation in individual patient responses to, and tolerance of, any particular drug. With more treatment options, there are more convenient dosing and formulations that do not require refrigeration or are less temperature sensitive. These choices give physicians the flexibility to precisely treat the individual needs of diverse patients. Therapeutic alternatives within the same drug class may also differ in their metabolism, molecule, regimen, dosing schedules, speed of action, delivery system, adverse effects, therapeutic profile and/or interactions. In other words, if you expand the choice of medicines, you expand the number of treatment options available and help eliminate side effects.

In the worst case, if national pharmacare will not cover a particular treatment, pharmaceutical companies may stop distributing them in Canada. For patients, this means a loss of access, even if they’re willing to pay out-of-pocket.

When the Trudeau government, in cooperation with the NDP, promises national pharmacare, Canadians should understand what they mean. While the government has not revealed the final plan, we know the risks to patient access, drug availability and treatment options. Policymakers across the country owe it to their constituents to determine whether the benefits of national pharmacare outweigh the sacrifices.