Cutting it close: Pharmacare deal made one day before agreed deadline

On February 23, news spread like wildfire that the New Democratic Party (NDP) had finally reached a deal with the Liberal government to develop a national pharmacare program—one that would include coverage for birth control and diabetes medication.

Today, Bill C-64, An Act respecting pharmacare, (Pharmacare Act) was introduced by Mark Holland, Minister of Health—one day before the agreed deadline.

Here’s what we know:

• The six-page bill outlines “foundational principles” of a national universal drug coverage plan—doesn’t directly implement one.
• Commitment is made to launch diabetes medication and birth control coverage for every Canadian with a health card—through a single-payer system (contingent on provincial and territorial agreement).
• Bill C-64 provides a new Canadian Drug Agency to work on developing the national formulary (list of essential prescription drugs) and bulk purchasing strategy—all within a year of the Act receiving Royal Assent.
• Commitment to long-term funding for provinces, territories, and Indigenous peoples.

A full pharmacare program would cost billions by the time it’s all up and running—as estimated by the Parliamentary Budget Officer. When probed, the government stayed quiet on the cost to cover initial list of drugs.

For many, public health insurance ends when they go to fill a prescription. This deal wants to fill the gaps.

It also marks progress within the supply-and-confidence agreement—initially made between the two parties in the spring of 2022. It’s a key moment for the NDP to remain in the marriage.

For the minority Liberal government, the possibility of an imminent election is also off the table—for now.

The bill commits the government to strike a committee of experts to advise on implementing the plan followed by a pursuit of bilateral deals with each of the provinces and territories regarding “operation” and “funding.”

Mixed reviews

The deal has ignited both optimism and apprehension across the country.

For some, the deal appears to be a long-awaited solution to financial burdens on individuals and families while streamlining the healthcare system. Proponents argue that pooling resources and negotiating drug prices on a national scale will lead to significant cost savings and improved health outcomes.

You will get the medicine you need with your health card, not your credit card — Jagmeet Singh.

However, opposition to the deal has been swift and vocal, raising concerns about implementation and sustainability. Critics warn that navigating provincial jurisdictions will be complex and that the program may lead to “massive bureaucracy” for those currently covered by private insurance or employer-sponsored benefits—exacerbating healthcare disparities rather than alleviating them.

Silence spoke louder than words for Conservative Leader, Pierre Poilievre—walking away Thursday morning without a statement when probed for his position by reporters.

Adding to uncertainty, Alberta and Quebec have expressed that they will opt out of the deal altogether.

Adriana LaGringe, Alberta Health Minister, claimed that the province wasn’t consulted. Alberta wants per capita funding to bolster its own program rather than a forced hand to sign-in on the national program.

Prior to this plan, some provinces, including British Columbia and Manitoba, were already moving towards covering contraceptives. Uncertainty remains on what they will do next. Will they align with the federal government and pull back planning on initiatives already in motion?

Atlantic provinces including Nova Scotia and New Brunswick want to see the details of the plan before saying, “I do.”

Should these provinces choose to opt out, it would undermine the universality of the pharmacare program.

With the federal election set for October 2025 (or sooner), we’ll see if this deal becomes a true “voter mover” on election day.

What it means for you

Clients operating in the healthcare, insurance, and pharmaceuticals space—this deal represents a seismic shift within the healthcare landscape. Key things to note:

Accessibility and Affordability
The immediate impact is the expansion of access to prescription medications. Increased accessibility ensures no one gets left behind due to a lack of affordability.

Market Dynamics
With the government negotiating prices on a national scale, specifically through the proposed single-payer strategy—companies may face increased pressures to lower prices to meet the government’s budgetary constraints. Questions remain on whether the single-payer strategy would also lead to lower premiums for insurance plans.

Supplemental coverage from insurance providers would need to step in for services not covered by the plan. Questions remain on whether a cap dispensing fee would also be implemented.

A single-payer model may provide greater certainty for patients around reimbursement rates and coverage policies.

Regulatory Environment
As the program is implemented, regulatory agencies may adapt to new reimbursement models and coverage criteria. We may see increased oversight to ensure transparency and fairness.

As the program is implemented, it will be essential for policymakers, regulators, and industry leaders to work collaboratively to address these challenges while ensuring the program achieves intended goals to improve health outcomes while reducing healthcare disparities across the country.

For more insights and in-depth analysis of Canada’s political landscape, reach out to or Public Affairs and Government Relations experts.