Canada’s getting national pharmacare. Here’s what it means for you

Posted on October 23, 2024 in Health Policy Context

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TheStar.com – News/Canada
Oct. 23, 2024.   By Andy Takagi, Staff Reporter

The newly implemented national pharmacare plan would mean more access for Canadians to medications that can cost hundreds or thousands out-of-pocket.

A new national pharmacare plan could mean free access to birth control and diabetes medication across Canada — but there’s still some deal-making to be done.

With the Liberal government’s pharmacare plan enacted earlier this month, the government only needs to sign individual deals with the provinces to realize widespread access to diabetes medication, like insulin, and a broad array of contraceptives.

The legislation was the result of the now-dead NDP-Liberal alliance that was canned in early September — and with the prospect of an election looming around the corner, the new national pharmacare program could have an uncertain future.

Still, experts say, while far from an all-encompassing pharmacare program, the two types of medication covered as a pilot under the new legislation is an important step toward making essential medication more accessible.

Here’s what you need to know about Canada’s new pharmacare program.

What will be covered by the pharmacare plan?

For now, the government-paid plan will only cover birth control and diabetes medication, though the government has hinted that it could expand the program in the future. The specifics of which medications will be covered by pharmacare will come down to the federal government’s negotiations with the provinces and territories.

Birth control

The government’s pharmacare plan includes a long list of oral birth control pills, copper and hormonal intrauterine devices (IUDs), contraceptive injections, hormonal implants, hormonal vaginal rings and emergency contraceptives.

Oral contraceptives, without pharmacare, cost approximately $300 per year and IUDs (which are effective for five years) cost about $500, according to the federal government.

In Ontario, OHIP+ — which covers Ontarians 24 years old or younger not covered by private insurance — currently provides coverage for some forms of contraceptives.

You can check out the full list of contraceptives under consideration for coverage under the pharmacare plan in this press release from Health Canada.

Access to contraceptives is a “necessity in universal health care,” Dr. Nadia Alam, a family doctor in Georgetown and former president of the Ontario Medical Association, said.

“For a number of reasons ranging from cost to intimate partner violence, women and people with a uterus don’t have access to reliable birth control,” Alam said. “Managing an unplanned pregnancy is far riskier than preventing it in the first place.”

Diabetes medication

The government’s proposed pharmacare plan would cover insulin, Metformin, combination medications and SGLT-2 inhibitors, all of which can range from $100 per year to $1,700 per year depending on the medication, according to the government.

In Ontario, OHIP+ covers various insulins and oral diabetic medications, while the province’s assistive devices program covers the full cost of an insulin pump.

The full list of diabetes medications under consideration for coverage can be found online.

Almost one in 10 Canadians over the age of 20 have been diagnosed with diabetes, a StatCan report from 2023 found, and three in four Canadians diagnosed with diabetes use medication to manage their condition. And, according to Diabetes Canada, out-of-pocket costs for people diagnosed with diabetes ranged from about $10,000 per year to over $18,000 per year.

How much will it cost?

The Liberals have said the program — budgeted at almost $1.5 billion over five years — will provide government-paid coverage for diabetes medication and birth control, and could expand in the future.

A 2015 study published in the Journal of Obstetrics and Gynecology Canada found that there were more than 180,700 unintended pregnancies annually in Canada, which cost the health care system $175 million per year through births, abortions and complications.

And, a 2017 study in the journal Health Promotion and Chronic Disease Prevention in Canada estimated that the costs due to diabetes from 2011 to 2022 was more than $16 billion across the country.

For both birth control and diabetes medication, expanded coverage “literally saves lives and money,” Steve Morgan, a population and public health professor at University of British Columbia, said.

The idea is that reducing the number of unwanted or unplanned pregnancies and increasing access to treatment for people with diabetes can improve health outcomes and reduce future strains on the health-care system, Morgan explained.

For the millions of Canadians living near or in poverty — a risk factor for chronic illness — pharmacare coverage of birth control and diabetes medication “is a fantastic start,” Alam said.

When will the pharmacare plan go into effect?

Earlier in October, federal Health Minister Mark Holland said that formal negotiations with provinces can start now that the pharmacare bill has passed, but that “informal” talks have already been ongoing.

Holland told reporters Friday that he’s confident Ottawa can sign deals with all provinces by next spring, describing talks that have happened so far as “very” positive.

British Columbia has already signed a memorandum of understanding with Ottawa, agreeing to work together on a program to cover diabetes medication, birth control and hormone replacement therapy for menopause.

Ontario’s government, however, is still mulling over the fine print of the program.

“Ontario, like many provinces, has yet to receive any details on the federal government’s proposal,” said Health Minister Sylvia Jones’s spokesperson Hannah Jensen by email on Oct. 11.

“Instead of calling on the provinces to strike a deal with no detail,” Jensen added, “the federal government should focus on working collaboratively with provinces to adequately support health-care services across the country.”

Andy Takagi is a Toronto-based general assignment reporter for the Star.

https://www.thestar.com/news/canada/canadas-getting-national-pharmacare-heres-what-it-means-for-you/article_0aec6d5a-8b1f-11ef-9564-83add69c3abb.html

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