Until recently, the Smart Health Benefits Coalition (SHBC) was preparing to double down on its advocacy work regarding the federal government’s draft Pharmacare Act, or Bill C-64. “We have been preparing to underline our position that the current wording of the Bill could result in some serious unintended consequences,” says Carolyne Eagan, spokesperson for SHBC and President of Benefits Alliance.
Then came NDP leader Jagmeet Singh’s announcement in early September to end its confidence-and-supply agreement negotiated with the Liberal government in 2022. This decision could potentially derail a pharmacare rollout, which had been scheduled to happen by April 1, 2025.
In provinces that choose to participate, the proposed Bill would see the federal government pay for a list of basic medications for diabetes and contraception. Other drugs not on the pharmacare list would continue to be paid by group insurance, personal insurance, or the patient directly.
SHBC, composed of seven of Canada’s largest benefits advisory firms, including Benefits Alliance, had meaningful conversations with Health Canada and the federal ministries of health, labour, seniors and families earlier this year. And in late May, SHBC was invited to present as a witness during the House of Commons Standing Committee on Health’s review of Bill C-64, where it recommended three amendments.
One amendment called for the federal Minister of Health to enter into secondary negotiations with provinces, in the event that a province were to formally reject single-payor pharmacare. SHBC’s second recommended amendment related to bulk-purchasing of drugs.
And the third recommendation called for public reporting and transparent communication of the results of the initial model—which would provide universal, single-payor coverage for a list of contraceptives and diabetes medications—before the program is expanded.
Bill C-64 passed third reading in the House of Commons on June 3. From there it was forwarded to the Senate for review, where it passed second reading on June 18. Prior to the third and final reading in the Senate, the Standing Senate Committee on Social Affairs, Science and Technology must complete its review, which resumed in mid-September following the Senate’s adjournment for the summer. SHBC is currently seeking to meet with members of the Senate committee during its review.
However, the big question now is how the NDP announcement will affect the Bill’s passage. “We just don’t know how that will impact things,” says Graham Young, Chair of the Board, Benefits Alliance, and Director, Employees Benefits at Capcorp in Ottawa.
One possible outcome is that the Bill may die on the table if Prime Minister Justin Trudeau prorogues—or postpones—parliament in any way. This would prevent the tabling of any confidence motions and would effectively block the calling of a snap election. “In that scenario, the only way [the Bill] could carry on is if there was unanimous consent in the house. And that’s not going to happen,” says Young.
SHBC is cautiously optimistic their meeting with the Senate committee—and the Bill—will proceed as originally expected. In addition to its three recommended amendments, SHBC’s messaging to the Senate will reiterate its main concern about the proposed legislation, which it brought forward to the House of Commons Standing Committee on Health.
As it currently stands, the legislation is ambiguous on what will happen if someone already has existing coverage through a private plan for the listed drugs for diabetes or contraception. “The way the legislation is written, Canadians would no longer be able to claim certain diabetes and/or contraceptive medications under their benefits plan. They would be forced to submit some of their claims to the government and others to their benefits plan,” says Eagan. “This would result in quite a disruption for managing claims, not only for one person but possibly multiple family members at a time.”
When pressed on this issue, the government has repeatedly said that there will be choice. But the legislation’s wording of “universal, single-payer, first-dollar coverage” implies the government would pay for the medications on the pharmacare list, and private group insurance plans would not be able to do so.
The SHBC continues to believe that Bill C-64 has the potential to financially assist low-income Canadians, as well as those without health insurance.
“We think the government can do a lot more for less money by allowing a multi-payer system, similar to the Canadian Dental Care Plan,” says Young. “The same budget could be used to cover a longer list of medications or even additional medications for other common health conditions. We believe this is a smart solution that is worthy of discussion at the Senate.”
Update on drugs for rare diseases
In related news, in July the federal government signed its first bilateral agreement, with B.C., to improve access to drugs for rare diseases. Under Canada’s new National Strategy for Drugs for Rare Diseases, the federal government will provide $194 million to B.C. to support early diagnosis, screening and coverage, starting with two drugs, Poteligeo (to treat an aggressive form of cancer that causes skin lesions) and Oxlumo (to treat a genetic condition that can lead to kidney failure).
This was welcome news, says Eagan. “One of our primary messages on pharmacare has always been that it focuses on universal coverage for drugs for rare diseases as well as high-cost drugs to treat other conditions,” she says. “Canada is lagging other countries in this area.”