Canada’s Pharmacare Act: Still a Work in Progress

More than a year has passed since Bill C-64, the Pharmacare Act, received Royal Assent.

Evra Taylor, Medscape October 21, 2025

More than a year has passed since Bill C-64, the Pharmacare Act, received Royal Assent.

The bill was enacted on October 10, 2024, to develop national, universal pharmacare in Canada for the roughly 1.1 million Canadians without drug insurance. The government has signed bilateral agreements with British Columbia, Manitoba, Yukon, and Prince Edward Island. Those agreements are valued at CAD $928 million over 4 years, starting in 2026.

The core principles of the bill include ensuring that pharmaceuticals are accessible regardless of location or income, minimizing financial barriers, prioritizing patient safety, and advocating for universal health coverage across Canada.

As a first step, the bill has focused on providing coverage for diabetes and contraception medications at little or no cost. It established a fund to improve Canadians’ access to supplies needed to manage and monitor diabetes, such as syringes and glucose test strips. It also established the Canadian Drug Agency and tasked it with developing a national formulary, a bulk purchasing strategy, and a strategy for the appropriate use of prescription drugs.

Jurisdictional Questions

The four bilateral agreements affect roughly 18% of Canadians, including an estimated 3.8 million Canadians with diagnosed diabetes, and more than 1.7 million women of reproductive age.

The remaining provinces have opposed the adoption of the Pharmacare Act on jurisdictional grounds, arguing that the federal plan risks disrupting coverage for Canadians who already have insurance. Officials in Quebec and Alberta argue that healthcare falls under provincial jurisdiction. They oppose what they consider to be federal interference with their existing public and private prescription drug insurance plans.

The federal government has attempted to allay these concerns. “Early feedback from the rollout of pharmacare coverage in Manitoba and Prince Edward Island indicates that removing cost barriers for contraception and diabetes medications is making a positive difference for patients,” noted Health Canada and the Public Health Agency of Canada in a statement. “The Government of Canada is committed to protecting the existing agreements, and we are working with provinces and territories to support better outcomes for all Canadians. The Government will continue to monitor and evaluate the existing pharmacare agreement.”

“There are several potential benefits to Bill C-64,” Seema Nagpal, MD, chief science officer at the Canadian Cardiovascular Society, told Medscape Medical News. “Having said that, the implementation details of the pharmacare program are not yet very clear. When will it expand? What is included? What is the role of private insurance? Are there criteria for access? Does the process place an additional administrative burden on physicians? The answers to these questions impact [drug] access. We want to ensure that all Canadians get access to evidence-based medications that are recommended by Canadian guidelines, and this bill may point us in that direction,” said Nagpal.

Calls for Amendments

But others express greater doubt. The benefits of the bill as it currently stands are limited, according to Joe Farago, executive director of market access at Innovative Medicines Canada, a national association of pharmaceutical companies. “Amending the bill would better address the uninsured across Canada, which would make the most of the funding that’s laid out, and this would offer patients and clinicians better access to the medicines they need.”

The bill is focused on a single public payer approach, which would transfer costs that employers now cover to the public system, Farago explained. This change would limit the value of the funds to transfer because the public system would now bear the cost of running programs, managing formularies, negotiating prices, and processing claims. “To gain the most value for patients, you need to allow provinces to allocate funds to their public programs while preserving the dual market [ie, the availability of public and private insurance] that is established across all the provinces. For example, patients with private coverage benefit from much faster, broader, and easier access to medicines.

“Public programs have the most to gain from expanding their coverage or from reducing the out-of-pocket burden for patients, which tends to be the focus of those who are advocating for a universal program,” he continued. “Canadians who have private coverage have broader access to many classes of diabetes drugs. And, of course, contraceptives are covered on most employer programs. If the coverage is expanded on the public-only programs, clearly, that would benefit patients. The current position of patients with diabetes is that the list [of medications] being offered doesn’t cover all the diabetic medication, so it limits access.”

But Bill C-64 has its supporters, too. “This is a monumental win for workers and their families,” said Bea Bruske, president of the Canadian Labour Congress (CLC), in a statement. “For too long, people across this country have had to choose between putting food on the table and paying for the medications they need. Bill C-64 brings us one step closer to ending that predicament, but we still have work to do.

“Canada’s unions urge all levels of government to move swiftly and decisively to ensure that this is just the beginning. Bill C-64 sets the framework, but it is essential that provincial and territorial governments sign bilateral agreements to implement the program fully and equitably across the country,” Bruske added.

The CLC has called on the federal government to ensure that the Committee of Experts, which was established to make recommendations about the future of national pharmacare, is free of conflicts of interest that could influence its work. “We will keep pushing for a truly universal, single-payer pharmacare program, as recommended by the Advisory Council on the Implementation of National Pharmacare, which was headed up by former Ontario Health Minister Dr. Eric Hoskins,” the statement continued.

Nagpal and Farago reported having no relevant financial relationships.

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.

Source Medscape

Also see
Pharmacare is now law in Canada, but negotiations with provinces could slow progress The Conversation
The first, fragile foundations of national pharmacare in Canada CMAJ
About National Pharmacare Government of Canada
A Prescription for Canada: Achieving Pharmacare for All Government of Canada
Doubts rise over Ottawa’s ability to implement universal drug coverage if pharmacare bill passes The Globe and Mail
Why Canada doesn’t have a national pharmacare program, and why we need one CBC
Pharmacare national prescription drug program gains support CBC