Mind the Gap: A Universal National Pharmacare Plan in the Making

Summary of Public Town Hall Dialogue Session

November 7, 2018 CPSI Town Hall for the Implementation of a National Pharmacare Plan

By: Nicole Dagher

As a result of of the Federal Government's 2018 Budget, the Advisory Council on the Implementation of National Pharmacare was established. Operating under Dr. Eric Hoskins as Chair, the Council has been working coast-to-coast, facilitating a patient-centered dialogue on how Canadians can sustainably pay for and implement a universal national pharmacare plan that is equal and accessible to everyone. The Council will deliver a report to the federal ministers of Health and Finance in the spring.

November 7, 2018 was a long-awaited night for many Nova Scotians, eager for a chance to have their voices heard in such an important national conversation. The Canadian Patient Safety Institute (CPSI) hosted a public Town Hall at the Delta Hotel, downtown Halifax for any and all Nova Scotians wanting to share their opinions and experiences navigating the current patchwork of a system. The townhall is one of dozens of meetings that have been held across Canada and follows a stakeholders’ consultation held September 19th in Halifax.

The only representative on the council from Atlantic Canada is Diana Whalen, the former Deputy Premier of Nova Scotia. Whalen began by explaining that since health is a provincial jurisdiction, it is imperative to have “the cooperation of all provinces, and for patients to be at the front and center of the dialogue.” The Council proceeded to listen to the needs and concerns of Nova Scotians as they were presented and considered from various perspectives.

Nova Scotia has one of the highest rates of chronic disease and disability in Canada, and yet it pays the second-highest cost for drugs in the world; the highest of all OECD countries.This is due in large part to each province and territory having to do their own negotiating, the ramifications of which have produced fragmentation and a relative unsustainable purchasing power.

According to the Council, research supports that centralizing and regulating the national pharmacare industry is essential to mitigating the “gaps,” or systemic barriers and inequalities that prevent many from accessing safe, supportive and/or equitable care. This must be an initial step in building a foundation for the establishment and implementation of a successful universal national pharmacare plan.

After initial introductory remarks, the public were invited to ask questions and provide comments.  Audience comments focused on the importance that a national pharmacare plan address major problems in the current system like unsafe and careless drug prescribing practices, barriers to filling prescriptions due to cost, and the incredible lack of market surveillance and reliable information. Many spoke from first-hand experience of the exhaustion, and frustration that comes with trying to navigate the complexity of the current system. It was consistently expressed that those with coverage are often unaware of it, and those with cultural or language barriers, in addition to the most marginalized populations, find themselves at a further disadvantage. These elements need careful consideration in the early stages of a plans construction so that population-based disadvantages are both addressed and prevented.

Representatives of the council told participants that the creation of a universal, public pharmacare program will require two things: the equitable redistribution of taxpayers’ dollars and simplifying and improving the quality and patient access to care. The strategic management of resources, including mechanisms like bulk-purchasing and improved technology for record keeping capacities, will improve patient safety and prescribing practices while maximizing value-for-money. This approach, most importantly, will create an environment in which all Canadians irrespective of income, will save money and have the drug coverage they need.

Although admittedly a grand task, the Council and the Canadian public have made it clear that a national, public and universal pharmacare program is necessary and long-overdue. A public pharmacare program is even more important in the face of ever-increasing cost of living, changing demographics, and a lack of access to necessary medications, which continues to have a disproportionate impact on the most at-risk populations: the homeless, refugees, seniors, and young adults.

Effective measures for transition are an important consideration in the continuation of care, and if not taken seriously, could pose significant health risks.  

One common thread ran throughout the meeting: we need a clinically-culturally competent system without user fees of any kind, that is based primarily on need. A national plan for pharmacare that is unconditionally universal, comprehensive, and accessible to everyone, is crucial. Moreover, the creation of a universal, national formulary should not negate the need to account for individual health care needs, and to have a system in place that allows for exceptions when necessary-a truth echoed by Ms. Whalen, in her closing remarks that evening.

Although the Council has yet to decide on a final blueprint for implementation, one thing is for sure: many barriers to accessing life-sustaining medications are systemic, thus posing an intergenerational risk on the health of current and future populations.

Gone are the days of fill-in-the gaps; we all need the accessibility and safety of a universal national plan.

If you weren’t able to attend the Halifax Town Hall dialogue session, you can still make your impact. Tell them why a universal national plan on pharmacare would benefit you, your family or your community. They need to hear from you!

The upcoming months are the best chance we have in influencing real, meaningful change. For more information and a chance to have your say, visit the following links below.






Fill our the Council’s feedback forum:


Upcoming events:



Learn More about pharmacare: