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What are the next steps on the long road to a national pharmacare plan?

OTTAWA — Prime Minister Justin Trudeau is calling his government's new pharmacare bill a huge step forward, but won't say what direction Canada's new national drug plan is headed.

Health Minister Mark Holland introduced a bill in the House of Commons Thursday that charts a course toward a universal pharmacare plan which, in the interim, will cover birth control and diabetes drugs and supplies.

The Liberals have been promising national pharmacare since 2019, and progress toward that goal is a major pillar of the federal government's political pact with New Democrats.

Holland said he's not certain a universal program — one that covers all drugs for anyone with a health card — will happen, or when the government will have the information needed to make a decision.

Trudeau also stopped short of promising a full-fledged pharmacare program at a press conference on Friday.

"This is something that we're glad to move forward on and we will continue to work toward making sure that all Canadians can afford all the medications that are necessary," he said Friday in Sudbury, Ont.

Here are the steps that the Liberals have laid out so far.

Step 1: Negotiate 13 deals to cover birth control and diabetes drugs and supplies

Holland doesn't plan to wait for the bill to get royal assent before sitting down with provinces to hammer out a deal to cover birth control and diabetes medication.

He's confident the drugs will be covered before the next election.

"We can't actually implement anything until the bill receives royal assent, but it allows us to have those conversations and build towards it so that we can take action as quickly as possible," Holland said.

The launch, which Holland described as something of a trial balloon for universal coverage, will cost in the realm of more than $1.5 billion, though that figure is subject to change over the course of the talks. Only a fraction of that cost is likely to appear in the Liberal's spring budget.

Step 2. The committee of 'How do we pay for this?'

Within 30 days of the bill receiving royal assent, the minister will need to convene a group of experts to study how the government would pay for a fully-formed pharmacare program.

He's hoping the committee will be able to show how much money pharmacare will save families and governments, in addition to how much it will cost the federal government.

"Of course, those are things we have to know in very specific and real terms," Holland said.

He also wants the committee to take another look at which model is the best way forward, based on what the government has learned from a pilot project in Prince Edward Island to bolster existing provincial programs and the universal rollout of birth control and diabetes meds.

The new committee's work will be in addition to the final report by an advisory panel led by Dr. Eric Hoskins in 2019. That report unequivocally recommended a universal, single-payer program.

The new committee will be expected to make its recommendations before the first anniversary of the bill receiving royal assent.

Step 3. Make a list of essential drugs

The bill also calls for The Canadian Drug Agency — basically a one-stop-shop for all things pharmacare — to come up with a list of essential medicines by the one-year anniversary of the act.

That list would theoretically form the basis of the drugs that would be covered as part of the next iteration of a national drug plan.

That doesn't exactly line up with the deadline set out in the Liberal's deal with the NDP, which calls for an essential medicines formulary by the end of the agreement, which is expected roughly in fall 2025.

Holland says the bill meets the spirit of the agreement, but that he thinks there needs to be flexibility.

NDP health critic Don Davies disagrees. He led the pharmacare negotiations on behalf of his party and says he expects to see that formulary before the end of the deal.

"The legislation is crystal clear and the commitments are crystal clear and we expect them to be honoured," he said.

Step 4. Buy in bulk

The Liberal's deal with the NDP also calls for a plan to buy drugs in bulk.

One of the major benefits of a universal pharmacare plan, proponents say, is that it's easier to drive a harder bargain when negotiating prices when there is only one buyer: the federal government.

Some describe it as the Costco method: buy in bulk to save money.

However, a single-payer model might not be necessary to see those savings, Holland said.

"There may be an opportunity with economies of scale to drive costs even lower through co-operation."

Provincial governments have already seen great results when it comes to banding together to buy drugs in bulk, Holland said. He wants to see the private sector insurance companies looped in as well.

The bill mandates the minister to talk it over with provinces and ask the Canadian Drug Agency to come up with a plan within a year of the bill receiving royal assent.

Step 5. Make sure medicine is being used properly

The final step laid out in the legislation is a strategy to make sure drugs are being prescribed appropriately. which must be published on the Health Canada website.

The goal is to eliminate underuse, overuse and misuse of prescription drugs.

"When you think of antibiotics, as an example, over prescription of antibiotics can lead to really injurious circumstances for an individual. It would mean that their ability, their body's ability to defend off bacterial infections can be seriously compromised," Holland said.

While that would be good for patients, it would also make a potential pharmacare plan more efficient.

Final destination: TBD

If the NDP-Liberal deal holds firm, all the strategies and studies outlined in the bill should be complete just in time for the next federal election.

But that doesn't necessarily mean a national, universal pharmacare plan will appear on the Liberal party's campaign platform.

The Liberals are already thinking about where they want to take the program, Holland said, but he offered little certainty about when a decision will be made.

When asked when the Liberals will have the information they need, Holland compared it to a marriage.

"I wish I knew," he said. "If you're in a relationship, and you wonder how much information do you need to get married? I don't know. You know it when you get there."

From the NDP's perspective, that Liberal reticence suggests they are unlikely to move forward.

"If Canadians want comprehensive, single-payer pharmacare for all medications, the only way they're going to get that is with an NDP government … or us forcing the Liberals to do it once again," Davies said.

This report by The Canadian Press was first published March 1, 2024.

Laura Osman, The Canadian Press