Provinces and territories that have not joined the new national universal pharmacare program are missing out on hundreds of millions of dollars in potential federal funding for cash-strapped public health care services.
Nine months after the Pharmacare Act (C-64) received Royal Assent on October 10, 2024 , just four provinces and territories have signed bilateral agreements with the federal government. Those agreements are valued at $928 million over four years starting in 2026.
The Pharmacare Act is meant to provide universal access to Diabetes medication and contraceptives, making those pharmaceuticals free at the point of access for people covered by public health insurance. In order to implement that vision, the federal government needs to sign funding agreements with the provinces, who are responsible for administering health plans.
Manitoba, British Columbia, Prince Edward Island and Yukon are participating in the federal program, covering nearly 7.5 million people. The remaining nine provinces and territories without agreements are passing up valuable federal health care funding—which could be providing free medication to residents paid for by the federal government.
New Brunswick would likely receive $136 million through a bilateral pharmacare agreement over four years. Nova Scotia would receive $171 million, and Ontario would receive an estimated $2.5 billion over four years. These are significant infusions of cash.
Using a per capita calculation* based on the four existing agreements, provinces would likely receive the following amounts over four years for pharmacare:
With so few jurisdictions enrolled in pharmacare, four out of five Canadians are not benefiting from the program. The gap is leaving a patchwork of coverage across the country.
A person in Manitoba benefits from free contraception, saving them hundreds of dollars each year, while someone in Alberta has to shoulder this cost on their own. A resident of British Columbia has their diabetes medication covered publicly, but loses that benefit if they have to move to Ontario.
The Pharmacare Act stipulates that the program must be “guided by the Canada Health Act.” The Canada Health Act includes universality and portability as two of its five central principles, which cannot be fulfilled until all provinces join the landmark pharmacare program.
Canada’s new Health Minister Marjorie Michel says she’s already meeting with her provincial and territorial counterparts, and many of her office’s key staff members helped to negotiate the four bilateral agreements under her predecessor.
But she cannot sign more agreements without willing partners in provincial capitals, challenging public pharmacare advocates and patient groups to pressure both levels of government to deliver long-promised national universal pharmacare to Canadians.
*Note on methodology: The per capita funding of the four participating jurisdictions varies widely, from $117 per resident for British Columbia to $198 per resident for Yukon. The average per capita amount of $156 was applied to non-participating jurisdictions to calculate likely amounts they would be eligible to receive in federal funding.
