Expert report calls on Ottawa to fund essential medicines, enshrine pharmacare in law

OTTAWA - Canada should create a pharmacare system that offers free access to essential medicines to anyone with a health card and allows private insurance to continue playing a role, an expert committee report recommended on Friday. "Pharmacare can and should be implemented now," said Dr. Navindra Persaud, chair of the advisory committee and a physician at St. Michael's Hospital in Toronto. The committee was tasked last year with reporting to the health minister on the best way to set up and fund a universal, single-payer pharmacare program. The committee was a requirement of the Pharmacare Act, which became law in October 2024. That law was the product of a supply and confidence agreement between the Liberals and the NDP that propped up the minority government under Justin Trudeau. Health Minister Marjorie Michel received the report in October and it was made public on Friday. The committee said the model it recommends would eliminate the need to negotiate individual agreements with the provinces and territories, something that's proven to be challenging and time-consuming. The first phase of pharmacare, which is intended to provide free access to contraceptives and diabetes medications, requires bilateral agreements with the provinces and territories. Persaud pointed out that in the year since the law came into effect, only four deals have been signed and a number of provinces have said they're not interested in negotiations. "It's clear bilateral agreements have not worked," he said. The program is also underfunded. The previous government budgeted $1.5 billion over five years, but more than 60 per cent of that money is already allocated to just three provinces and one territory. The most recent federal budget included no new funding for pharmacare at all. The expert committee said "the federal government's responsibility is to initially protect the right to a minimal standard of essential medicine." To do so, it recommends the government create a list of essential medicines. Persaud said the World Health Organization has a suggested list countries can use as a starting point, and many of the medications listed would be generic, low-cost drugs that can be purchased in bulk -- things like antibiotics, medications for heart disease and diabetes, and treatments for HIV. The committee called on the federal government to provide sustainable funding to all provinces and territories to fully cover the cost of drugs on the essential medicines list. The report said the provinces and territories, which are responsible for delivering health care, would be expected to put any savings from existing drug plans into improving access to primary health care. For patients with health cards, the cost of filling a prescription for an essential medicine under such a system would be nothing. And if a patient was prescribed something not on the list, Persaud said, they would turn to their existing private insurance provider or pay out of pocket. The list is intended to evolve and the committee said an independent body should maintain the list to insulate it from political influence. "In basically every other country that has such a list, anyone can suggest an addition to the list. So that could be a patient, it could be pharmaceutical company, it could be doctor or a group of doctors," Persaud said. The report recommends against a fill-the-gaps approach that would offer drug coverage only to people without private insurance, similar to the way the federal dental care program works. In September, a group of pharmaceutical and insurance industry representatives argued for that model for pharmacare, given the new fiscal reality created by the U.S. trade war. In its letter to Michel, the committee argued that pharmacare offers a way to strengthen Canada's cherished public health system and protect national sovereignty. "External threats throw into relief Canadian values that are never to be traded," the letter said. The expert committee estimates the cost of a publicly funded essential medicine list at between $6 and $10 billion. Persaud said the added cost to taxpayers is more like $3 billion, because the government would save billions on bulk drug purchases and by redirecting funding from existing drug plans. It's a cheaper option than some that have been considered over the many years that Canada has debated a national pharmacare program. Persaud said there has been a lot of opposition to universal pharmacare. "An important part of the reason that we haven't seen a lot of progress is because each dollar that pharmacare saves is a dollar less in potential profit for private insurance companies and pharmaceutical companies," he said. But he said public support is strong. The committee says it wants to see the Liberal government enshrine pharmacare in law by introducing legislation that defines exactly how the policy works and explicitly recognizes the "right to essential medicines" as a human right. The health minister was not made available to answer questions about the report on Friday. In a statement, a spokesperson for Michel thanked the committee for its work. "Our new government will always protect Canada's health care system, including pharmacare and dental care. These are clear commitments, and we will keep them," Guillaume Bertrand said. This report by The Canadian Press was first published Nov. 21, 2025.