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Canada has passed the Pharmacare Act, and provinces and territories need to act quick to secure free contraceptives and diabetes medications before a federal election is called, say advocates.

Bill C-64 was given royal assent on Oct. 10. It will help create a national public insurance plan for pharmaceuticals, starting with free contraceptives and diabetes medications. Health Canada estimates this will support reproductive freedom for nine million women and gender-diverse people and benefit 3.7 million Canadians living with diabetes.

Provinces and territories will need to negotiate individual agreements with the federal government over funding and what drugs will be covered. Canada’s Drug Agency has a year to come up with a list of “essential drugs and related products” that the government could build a bulk-purchasing strategy around to drive down costs.

According to calculations by the Globe and Mail, Canada spent $41 billion on prescription drugs in 2023, with $18 billion covered by public insurance plans, $15 billion by private plans and $8 billion out of pocket.

Canadians currently pay the second-highest drug prices in the world, trailing only the United States, according to the Council of Canadians, a grassroots national organization working to protect health care and advocate for health equity.

But advocates with the Council of Canadians and AccessBC, a campaign that advocates for free prescription contraceptives in B.C., say they worry that if these provincial and territorial agreements aren’t made fast enough and an election is called, the program could be dissolved by an incoming Conservative government.

Conservative party leader Pierre Poilievre has said he does not support the Pharmacare Act. He has called it “radical” and said he will revoke it if elected.

But there’s safety in numbers, said Nikolas Barry-Shaw, campaigner in trade and privatization with the Council of Canadians. The more provinces and territories that sign agreements, the harder it will be for a new government to reverse course, he said.

“Our goal is to get the national pharmacare plan so far past the finish line that no federal government can undo it,” said Teale Phelps Bondaroff, co-founder and committee chair of AccessBC.

BC’s existing provincial program

B.C. introduced a provincial program in March 2023 to make 60 commonly used contraceptives, including emergency contraceptives, free.

In addition to preventing unwanted pregnancies, these contraceptives can be used to help treat or manage endometriosis, polycystic ovary syndrome, gender-affirming care, menstrual regulation and hormonal acne, and to prevent against some forms of cancer, Phelps Bondaroff said.

In the first 15 months of the program, patients accessed free contraceptives around 252,000 times, with around 60 per cent getting hormonal birth control pills and 19 per cent getting hormonal IUDs.

In September B.C. and Health Canada said that once C-64 got royal assent, they’d kick off negotiations to expand B.C.’s existing program to include diabetes medications and hormone replacement therapy for women going through menopause.

On Oct. 1 Manitoba became the second province to launch a free contraceptives program.

Opposition to Bill C-64

Barry-Shaw said Quebec and Alberta are opposed to the Pharmacare Act, arguing health care is under provincial, not federal, jurisdiction. Quebec already has its own prescription drug insurance plan but does not use a single-payer model where the government could use bulk buying to lower prices, he added.

Both provinces already take federal money under the Canada Health Act to provide health care, Barry-Shaw said. The Pharmacare Act is similar, he added.

Barry-Shaw said that while he wants to see provinces and territories sign on to the Pharmacare Act as quickly as possible to protect it from a possible Conservative government, the legislation does also leave the door open for the possibility of what’s known as the P.E.I. model.

In 2021 P.E.I. signed an agreement with the federal government to help cover the cost of prescription drugs for Islanders. The coverage was patchwork and included many drugs but did not create a universal system, Barry-Shaw said. Pharmaceutical companies liked this model, he added, because it used government funding to buy their products without creating a single-payer system that would allow the government to negotiate lower prices.

He worries federal Health Minister Mark Holland has left the door open for the second stage of the Pharmacare Act to follow the P.E.I. model, where the government will cover the cost of “essential drugs” but not under a single-payer system.

He said he suspects the “unstated” reason there’s opposition to the bill or willingness to consider the P.E.I. model is connected to the lobbying done by insurance companies and the pharmaceutical industry since the bill was introduced.

“Drug companies have not come out in opposition to pharmacare as such; they’ve just said, ‘We want to do it differently,’” Barry-Shaw said. “The main thing the drug companies object to in this bill is the fact that it has a bulk-buying plan and is going to create a single-payer framework, which would give Canada the buying power that it would need to negotiate down drug prices like every other country does other than the U.S.”

Every country that has a “developed public health-care system” also has coverage for pharmaceuticals, and they use their national purchasing power to get better deals on drugs, he said. Because Canada doesn’t do this, it pays on average 28 per cent more for drugs than other Organization for Economic Co-operation and Development countries, he added.

Barry-Shaw said that between March 2022 and January 2024 pharmaceutical and insurance industry lobbyists met with the federal health minister and their top aides 381 times, which means roughly four meetings per week for two years. Lobbyists for the pharmaceutical industry had 305 meetings and lobbyists for insurance companies had 76 meetings, he said.

This is a big jump compared with lobbying efforts before the federal Liberals and NDP entered into a supply and confidence agreement, which allowed the NDP to push for a national pharmacare deal. Compared with 2015-19, pharmaceutical lobbying increased by 3.78 times and insurance lobbying increased by 7.97 times, Barry-Shaw said.

That lobbying continued once the bill was tabled.

According to reporting by the Investigative Journalism Foundation, the federal government has been lobbied 106 times by groups opposed to Bill C-64 since it was tabled earlier this year.

Further reporting by the Globe and Mail found representatives from Loblaw Cos. Ltd. and Shoppers Drug Mart, which is owned by Loblaw, lobbied federal officials 22 times.

“Not only is Loblaws overcharging for bread, but they’re trying to take away free contraceptives too,” Barry-Shaw said.

The Neighbourhood Pharmacy Association of Canada says a national pharmacare program that covers contraceptives and diabetes medications would cost community pharmacies $43 million per year because public plans pay less in dispensing fees than private ones.

Drug companies know the program will be popular and “hard to hold back once it gets going,” Barry-Shaw said.

Phelps Bondaroff said that when individuals oppose the Pharmacare Act, it’s generally because they are upset that their medications are not covered.

He said the act is set to expand to cover “essential medications” and that he hopes one day all medications will be covered “because you should never hit a paywall for any life-saving medications.”

Support for Bill C-64

Free prescription contraception appeals to people of all political stripes, Phelps Bondaroff said.

He said it appeals to progressives because it addresses equity, affordability and health impacts; to centrists because it addresses equity, affordability and health impacts and is revenue positive; to fiscal conservatives because it saves millions of dollars; and to social conservatives because it reduces teen pregnancy and abortion rates.

The “revenue positive” calculations were done by Options for Sexual Health, a registered society that offers current sexual and reproductive health care, information and education, and by Dr. Wendy Norman, a professor in the University of British Columbia’s department of family practice in the faculty of medicine.

Norman calculates that the free contraceptive program saves B.C. $27 million annually in health-care costs compared with care for pregnant people up to six weeks postpartum. A 2010 Options for Sexual Health study found that for every $1 spent on contraceptives, the government saved $90 on social supports.

Nearly one in four Canadians say they have skipped, split or not filled their medications due to cost, according to a recent survey by the Heart and Stroke Foundation of Canada.

The same study found one in 10 Canadians with chronic conditions have landed in the ER because they were not able to afford prescription medications.

When provinces pay for pharmaceuticals, they could expect to keep people healthy and away from the ER, thereby saving between a median of $1,641 and a mean of $4,465 per patient every three years, according to a 2023 study.

Pharmacare would also remove barriers for women in conservative or traditional households, said Emily Tang, a University of British Columbia master’s student and vice-president of external relations of the school’s Graduate Student Society.

“If you are a minor or a student under your parent’s insurance or health-care plan, you run the risk of your parents finding out you’re using contraceptives,” she said. “Now you can go to a pharmacy and access contraceptives or emergency contraceptives on your own. It removes the confidentiality barrier.”

A national pharmacare plan will hopefully help synchronize health-care systems and reduce the stress out-of-province students feel when trying to access health care, she added.

Having a wide range of contraceptives available helps people find one that works for them, said Shylo Peterson, a woman who works in child development. She said that since B.C. introduced free prescription contraceptives, she’s heard more people talk openly about what contraceptives they use and what did and didn’t work for them.

“Now we just need to expand it so there’s options for men to take contraceptives too,” she said. “That would be more inclusive.”

Room for improvement

Dr. Ruth Habte, who is finishing her fifth year as a student in the department of obstetrics and gynecology at UBC, said people often pick contraceptives that are the cheapest instead of what works best for them.

What works best is more than a personal preference.

Estrogen-containing contraceptives shouldn’t be used by people with blood clotting disorders, high blood pressure or higher risk of cardiovascular disease, people who smoke and are over 35 years old or people who get auras with migraines, she said.

An IUD may be cheaper than a pill if you compare per-day costs, but a hormonal IUD comes with an upfront cost of nearly $500, which is a “steep price to pay” for a product that you might not like — especially if you’re living paycheque to paycheque, Habte said.

To improve the program, Phelps Bondaroff said, AccessBC is asking the government to expand coverage so that a wider range of types and brands of contraceptives is available. They also want the government to increase the number of medical professionals trained in IUD and implant insertion, improve pain management during IUD insertion and further improve access by making some forms of contraceptives available over the counter.

During the provincial election campaign, the NDP said it would expand the scope of practice for midwives in B.C. to include IUD insertions and medical abortions.

AccessBC is asking for the birth control patch, Lo Loestrin Fe (a low-dose estrogen pill), Slynd (an estrogen-free pill) and Ella (an emergency contraceptive similar to Plan B but that works for a larger number of days and works for heavier people) to be made free too.

Lo Loestrin Fe, Slynd and Ella are very popular in Vancouver, Habte said.

— This article was originally published by The Tyee.

News from © The Canadian Press, 2024