A new report from the C.D. Howe Institute is urging Ottawa to ditch its plans for a single-payer, universal pharmacare program, warning that the country’s shifting fiscal and economic priorities make such a program unsustainable.
Rosalie Wyonch, associate director of research at C.D. Howe and the report’s author, argues the federal government should focus instead on filling existing gaps in drug coverage while building on Canada’s mixed public-private model. She pointed to Quebec’s long-running system, which mandates coverage through either private insurance or the province’s public prescription drug plan, as a practical template for the rest of the country.
The report comes as Prime Minister Mark Carney faces questions about his government’s commitment to pharmacare. Although the Liberals promised during the last election to “protect” pharmacare, Carney has been vague on whether a universal, fully public plan will materialize. His latest comments focused only on signing agreements with provinces and territories to deliver the first phase of coverage, which includes contraceptives and some diabetes medications.
Universal pharmacare has long been a political flashpoint, originating from a confidence-and-supply deal between the Trudeau Liberals and the NDP that forced the passage of the Pharmacare Act last October. But Wyonch noted that economic conditions have shifted dramatically, with Ottawa now prioritizing infrastructure and defence spending in the face of tariff-related uncertainty.
The Parliamentary Budget Officer previously pegged the annual cost of universal pharmacare at nearly $39 billion by 2027-28 — $13.4 billion more than current drug spending. Even the limited first phase is not fully funded, with only Manitoba, B.C., P.E.I., and Yukon signing deals to date, consuming over 60% of the $1.5 billion allocated despite covering less than one-fifth of Canadians.
The C.D. Howe workshop behind the report brought together pharmaceutical executives, insurers, academics, and former public servants, and Wyonch said there was “broad consensus” that a targeted approach is more realistic. The expert committee reviewing pharmacare models is expected to submit its recommendations to the health minister by October 10, potentially shaping the future of the national plan.