A centre piece of Justin Trudeau’s 2019 platform was a promise to implement national universal pharmacare. He said this would ensure all Canadians have the drug coverage they need at an affordable price. Needless to say, this was incredibly popular and probably helped boost Liberal fortunes in that election.

Fast forward to today, and the national pharmacare commitment is gone from the Liberal’s platform. The current document brags about the progress the Liberal government has made but that is not enough for several stakeholders who continue to criticize Trudeau for not committing to a full national program and pressing him for further action.

So what happened? First of all, COVID put all other health care priorities on the back burner. It also sucked up every new penny the federal government could find (and more) to allocate to health care leaving them little room to make other expensive promises. We always knew a full universal national pharmacare program would be expensive; the advisory panel chaired by Dr. Eric Hoskins estimated a national program would cost $15.3 billion if fully implemented by 2027. However, the Parliamentary Budget Office estimated the net cost to the federal government to be $19.3 billion per year. Wherever the final cost might land, it seems safe to say it would be eye watering.

The other dynamic is the usual back and forth between the federal and provincial governments about who pays for these new commitments. Experience tells us that when a federal government has technicolour dreams about health care it better get the chequebook ready. Adrian Dix, British Columbia’s Minister of Health, has been consistent in his position that if the federal Liberals want agreement from provinces on anything that expands access to taxpayer funded drugs, they will need to match their passion with a large investment of money.

While stakeholders bemoan that there is no universal pharmacare program, federal and provincial governments have made a lot of progress reducing what the taxpayer pays for drugs in recent years. However, the steps taken are not flashy and probably won’t lead to cheers from voters if anyone included this narrative in a stump speech. For the past decade provinces have combined their bargaining power to negotiate lower drug prices through the pan-Canadian Pharmaceutical Alliance. They state that these collective negotiations have led to $2.58 billion in annual savings nationally. At the federal level the first steps have been taken to set up a new Canada Drug Agency, create a national formulary and create a national drug plan for rare diseases. The federal Liberal government even secured an agreement with one province, Prince Edward Island, which will receive $35 million to list new drugs and lower out-of-pocket costs for drugs already covered.

What about the other parties? Jagmeet Singh and the NDP are once again promising to make prescription drugs free starting with a $10 billion investment to establish a national pharmacare system. He said that if elected his government would work with provinces and territories to achieve this but has continued to be light on details of what he is proposing. He is also promising national plans for dental and mental health care in a bid to distinguish his team from the federal Liberals.

Erin O’Toole’s Conservatives simply say they will negotiate constructively with the pharmaceutical industry to reduce drug prices. Perhaps trying to create a wedge issue of their own, their platform takes a dig at the Liberals by saying they, “won’t allow Liberal regulation to drive pharmaceutical companies out of Canada anymore.”

So what does this mean for Canadians waiting for universal access to drugs? In the short term a national pharmacare program as laid out by the Advisory Panel led by Dr. Hoskins is probably out of reach. We are therefore going to have to be satisfied with incremental progress no matter who forms government. But by continuing to make this an issue in upcoming provincial and federal elections, creating opportunities between elections to discuss the issue, and encouraging collaboration between stakeholders and health ministers, we’ll continue to move towards universal access which is a goal we can all agree on.