As four months pass since the federal Liberals’ historic pharmacare legislation, provinces and territories remain stuck in a waiting pattern with growing frustration over the lack of funding details for the new national drug program.
The Liberals passed Bill C-64 in June, positioning Canada to eventually join other developed nations with universal prescription drug coverage. But what seemed like a transformational moment has evolved into a complicated federal-provincial standoff.
“We’ve received nothing concrete from Ottawa about how this is supposed to work financially,” a senior health policy advisor from Manitoba told me last week. “It’s like being invited to dinner without knowing who’s paying the bill.”
The legislation established a framework for the program starting with diabetes medications and contraceptives, but provinces say the federal government still hasn’t provided the funding formulas needed to implement the first phase.
Finance Minister Carney has maintained that program details will come in the fall fiscal update. “We’re developing a sustainable model that respects provincial jurisdiction while ensuring Canadians get the medications they need,” Carney said during a Toronto economic forum last month.
But provincial health ministers are growing increasingly vocal about the delay. Quebec Health Minister Christian Dubé has emphasized his province will maintain its existing pharmaceutical program regardless of federal plans. “Quebec has built a system that works for Quebecers. We need to understand exactly what the federal government is proposing before we consider any changes.”
The Parliamentary Budget Officer estimated in July that the diabetes and contraceptive coverage alone would cost approximately $1.5 billion annually once fully implemented. However, provincial officials I’ve spoken with question whether Ottawa has budgeted adequately for implementation costs.
BC’s Adrian Dix expressed frustration during last month’s health ministers meeting in Halifax. “British Columbians need to know if this is going to enhance our PharmaCare program or create administrative duplication. Right now, we simply don’t have those answers.”
The delays are particularly concerning for patient advocates who’ve fought decades for national pharmacare. Linda Wilhelm from the Canadian Arthritis Patient Alliance told me, “Every month without clear implementation plans means another month where people are cutting pills in half or choosing between medications and groceries.”
Recent polling from the Angus Reid Institute shows 78% of Canadians support a national pharmacare program, but 54% are concerned about how it will be funded. This reflects the financial anxiety provinces are expressing behind closed doors.
For many policy experts, the current situation mirrors previous federal-provincial health agreements where ambitious plans faced implementation hurdles. “We’ve seen this pattern before,” said Dr. Katherine Fierlbeck, a health policy professor at Dalhousie University. “Ottawa sets the vision, but provinces bear the administrative burden and often more costs than initially discussed.”
The NDP, whose support was crucial in passing the legislation, has been pushing the government to accelerate implementation. “Canadians voted for parties supporting pharmacare, and they’re tired of delays,” NDP health critic Don Davies said during Question Period last week.
Conservative leader Pierre Poilievre has criticized the approach entirely, calling it “another expensive Liberal promise without a plan to pay for it.” The Conservatives have instead advocated for targeted assistance to those without existing drug coverage.
For Canadians like Toronto resident Jamal Williams, who spends over $300 monthly managing his diabetes, these political delays have real consequences. “I’ve heard about this program since June, but nothing’s changed. I’m still paying the same prices, making the same sacrifices,” he told me while attending a community health forum.
The provinces are particularly concerned about long-term funding stability. After the 10-year health transfers were negotiated last year, many provincial officials worry pharmacare could follow a similar pattern – initial federal investment followed by increased provincial cost burden.
“We’ve been down this road before with childcare and housing programs,” a senior Ontario health ministry official said on condition of anonymity. “The federal government announces big programs, but provinces are left managing underfunded systems when attention moves elsewhere.”
Meanwhile, the pharmaceutical industry is closely watching developments. Innovative Medicines Canada, representing brand-name drug manufacturers, has cautioned that pricing pressures could affect medication availability. “We support expanded access but need to ensure a balanced approach that maintains innovation,” their spokesperson said in an emailed statement.
As fall budget discussions approach, both levels of government face mounting pressure to move beyond framework legislation to tangible implementation. For millions of Canadians currently rationing medications or foregoing prescriptions entirely, the political impasse represents more than policy disagreement – it’s a matter of health and financial security.
The question remains whether pharmacare will follow the path of medicare – eventually becoming a defining Canadian program – or join the list of ambitious federal initiatives that faded amid jurisdictional complexity and funding disputes.
