Pill, bills, budgetary aches

We’re a nation of drug users. Well, not those drugs.

Rather, many Canadians have their health supported by pharmaceutical medications prescribed by a physician.

In our universal health-care system, medication can come with a big additional cost.

The federal government introduced a national pharmacare program in 2024. Manitoba was among the first to sign on, partly leading to its Enhanced Pharmacare Program, which now offers birth control, diabetes and a few other medications at no cost to Manitobans.

Now pharmacare appears to be in palliative care, with no additional funding beyond 2029, and that limited funding is only for the few provinces that signed on to the deal initially.

In a statement from the office of federal Health Minister Marjorie Michel, the government claims it “will always defend” the health-care system, including honouring existing agreements.

While it doesn’t directly state the new program is dead, it effectively is, says Andrew Longhurst, a health policy researcher at Simon Fraser University in Vancouver.

The feds are “being very careful in not communicating the fact that they’re killing it, but in effect, that’s what they’re doing,” he says.

At first glance, the federal government will save billions of dollars annually.

Dr. Steve Morgan at the School of Population and Public Health at the University of British Columbia — among the foremost experts in health-care economics in Canada — offers a few reasons why that may be short-sighted.

In a lengthy email to the Free Press, he notes Canadians spent $45 billion on prescriptions outside the hospital — about $1,000 per capita — in 2025. Canadian Institute for Health Information statistics show total health-care spending in Canada was $399 billion (or about $9,600 per capita).

A significant amount of drug costs (42 per cent) is covered by federal and provincial plans, often supporting “vulnerable populations,” he says.

Yet that support involves a patchwork of programs.

“There are more than 140 differently targeted public drug plans in Canada … in contrast with just 13 universal ‘medicare’ plans that the provinces and territories run to cover hospital care and physicians’ services,” Morgan writes.

An additional 40 per cent of costs are paid by private insurance.

“The overwhelming majority of Canadians with private drug coverage obtain it through work-related extended health benefits, meaning the cost comes off their paycheque,” he says.

It may feel like it’s free to workers, but it’s a form of earned compensation, Morgan says.

While many may be covered by plans, about 18 per cent of prescription drug costs are paid out-of-pocket by about 10 per cent of citizens without coverage. “This is either because they do not qualify for … public or private drug coverage, or because they qualify but cannot afford the premiums,” he adds.

As well, another 10 per cent of the population is under-insured whereby coverage is partial — often 50 per cent of costs.

Many of those instances involve folks who are technically covered by a provincial drug plan, but face an annual deductible of hundreds or even thousands of dollars before public subsidies kick in, Morgan says.

Indeed, that is how most of Manitoba’s pharmacare program works.

“(It) is an income-based drug benefit program that helps eligible Manitobans, regardless of age, manage the cost of prescription drugs,” the Manitoba government wrote in an email to the Free Press.

“An annual deductible based on family income is applied in an equitable manner for all beneficiaries and ensures that all Manitobans have access to coverage for prescription drugs and eligible supplies.”

The deductible ranges from 3.45 per cent for those earning less than $15,000 in annual income to 7.77 per cent for income above $75,001.

The calculation is based on total household income (i.e. both spouses), while accounting for dependents. As an example, a household earning a little more than $150,000 before taxes, with one dependent, must pay $11,422.06 out of pocket first before the provincial plan covers eligible prescription costs, based on the province’s deductible calculator.

Morgan writes coverage for many households often comes into effect when experiencing “catastrophic” drug costs.

That said, he lauds Manitoba for providing coverage for a few medications without deductibles.

He suggests all governments follow the 2019 federal report recommending the public system cover 100 of the most essential medicines in a countrywide plan.

This would come with a cost for government coffers. Yet Morgan writes the “best available evidence is that a public pharmacare system will bring down overall costs.”

Australia, New Zealand, Sweden, Norway and the United Kingdom have universal drug coverage plans, at a cost of about $500 per capita.

“All of these countries are able to use the price negotiating power of a single payer for pharmaceuticals to achieve the lowest prices,” Morgan says.

The numbers show it costs Canadian governments and households more with the existing patchwork, he adds. So much so that millions cannot afford medication.

“Survey after survey has found that about 10 per cent of Canadians who received at least one prescription in the previous year chose not to fill at least one of their prescriptions because of the out-of-pocket costs,” Morgan says.

And evidence points to better health outcomes and lower costs if access was improved.

That 2019 study states that just removing drug costs for diabetes, cardiovascular disease and chronic respiratory conditions would result in 220,000 fewer emergency room visits and 90,000 fewer hospital stays, resulting in about $1.2 billion in cost savings a year.

What’s more, national pharmacare would help Canadians better deal with rising costs for everything else.

Morgan points to federal data showing in 2016 about 500,000 Canadians went without food, heat or other expenses because of drug costs. To him, the argument for the status quo isn’t about finances. It’s political.

“It takes leadership to confront opposition from powerful industries (insurers and pharma) and from organized opponents to anything publicly financed and managed (a large swath of politics but driven hard by those with the greatest wealth),” he writes.

So if pills, bills and budgetary aches ail you, remember that next time around at the ballot box.

Joel Schlesinger is a Winnipeg-based

freelance journalist

joelschles@gmail.com