This bill is from the 44th Parliament, 1st session, which ended in January 2025.
Mark Holland Liberal
This bill has received Royal Assent and is now law.
This is from the published bill. The Library of Parliament has also written a full legislative summary of the bill.
This enactment sets out the principles that the Minister of Health is to consider when working towards the implementation of national universal pharmacare and obliges the Minister to make payments, in certain circumstances, in relation to the coverage of certain prescription drugs and related products. It also sets out certain powers and obligations of the Minister — including in relation to the preparation of a list to inform the development of a national formulary and in relation to the development of a national bulk purchasing strategy — and requires the Minister to publish a pan-Canadian strategy regarding the appropriate use of prescription drugs and related products. Finally, it provides for the establishment of a committee of experts to make certain recommendations.
All sorts of information on this bill is available at LEGISinfo, an excellent resource from Parliament. You can also read the full text of the bill.
Bill numbers are reused for different bills each new session. Perhaps you were looking for one of these other C-64s:
This is a computer-generated summary of the speeches below. Usually it’s accurate, but every now and then it’ll contain inaccuracies or total fabrications.
Bill C-64, also known as the Pharmacare Act, proposes a framework for a national universal pharmacare program in Canada, starting with coverage for contraception and diabetes medications. The bill aims to improve accessibility, affordability, and equity in prescription drug coverage while also establishing the Canadian Drug Agency to oversee a national formulary and bulk purchasing strategy. However, some argue that the bill infringes on provincial jurisdiction, duplicates existing programs, and does not address the root causes of affordability issues.
Liberal
Conservative
NDP
Bloc
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Mr. Speaker, a Canadian is a Canadian. We have a program that is there for Canadians, and we are going to make sure that Canadians are respected in every province and territory, including Quebec. We are very proud to work closely with our colleagues, and we will continue to do so.
Lindsay Mathyssen NDP London—Fanshawe, ON
Mr. Speaker, the hon. member talked a lot about the cost savings in terms of this program. Of course, this goes right back into medicare and our health system.
The direct cost associated with unintended pregnancies here in Canada is an estimated $320 million, so the benefits of universal contraception do not just end unwanted pregnancies with prevention and cost savings, but can actually help in terms of prescription contraceptives for other health conditions like abnormal uterine bleeding and endometriosis, precancer of the uterus, polycystic ovary syndrome and the prevention of ovarian and uterine cancer.
Can the member talk about the importance of seeing those benefits and the cost savings to our system as well, in addition to the health of people who need that support?
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Mr. Speaker, often, it is not about throwing more money. There are ways of changing how we do things so that the end result of the investment is to supply and support more Canadians by investing less.
There are cost savings. We already talked about the cost savings with bulk purchase, which are in the billions of dollars, and there are more cost savings to be had in other areas that the member mentioned as well, such as contraception, etc.
Mark Gerretsen Liberal Kingston and the Islands, ON
Mr. Speaker, I find it funny that the Conservatives were laughing when the member said that we are investing while they are spending. They laugh as though it is some kind of joke. Let us not forget that Tony Clement had money to spend on the G8 and used it to build gazebos in his backyard. Conservatives' memory is so short-term.
The reality is that the member is absolutely correct. We are investing in Canadians. We are investing in the future. We are asking those who make the most to pay a little bit more in order to keep those investments going. Would the member agree with me on that?
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Mr. Speaker, my colleague is 100% correct. We are not investing in gazebos. We are investing in pharmacare, dental care, a disability benefit, a school food program, CCB and early learning.
We continue to support Canadians. That is why people want to move to Canada. They are proud of our great—
Second readingPharmacare ActGovernment Orders
Anju Dhillon Liberal Dorval—Lachine—LaSalle, QC
Mr. Speaker, I am grateful for the opportunity today to speak to Bill C‑64, an act respecting pharmacare.
This bill represents the next phase of our government's commitment to a national universal pharmacare program. It proposes the foundational principles of national universal pharmacare and our intent to work with provinces and territories to provide universal single-payer coverage for many contraceptives as well as diabetes medications.
This is an important step forward in improving health equity, affordability and outcomes, and it could save the health care system money in the long term.
Public health care in Canada was built on the promise that no matter where one lives or what one earns, one will always be able to get the medical care one needs. Despite this promise, Canada is the only country in the world with universal health care that does not provide universal coverage for prescription drugs.
When medicare was first introduced, prescription drugs outside of hospitals cost less and played a smaller role in health care. Today, prescription drugs are an essential part of our health, helping to control chronic conditions, treat temporary ones, and aid in overall health and well-being.
One area that has seen significant changes is diabetes treatment. Over 100 years ago, thanks to a Canadian team of researchers, Frederick Banting, Charles Herbert Best, John J. R. Macleod and James Bertram Collip, insulin was discovered.
Since this monumental scientific discovery, there have been several advancements in diabetes treatment, from the introduction of fully synthetic human insulin to glucose monitors and insulin pumps. These breakthroughs have immensely improved the quality of life for people who have to live with diabetes, enhancing self-esteem, increasing social participation and improving the overall health and well-being of these individuals.
They have also come with higher costs, creating affordability challenges for Canadians affected by diabetes.
Outside of hospital, prescription drug coverage comes from a mix of private insurance, out-of-pocket cash payments and various provincial programs. While the majority of Canadians have access to some form of public or private insurance, about 2.8%, or 1.1 million Canadians, do not have access to private or public drug coverage.
Although most Canadians have some form of drug coverage, this does not mean that those with insurance have equal access to the prescription drugs they need. The existing patchwork system of private and public drug plans leaves millions of Canadians under-insured, and that means their out-of-pocket prescription drug costs create a financial burden that leaves them struggling to afford an essential part of health care.
In 2021, Statistics Canada found that more than one in five adults in Canada reported not having the insurance they needed to cover their prescription drug costs. Being under-insured can take many forms, for example, Canadians may have high deductibles, resulting in significant out-of-pocket costs before their insurance coverage even kicks in. They may reach the maximum annual or lifetime coverage limits for their insurance and have to pay out-of-pocket, or they may have to make co-payments, which are often 20% of the drug's cost on private plans and sometimes more on public plans.
All provinces have drug coverage to protect Canadians from catastrophic drug costs, but deductibles under these plans can range from 0% to 20% of net family income. In many cases, Canadians will never reach the deductible, leaving them without any support for their drug costs. This variability across the country creates a postal code lottery.
Let us consider the advancements in diabetes treatments. For a working-age Canadian with no private insurance, out-of-pocket costs vary widely. In some parts of the country, out-of-pocket costs for people living with type 1 diabetes can be higher than $18,000 per year out-of-pocket; for type 2 diabetes, they can be higher than $10,000 per year in out-of-pocket expenses. Even those with private insurance can face high co-pays or exceed annual plan maximums, resulting in high out-of-pocket costs.
Even for cases in which an individual is not accessing devices that cost thousands of dollars, they can face significant out-of-pocket costs. For example, we can consider a woman in her mid-twenties who is working a minimum wage job. An IUD, one of the most effective forms of birth control, can cost up to $500 with no insurance. Even with private insurance, a co-pay of 20% would be $100. While IUDs can last from three to 12 years and save money over the long term, the high upfront cost can make them inaccessible.
Under-insurance can be a particular concern for young adults who age out of their parents' private insurance but who do not have their own form of private coverage. Lower-income Canadians also make up a disproportionate share of the under-insured. While most provinces have put in place drug coverage for those accessing social assistance benefits, a gap still exists. Many lower-income households that do not qualify for social assistance continue to struggle with out-of-pocket prescription drug costs.
Employment factors contribute to differences in insurance coverage. People with low-paying jobs, such as entry-level, contract and part-time positions, often report less adequate drug insurance coverage. This may even discourage people from accessing social assistance benefits or from applying for jobs, because once hired, they may lose their public drug insurance coverage. However, many entry-level and part-time jobs do not offer drug benefits. One study found that only 27% of part-time employees reported receiving medical benefit coverage.
Under-insurance can have serious consequences. Many Canadians with high out-of-pocket costs report foregoing essential needs, such as food and heat, or not adhering to their prescription due to drug costs. Statistics Canada found that, in 2021, close to one in five Canadians spent $500 or more out-of-pocket for their prescription medication, and almost one in 10 reported not adhering to their prescription medication because of costs. This includes delaying filling prescriptions or skipping doses to contain costs.
When people do not take their prescription drugs the way they are supposed to, their health can suffer. This results in serious consequences for the individual and their household, and unnecessary costs to the health care system in the long run, as patients are more likely to visit an emergency room or to be admitted to hospital when they do not receive consistent treatment. For example, the full cost of diabetes to the health care system in 2018 was estimated to be around $27 billion and could exceed $39 billion by 2028.
I think we can all agree that no Canadian should be put in a position where they must choose between the prescription drugs they need for their health and well-being and putting food on the table. This is unacceptable, and it is why we are continuing our work to improve accessibility, affordability and appropriate use of prescription drugs as we move forward with national universal pharmacare.
Simon-Pierre Savard-Tremblay Bloc Saint-Hyacinthe—Bagot, QC
Madam Speaker, I know that my colleague is a member from Quebec. The members of the National Assembly of Quebec unanimously requested a right to opt out of the pharmacare program with compensation. This means that we are not opposed to Canada having its own program. They say that as Quebeckers, we have the expertise and experience in social programs, we definitely do not want this program to be managed like the borders or the passports. We want the federal government to give money to Quebec and let Quebec manage its own affairs. If the others want to keep this program, we have no problem with that. We respect that.
Does my colleague, as a Quebecker, agree with the position of her national assembly?
Anju Dhillon Liberal Dorval—Lachine—LaSalle, QC
Madam Speaker, indeed, I am a proud Quebecker.
Our program is going to help millions of women, people from various backgrounds and people with diabetes. It is going to help everyone, all Canadians and all Quebeckers.
Lindsay Mathyssen NDP London—Fanshawe, ON
Madam Speaker, members have spoken a lot today about the money saved by individuals and the money saved by the system, which we could reinvest into health care. By providing free contraception, an individual is said to have a lifetime savings of up to $10,000, which is huge.
I would like to hear more about the larger issue. How can this piece of legislation itself, through contraception, empower women and those who menstruate?
Anju Dhillon Liberal Dorval—Lachine—LaSalle, QC
Madam Speaker, we have been talking a lot throughout our speeches, as have all our colleagues, about how we are investing in Canadians, and this is an investment. There is a saying that it is better to prevent than to cure. This is one of those times when we could prevent, for example, botched procedures or when women have to go out of their way to do things to protect themselves and to make sure there are not unwanted pregnancies. This national pharmacare program would help women and those who are gender diverse to be able not just to cure but also to prevent. It would make sure that they have optimal health and that their well-being and mental health are being taken care of at the same time.
Brenda Shanahan Liberal Châteauguay—Lacolle, QC
Madam Speaker, I listened to my colleague's remarks with great interest, particularly around the risk of people being uninsured. I am not sure everyone always realizes what that is and what it means until they get into trouble. I would like to hear her speak more on the different vulnerable population groups who could be working but who could be under-insured.
Anju Dhillon Liberal Dorval—Lachine—LaSalle, QC
Madam Speaker, it would be surprising to most Canadians to learn that there is a huge under-insurance problem in this country. Many people, we could say, slip through the cracks. As I mentioned in my speech, for those who are part-time workers, who end up getting phased out of their parents' health insurance plans and for those who are taking social assistance, there is always a gap between the two insurances. We need to make sure that everybody is covered and that every Canadian is treated equally. It is all about equality and equity. This is how those gaps can be prevented.
As my hon. colleague from London—Fanshawe mentioned, it is important for women to be able to take care of themselves. It should not matter what one's income bracket is. One should be able to access contraceptives and these services in order to create a more equal society.
Blaine Calkins Conservative Red Deer—Lacombe, AB
Madam Speaker, it is a pleasure for me today to speak to Bill C-64.
Before I go any further, I would like to let the Speaker know I will be splitting my time with my good friend and colleague from Souris—Moose Mountain.
The debate today is about Bill C-64, an act regarding pharmacare. At least everybody is being told that is what it is about. I would rather call it, I guess, the so-called pharmacare bill because I think that “the cost of keeping the Parliament going bill” is probably a name that has already been used.
This bill is very tepid. It is not a national pharmacare program. This is actually just a piece of legislation that is meant to check a box to keep a supply and confidence agreement in place.
To the NDP members, I cannot believe they actually think this is the pharmacare bill they envisioned. I have not met a program the NDP members would not want to nationalize, but they say it is a very sad day when one—
