I think we already have the institutional capacity to do an excellent job of running a drug plan. Let's face it: our provinces already do a lot of work on this, and we have world-renowned experts and agencies like CADTH. We now have really good capacity within the pCPA to do price negotiations.
As per the “Pharmacare 2020” report, the summary of our recommendations after many years of research, we envision this as a federal, provincial, and territorial cost-shared program with a national agency that is given a defined budget to manage and that manages a formulary to that budget on behalf of its FPT partners. Real money comes in from the federal government.
The current medicare deal is that the federal government cost-shares about 25% of the cost of medicare services. That might be a fair starting point for negotiating a cost-shared pharmacare program.
You establish a national formulary that becomes the standard benefit for all Canadians. If provinces want to top up beyond that with their own money that's independent of the national agency, that would be fine. Of course, if employers and unions want to negotiate gold-plated drug benefits for medicines that aren't cost-effective, they're welcome to do that as well.
We definitely see value in an evidence-based, budgeted, national program that at least manages the formulary that defines the standard benefit for all Canadians. We also see value in that formulary being reasonably comprehensive, as it is in comparable countries abroad.