Members of Parliament have headed back to work in the House of Commons. In anticipation of their return, pharmacare advocates like the Canadian Labour Congress, the Heart & Stroke Foundation and others issued a call urging government to put pharmacare at the top of their agenda.

During the fall election, pharmacare was a major campaign promise from the Liberals, the NDP and the Greens. The Advisory Council on the Implementation of National Pharmacare, led by Dr. Eric Hoskins, has provided a clear road map for the rollout of universal public drug coverage. And in Health Minister Hajdu’s mandate letter she was asked by the prime minister to “continue to implement national universal pharmacare.”

With all signs pointing to implementation in this mandate, why then are advocates and health-care providers all over the country still worried? The case should be a no-brainer: one-in-five Canadian households includes a family member who has not taken a prescription medicine due to cost during the past year, and with increasing rates of chronic disease, access to medicines will be critical to keep people healthy and out of hospital.

Universal public pharmacare will also be less expensive than our current wasteful systems: study after study, including the government’s own numbers, confirm that public pharmacare will save Canadians billions of dollars a year.

And yet, implementation feels uncertain. Minister Hajdu recently cited the federal-provincial-territorial negotiations required to replace the patchwork of current programs into one comprehensive national program as a source of complexity. (Some premiers have mused aloud as to whether pharmacare should even be a priority, given the current funding pressures provinces face with respect to existing programs like hospitals and transit. The difference between pharmacare and these other programs is that over time, national pharmacare will save individual Canadians and provincial governments billions of dollars.) The question is how to get federal and provincial politicians to take the first step together.

Clearly the next hurdle for pharmacare is not a health policy challenge, nor even an economic challenge. It’s a political one.

One possibility — the surest way to ensure pharmacare — would be for the federal government to take full financial responsibility for prescription drugs or for a substantial national formulary. As provinces and territories struggle with limited resources, uploading the cost of drugs would free up billions of dollars that could be used to solve problems like “hallway health care.”

Fully uploading the cost of pharmacare was actually proposed by premiers unanimously in 2004 and ultimately declined by then-Prime Minister Paul Martin. In Ontario alone, uploading the Ontario Drug Program could save Ontario nearly $4 billion per year — well in excess of the extra $1 billion infusion Ontario hospitals are requesting to deal with crowding.

While the Hoskins plan didn’t propose a full uploading of all those costs to the federal government, any amount could help cash-strapped provinces desperate to move people out of hospital hallways and invest in better community supports.

A second best alternative, and one that would help dodge tricky negotiations with the provinces — would be for the federal government to work on implementing the institutional building blocks of pharmacare, in hopes that this would generate greater momentum and public support.

This would involve setting up a national drug agency, developing a national formulary or list of drugs to be covered, and beginning to take a stronger position during drug price negotiations with pharmaceutical companies, in order to lower prices. All these steps are necessary but not sufficient to get us where we need to go.

Finally, alongside this infrastructure-building, the federal government could begin to implement universal pharmacare with a coalition of willing provinces and territories. The fact that medicare started in Saskatchewan and then spread across the country is of course a precedent.

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Given the political tensions between the federal government and many provincial governments, this may be a practical option, but it is it still second-best, leaving Canadians in the other provinces and territories behind.

With premiers desperate for solutions to their health care woes and supportive opposition parties, there has never been a better political opportunity to do the right thing for millions of Canadians. Let’s not take our eye off the ball.