OTTAWA—The chair of the Liberal government’s pharmacare advisory council is suggesting any new system for drug coverage in Canada should be voluntary for provinces and territories.

In an interview with the Star on Friday, former Ontario health minister Eric Hoskins emphasized that no final decisions have been made on what sort of pharmacare system he will recommend to the government next spring. But whatever shape pharmacare takes, the system he ultimately recommends will likely be voluntary for provinces and territories, he said.

“It would probably need to be more of an opt-in approach, rather than something imposed,” Hoskins said, describing the mood amongst provincial health ministers as “cautious optimism” about Ottawa’s plans to address limited drug coverage and expensive medicine in Canada.

“At the end of the day,” he said, “we hope what we put forward in the recommendations would be well-received right across the country.”

Making pharmacare voluntary was a key demand to emerge from a summit of Canada’s premiers held in New Brunswick in July. The provincial leaders said in a joint communiqué that provinces should also retain responsibility for the “design and delivery” of public drug coverage in their jurisdictions, and that Ottawa must provide “long-term, adequate, secure (and) flexible” pharmacare funding.

Last spring, in its 2018 budget, the Trudeau government announced it would explore creating a national pharmacare program to ensure Canadians have access to the prescription medicine they need. The government appointed Hoskins, a long-time advocate for a national drug coverage plan, to chair a six-member advisory panel tasked with studying different ways to deliver pharmacare and report back with recommendations within a year.

The House of Commons health committee has already called for the creation of a universal pharmacare system, where prescription drugs dispensed outside of hospitals are covered under public health care. The NDP, meanwhile, is accusing the Liberals of dragging their feet with Hoskins’s ongoing study of the issue, and wants the government to immediately start implementing universal pharmacare across Canada.

Last year, the Parliamentary Budget Office estimated a national pharmacare program would cost the federal government $22.6 billion by 2020-21.

Hoskins said Friday that every provincial health minister he has spoken with — including Ontario’s Christine Elliott — has been open to discussions about pharmacare. Any caution he’s hearing stems from the uncertainty around how the proposed system will work and how much it would cost, he said.

“I’m not going to gloss over the reality that a lot of this comes down to how this is going to get paid for,” Hoskins said. “I think it’s a natural conversation to have, where health ministers and finance ministers are feeling the pressure of wanting to deliver those medications, but also the cost behind it.”

A big factor, of course, will be what system for drug coverage the government chooses, Hoskins added. The government published a discussion paper in June that outlined some of the options Hoskins’s council is studying. These include a universal or “single-payer” system, first proposed in 1964, that would see everyone — even those already covered by private insurance — receive their medications under a government-funded plan. Another option the paper describes is a pharmacare plan that caps how much one person would pay for medicine and provides public coverage for drug costs above that limit.

The paper also outlines how Canada — the only country in the world with universal health care but no national drug coverage plan — currently has a “patchwork” of private and public pharmacare plans that don’t cover costs of medicine for all citizens. On average, each Canadian spends $926 per year on prescriptions, while the total spending on drugs in the country has skyrocketed from just $2.6 billion in 1985 to $33.8 billion last year, the paper says.

And while there may be disagreement on the best way to make medicine more affordable, the voluntary system that Hoskins predicts would mean that Ottawa could establish a form of pharmacare without buy-in from all the provinces. But he said the goal is to ensure participation across the country, so that access to medicine doesn’t vary from region to region.

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“We’re being asked to build the architecture of national pharmacare, and if we succeed it will be the biggest thing to happen to health care in this country in 50 years,” he said.

“This is nation-building.”