Momentum has been building for national pharmacare for the past year. The time has come — in fact it is long overdue — for federal, provincial and territorial leaders to sit down and work out a plan.

The need is great. Private coverage through employment plans do not include those who have minimum wage, temporary or seasonal jobs. Provincial safety net plans vary considerably in breadth and depth of coverage such that it makes a big difference whether you live in Atlantic Canada or the rest of Canada. And even with private or public coverage, many Canadians cannot afford the copayments and deductibles associated with their prescription medication costs. As a consequence, one in five Canadian households cannot afford the prescription medicines they need.

At the same time, we are paying far too much for drugs in Canada. Fragmented plans and the lack of a national formulary have led us to have the second highest prescription drug costs of all countries in the OECD.

Our new prime minister has said we should always strive to do better in Canada. As one of the only OECD nations with a universal health plan that does not include prescription drugs, the time has come for us to do better.

As we look with optimism to a new government in Ottawa, it is time to push hard for a version of pharmacare that will truly address our challenges. The incoming prime minister has said that he wants to sit down with the premiers very soon. However, it will be tempting for all governments to take the easy way out and do something that falls far short of universal pharmacare. For example, the C.D. Howe Institute recently recommended catastrophic coverage as a more feasible option.

In the Romanow Royal Commission report of 2002, we saw catastrophic coverage as a minimum, short-term step on the road to universal pharmacare for carefully selected medicines. Since then, almost all provinces have put catastrophic coverage in place. But the way in which catastrophic coverage has been implemented means that it only kicks in when costs exceed very significant levels. These plans do not help Canadians with many of the day-to-day drugs that manage chronic disease. While spending in many families will never clear the catastrophic bar, the health consequences for not taking the medicines are catastrophic — and the reality is that they are unaffordable for many.

Furthermore, in spite of our hopes that it could be a first step to real pharmacare, catastrophic coverage appears to be giving some governments the excuse not to do the hard work to make coverage truly universal for Canadians and affordable to taxpayers.

Some will argue in favour of the Quebec model of layering public coverage on private insurance plans. While this can achieve universal coverage it can never bring prices down in a way that is affordable to taxpayers. We would be stuck, almost indefinitely, with the highest prescription drug costs in the OECD.

Neither catastrophic drugs nor the Quebec model can deliver all four critical elements of a universal pharmacare program:

Universal access on the same terms and conditions to a core list of prescription medicines;

A single, national formulary based on clinical and cost effectiveness;

Price negotiations and bulk purchasing by a single payer from the pharmaceutical companies in order to reduce prices;

A quality agenda at the clinician-patient level to reduce over-prescribing and inappropriate prescribing of drugs.

In fact, some version of all these elements was included in the National Pharmaceuticals Strategy negotiated in the 2004 Health Accord, which was killed by the Harper Conservatives. It would be hard to imagine the Trudeau government would want to aim lower, particularly when some premiers and provincial health ministers have made it clear they want a truly national approach now.

If better is always possible, the time to do better is now. Nothing less than the health of Canadians and the sustainability of our systems is at stake.

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Roy Romanow was premier of Saskatchewan from 1991 until 2001 and sole chair of the Royal Commission on the Future of Health Care in Canada.