In 2005, we wrote in this newspaper that momentum was building for national and universal Pharmacare, a policy change that was long overdue, having been recommended by previous Royal Commissions such as the Hall (1964) and Romanow (2002) commissions. We were perhaps premature in our diagnosis of the political moment, but our conclusions regarding the need for this program remains more relevant than ever.

Employment-based private coverage does not include those who have minimum wage, temporary or seasonal jobs. In fact, it is estimated that one third of Canadian workers do not get coverage from their employer. The gig economy almost guarantees that this percentage will only grow.

Canadians without private coverage fall into two groups — those without any coverage and those who quality for provincial government drug plans, safety nets that vary considerably in breadth and depth of coverage across the country.

Our disorganized system also means we are paying the pharmaceutical companies and retail drug stores far too much for drugs. As a consequence, we have among the highest drug prices in the world, something that we will never be able to fix without an effective public drug coverage system.

Now, here we are in 2020, after two major recent reports, one from the Parliamentary Standing Committee on Health and the second from the federal government’s Advisory Council on the Implementation of National Pharmacare. Both recommend that we establish universal, single-payer Pharmacare.

The experts have spoken. The need is clear. It’s time for the federal government to take action. We are encouraged that the prime minister has now repeatedly committed to universal Pharmacare and has in fact included this as a top objective in the mandate letter of the minister of health. This is, by far, the most concrete commitment made by any prime minister on this critical issue.

It is time for the leaders of the Liberal, NDP and Green parties to put their heads together and implement universal Pharmacare. Using the advisory council’s report, they can come up with the national criteria for the program in fairly short order. This should be followed by Trudeau convening a first ministers’ conference to present the federal criteria and begin to work out the details.

As in the case of medicare, the provinces can opt in (and receive federal funding) on their own time, within a reasonable maximum — perhaps two years. If a critical mass of provinces do not enter the scheme within the two years, the federal government should exercise the option of enacting its own program.

Contrary to hospital care, for example, prescription drugs are not within the primary, much less exclusive, jurisdiction of the provinces. The federal government has a firm constitutional foothold over pharmaceuticals in key areas such as safety, price regulation and patent protection.

By agreeing to opt into a pan-Canadian program with some common standards, including a national formulary, the provinces and territories would receive an agreed-upon transfer from the federal government. This would mean increased drug plan coverage for many provincial residents, much lower costs for existing provincial drug plans, and lower costs for employers, especially in Quebec, which mandates employer plans.

As with the Canada Pension Plan, the national framework should be flexible enough to allow for broadly similar provincial plans. If a critical number of provinces do not opt in, a purely federal program would be a constitutionally viable alternative.

Millions of Canadians who can’t afford the drugs they need, or who are underinsured, are counting on their federal government to do better.

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We can do better with this minority government supported by other parties with the national interest in mind. Remember: the Canada Pension Plan and medicare itself were both introduced in the 1960s by a minority government.

We can ensure that 2020 is the year that truly affordable drug coverage for all Canadians becomes the reality that the founders of medicare always envisaged.