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National pharmacare is part of the election platforms of three federal political parties. The three plans differ but opinion polls show most Canadians do support a national insurance scheme for prescription drugs. Will election promises bring the benefits Canadians need?

The situation now is that all provincial public plans provide at least some coverage for seniors, low-income residents and persons with disabilities, and most also have means-tested programs to protect against catastrophic costs. However, coverage is subject to out-of-pocket copayments and deductibles that vary by province but must be paid before financial assistance can be claimed.

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Large differences also exist between provinces in how many medicines are covered. Quebec’s public plan, the most comprehensive, covers around 8,000 products, Ontario’s about 5,000, and other provinces fewer. The biggest differences across provinces are in the coverage of new drugs. Where they are covered, medicines are often limited to patients likely to benefit from them, which is only reasonable. But these criteria sometimes make little or no clinical sense to the specialist physicians who treat the patients and they are frequently so restrictive only one or two patients qualify.