WINNIPEG — Health Minister Patty Hajdu says it’s “hard to say” at this point whether the Trudeau Liberals will be able to implement the national, universal pharmacare plan they promised on the campaign trail within their second mandate.

“Some of that will be predicted by, predicated by, the responses of the provinces and territories,” Hajdu told reporters on Tuesday afternoon, as federal ministers wrapped up a three-day cabinet retreat in Winnipeg, Man.

READ MORE: Trudeau details path ahead for his Liberal government as Winnipeg retreat wraps

While Hajdu maintains that a majority of Canadians want a pharmacare system in some form, she also conceded that she had heard “some reluctance” already from provincial and territorial governments — whose cooperation and willingness to opt-in to pharmacare is critical in order for the program to move forward.

“One of the things that I am considering is having an actual public timeline for Canadians,” Hajdu revealed. “So that they can see the complexity of this work, and also hold us as a federal government to account, and our provincial governments to account, in terms of the length of time that it may unfold over.”

Hajdu’s comments come at the tail end of a cabinet retreat that, in part, focused on how the feds can foster better relations with provinces like Alberta and Saskatchewan — where the Liberals lost all their seats in the fall vote. The retreat also saw Prime Minister Justin Trudeau and Deputy Prime Minister Chrystia Freeland liaise with Manitoba Premier Brian Pallister and Winnipeg Mayor Brian Bowman in sit-down meetings.

READ MORE: First day of cabinet retreat in Winnipeg puts focus on federal-provincial relationships

Those meetings bore some fruit, with Pallister telling reporters afterwards that he was reconsidering a homegrown carbon tax. But on pharmacare, Pallister is one of several provincial leaders who have displayed thin enthusiasm for the federal Liberals’ plans. At a meeting between all 13 of Canada’s premiers in Mississauga, Ont., in early December, Pallister urged Ottawa not to “start broadening healthcare when you can’t get it right now,” requesting sustained healthcare funding before attention turned to pharmacare.

John Horgan of B.C., Scott Moe of Saskatchewan, and François Legault of Quebec each noted to reporters that their provinces already had pharmacare programs of some kind, with Legault reporting that the collective of premiers had agreed to ask the federal government to include an opt-out clause in their national plan. Jason Kenney, Alberta’s premier, expressed agreement with Legault’s comments. And in the month before the premiers’ meeting, Ontario’s health minister told iPolitics she didn’t want a full pharmacare overhaul.

Collectively, the 13 premiers asked instead for Ottawa to turn its attention to the Canada Health Transfer, requesting an increase in funding by an annual escalator of 5.2 per cent. “We’d welcome dialogue with the federal government on standards across the country. These are important issues. But for us as a group today, we felt that the Canada Health Transfer was more than just symbolic,” Horgan said at the time.

READ MORE: Premiers offer tepid words about feds’ pharmacare pledge

Newfoundland and Labrador Premier Dwight Ball, meanwhile, was more on-side. “We could reduce our wait times. But if when they leave that physician’s office, or leave that health practitioner’s office, and they need medication — if they can’t afford it then, what is the point of reducing the wait-list?” he said in December.

At the moment, Canada’s provinces and territories offer a miscellany of drug plans, which exist alongside private insurance coverage. According to data shared by the Canadian Institute for Health Information, provincial or territorial drug programs spent $12.2 billion across Canada in 2018. Federal direct drug subsidy programs spent $830 million; social security funds spent $1.3 billion; and private insurance spent $12.3 billion. Households or individuals in Canada spent $13.1 billion in 2018 on drugs out-of-pocket, or $354 per capita.

Hajdu told reporters on Tuesday afternoon that she believed “a lot of work” could still be done, while the federal government “set up the stage for the eventual implementation” of national, universal pharmacare with the provinces and territories — citing “some agreement” at present on the need to develop a rare disease drug strategy for Canada.

“I’m a pragmatist. I always look for opportunities to work with the willing, and we’ll continue those conversations when we have our federal-provincial-territorial meeting later this year,” Hajdu said.

READ MORE: Elliott says Ontario doesn’t want full pharmacare overhaul, urges focus on drugs for rare diseases

A federal focus on rare diseases, and the drugs that can treat them, was requested by Ontario health minister Christine Elliott in an interview with iPolitics this fall. Elliott anticipates that the issue will only grow in Ontario, as new — and, at times, prohibitively expensive — medications move to market and become available to patients.

“It’s wonderful that these advancements are being made, because they save lives,” Elliott told iPolitics by telephone in late November, just a day after Hajdu was appointed as her counterpart in Ottawa. “But we are going to see more of them come on the market in the next few years. We will be looking to the federal government to help us with that.”