Ottawa imposes conditions on Quebec to affect its drug insurance

Photo: Adrian Wyld The Canadian Press Federal Health Minister Mark Holland alluded to the fact that he does not recognize that health is a provincial responsibility since, according to his own interpretation, health is the responsibility of each person.

The federal government agrees to cover the bill for contraceptives and diabetes medications, but Quebec will have to come to an agreement with it if it wants this to involve improving its own insurance plan medications.

“In some sense, I guess it's a condition,” federal Health Minister Mark Holland agreed on the sidelines of his Thursday announcement.

He was referring to the fact that the federally imposed model will be universal, single-payer access to provide certain medications free of charge. These include contraceptive pills or emergency oral contraceptives, or medications to treat diabetes, including the supply of medical products such as syringes and blood sugar test strips for diabetics.

Bill C-64, tabled in federal Parliament on Thursday, indicates that the federal government must enter into an agreement with the provinces and territories that wish to include this program in their own drug insurance system, like the one that exists in Quebec.

“It is understood that any agreement [….] with a province or territory provides for first dollar coverage for patients,” specifies the text.

Skill question

Minister Mark Holland did not specify what would happen if no agreement was reached. Rather, he alluded to the fact that he does not recognize that health is a provincial jurisdiction, since, according to his own interpretation, “health is not a question of a province or a territory, of federal government, [it is] the responsibility of each person. […] It’s not a question of [competence], in my opinion.”

The minister assures that he is “flexible” in his approach and does not look for “a quibble”. He says he already has good, “productive” conversations with Quebec Health Minister Christian Dubé, with whom he shares the same goal of providing access to more medications.

Quebec has had a hybrid drug insurance plan (public-private) since 1997, which already covers drugs that Ottawa wants to distribute free of charge.

The office of Quebec Minister of Health, Christian Dubé, believes that obtaining financial compensation instead of the Ottawa program would allow it to “improve [its] regime and enhance [its] services, according to the needs of Quebecers.” . He reiterates that health constitutes a field of competence of Quebec.

The government of Quebec therefore intends to exercise its right to withdraw from the new federal regime and asks to receive its share of federal money “unconditionally”. Alberta does not want this program either. “The provinces should be able to withdraw,” also said the leader of the Conservative Party of Canada, Pierre Poilievre.

Contribution from the NDP

The announcement of this federal drug insurance was a condition for the survival of the “support and confidence” agreement between the Liberal Party of Canada and the New Democratic Party (NDP), which plans to keep Prime Minister Justin Trudeau's Liberals in power until fall 2025.

NDP Leader Jagmeet Singh praised the “historic” day on Thursday. He had threatened to tear up his agreement with the minority Liberals, before reaching an agreement at the last minute with the government on drug insurance.

The Bloc Québécois, for its part, criticized the idea during Thursday's question period, accusing the government and the NDP of “putting forward a drug insurance project that does not 'adds absolutely nothing to Quebec.'

Bill C-64 is presented as the first step towards a universal and national drug insurance plan. It allows Ottawa to purchase drugs in bulk, but does not quantify the cost of the products covered. The Liberals and NDP believe this program will save the public system money.

According to the federal government, one in four people with diabetes in Canada say they do not follow their treatment due to costs. Some 3.7 million diabetics should see their pharmacy bills reduced by Thursday's announcement, Ottawa says.

With Sandrine Vieira