National pharmacare program: Phase one details announced

The federal government has released new details on the first phase of the national pharmacare program. The legislation (Bill C-64) also provides for continuing work toward a national formulary, the development of a national bulk purchasing strategy, and support for a pan-Canadian strategy on the appropriate use of prescription medications.?

It was announced that the initial phase will include universal coverage for contraception and diabetes, including:

• oral contraceptives, copper and hormonal IUDs, injections, implants, rings, and morning-after pills
• insulin for Type 1 and Type 2 diabetes, Metformin, Sulfonylureas, SGLT-2 inhibitors, and insulin pumps

The impact to private plans will continue to evolve as more details emerge and dependent on adoption by the provinces. However, given that the national program is intended to provide universal, single-payer, first-dollar coverage, it is likely that plan sponsors will see some cost shift. Full impact for sponsors will depend on current plan design, demographics, and utilization.

However, we note that the category of initial drugs is limited and that the list of covered diabetes medications is restricted to first-line treatment. Most notably, it does not include GLP-1 inhibitors, such as Ozempic, which has been a recent significant driver of plans costs.

We will continue to monitor and provide additional details as they become available.?In the meantime, we invite you to connect with your Eckler consultant or reach out to us at Eckler.ca to learn how you can prepare for the potential impact on your benefits plan.

?You can learn more about this recent announcement at the links below:?

• Legislation: Bill C-64, An Act respecting pharmacare (Pharmacare Act)
• Backgrounder: Universal Access to Contraception
• News Release: Government of Canada Introduces Legislation for First Phase of National Universal Pharmacare
• Backgrounder: Universal Access to Diabetes Medications, and Diabetes Device Fund for Devices and Supplies

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