Health
National pharmacare – might it be a pig in a poke?
From the Macdonald Laurier Institute
By Nigel Rawson and John Adams for Inside Policy
No Canadian should have to choose between paying for medicines and paying for rent or food. National pharmacare has been proposed as a remedy to this situation.
“When will Canada have national pharmacare?” asks the author of a recent article in the British Medical Journal (BMJ). Better questions are: will Canadian pharmacare be the system many Canadians hope for? Or, might it turn out to be skimpy coverage akin to minimum wage laws?
In its 2024 budget document, the federal government proposed providing $1.5 billion over five years to support the launch of national pharmacare for “universal, single-payer coverage for a number of contraception and diabetes medications.” This has been hailed as a “big day for pharmacare” by some labour unions, patients and others, including the author of the BMJ article who said that national pharmacare should be expanded to cover all medication needs beginning with the most commonly-prescribed, clinically-important “essential medicines.”
In its budget, the government stated “coverage of contraceptives will mean that nine million women in Canada will have better access to contraception” and “improving access to diabetes medications will help improve the health of 3.7 million Canadians with diabetes.” Why not salute such affable, motherhood and apple pie, sentiments? The devil is in the details.
The plan does not cover new drugs for diabetes, such as Ozempic, Rybelsus, Wegovy, Mounjaro or Zepbound, all based on innovative GLP-1 agonists, where evidence is building for cardiovascular and weight loss benefits. This limited rollout seems based on cheap, older medicines, which can be less effective for some with diabetes.
The federal government has also consistently under-estimated the cost of national proposals such as pharmacare – not to mention other promises. In their 2019 election platform, the Liberals promised $6 billion for national pharmacare (the NDP promised $10 billion). Keen analysis shows that even these expansive amounts would be woefully inadequate to fund a full national pharmacare plan. This makes the $300 million a year actually proposed by the Liberals’ look like the skimpy window-dressing that it is.
National pharmacare, based on the most comprehensive existing public drug plan (Quebec’s), would cost much more. In 2017, using optimistic assumptions, the Parliamentary Budget Officer (PBO) estimated the cost for a national plan based on Quebec’s experience to be $19.3 billion a year. With more appropriate assumptions, the Canadian Health Policy Institute estimated $26.2 billion. In June 2019, the federal government’s own Advisory Council on the Implementation of National Pharmacare put the cost at $40 billion, while a few months later, the tax consulting company RSM Canada projected $48.3 to $52.5 billion per year. Five years later, costs no doubt have soared.
Even with these staggering cost a program based on matching Quebec’s drug plan at the national level would fail to provide anywhere near the level of coverage already provided to the almost two-thirds of Canadians who have private drug insurance, including many in unionized jobs. Are they willing to sacrifice their superior coverage, especially of innovative brand-name medicines, for a program covering only “essential medicines”? Put another way, are Canadians and their unions prepared to settle for the equivalent of a minimum wage or minimum benefits?
The PBO has estimated the cost of coverage of a range of contraceptives and diabetes medicines as $1.9 billion over five years, which is more than the $1.5 billion provided in the budget. However, this figure is based on an assumption that the new program would only cover Canadians who currently do not have public or private drug plan insurance, those who currently do not fill their prescriptions due to cost related reasons, and the out-of-pocket part of prescription costs for Canadians who have public or private drug plan coverage. This is major guesswork because existing public and private drug plans may see the new federal program as an opportunity to reduce their costs by requiring their beneficiaries to use the new program. If this occurs, the national pharmacare costs to the federal government, even for the limited role out of diabetes and contraceptives, would soar to an estimated $5.7 billion, according to the PBO.
Our governments are not known for accurate estimates of the costs of new programs. One has only to remember the Phoenix pay system and the ArriveCAN costs. In 2017, the Government of Ontario estimated $465 million per year to extend drug coverage to every resident under the age of 25 years. What happened? Introduced in 2018, prescriptions rose by 290% and drug expenditure increased to $839 million – almost double the guesstimate. In 2019, the provincial government back peddled and modified the program to cover only people not already insured by a private plan.
Although we believe governments should facilitate access to necessary medicines for Canadians who cannot afford their medicines, this does not require national pharmacare and a growing bureaucracy. Exempting lower-income Canadians from copayments and premiums required by provincial programs, as British Columbia has done, and removing the requirement to pay for all drugs up to a deductible would allow these Canadians access sooner, more simply, and more effectively.
Moreover, it isn’t just lower-income Canadians who want help with unmet medicine needs. Canadians who need access to drugs for diseases that are difficult to treat and can cost hundreds of thousands of dollars per year also require assistance. Few Canadians whether they have low, medium or high incomes can afford these prices without government or private insurance. Private insurers often refuse to cover these drugs.
The Liberals provided a separate $1.5 billion over three years for drugs for rare disorders, but no province or territory has signed a bilateral agreement with the federal government for these drugs and no patient has received benefit through this program. Even if they did, the $500 million per year would not go far towards the actual costs. There is at least a zero missing in the federal contribution, as the projected cost of public spending on rare disease medicines by 2025 is more than threefold what Ottawa has budgeted.
Expensive drugs for cancer and rare disorders are just as essential as basic medicines for cardiovascular diseases, diabetes, birth control, and many other common conditions. If a costly medicine will allow a person with a life-shortening disease to live longer or one with a disorder that will be severely disabling left untreated to have an improved quality of life and be a productive taxpayer, it too should be regarded as essential.
The Liberals and NDP are working to stampede the bill to introduce the pharmacare program (Bill C-64) through the legislative process. This includes inviting witnesses over the first long weekend of summer, when many Canadians are away, to appear before the parliamentary Standing Committee on Health three days later.
Too much is unknown about what will be covered (will newer drugs be covered or only older, cheaper medicines?), who will be eligible for coverage (all appropriate Canadians regardless of existing coverage or only those with no present coverage?), and what the real cost will be, including whether a new program focusing on older, cheaper drugs will deter drug developers from launching novel medicines for unmet needs in Canada.
This Bill as it stands is such a power grab that, if passed, the federal Health Minister never has to come back to Parliament for review, oversight or another tranche of legal authority, it would empower the Cabinet to make rules and regulations without parliamentary scrutiny.
A lot is at stake for Canadians, especially for patients and their doctors. Prescription medicines are of critical importance to treating many diseases. National pharmacare must not only allow low-income residents to access purported “essential medicines” but also ensure that patients who need specialized drugs, especially higher-cost innovative cell and genetic therapies that may be the only effective treatment for their disorder, are not ignored. Canadians should be careful what they wish for. They may receive less than they anticipate, and, in fact, many Canadians may be worse off despite the increase in public spending. Time to look under the hood and kick the tires.
Nigel Rawson is a senior fellow with the Macdonald-Laurier Institute.
John Adams is co-founder and CEO of Canadian PKU and Allied Disorders Inc., a senior fellow with the Macdonald-Laurier Institute and volunteer board chair of Best Medicines Coalition.
From LifeSiteNews
Placebo trials are critical for determining a new drug’s safety and identifying side effects, but vaccines have been exempt from the requirement for such safety testing until now.
All new vaccines will be required to undergo placebo-controlled safety trials by the order of Robert F. Kennedy Jr., head of the Department of Health and Human Services (HHS), in a break with longstanding establishment policy and triggering protests from mainstream media outlets.
HHS spokesman Andrew Nixon said that, according to the new policy, such safety trials for all “new vaccines” will be required for licensure, a “radical departure from past practices.”
Placebo trials allow researchers to identify adverse side effects from a drug, clarifying that symptoms are not due to other factors such as the disease the drug seeks to protect against. For this reason, placebo trials are “critical for determining the safety profile of the new drug,” as BioPharma Services has noted.
“Except for the COVID vaccine, none of the vaccines on the CDC’s childhood recommended schedule was tested against an inert placebo, meaning we know very little about the actual risk profiles of these products,” HHS said in a statement.
“HHS is now building surveillance systems that will accurately measure vaccine risks as well as benefits — because real science demands both transparency and accountability,” an HHS spokesperson told The Washington Post.
For years, Kennedy has criticized the fact that vaccines have been exempted from a placebo trial requirement in place for other medicines.
“A lot of the injuries that come from medication are autoimmune injuries and allergic injuries and neurodevelopmental injuries that have long diagnostic horizons or long incubation periods, so you can do the study and you will not see the injury for five years,” Kennedy said in a 2021 interview.
Last year, during a NewsNation Town Hall he highlighted the fact that not one of the 72 vaccine doses now mandated for U.S. children “has ever been subject to a pre-licensing, placebo-controlled trial.”
At the time, the host insisted that this was “not true.” Now that the mainstream media and medical establishment cannot dispute that this has been the case, outlets such as NPR and the BBC are criticizing placebo safety testing trials by claiming that this will allegedly limit access to vaccines and undermine confidence in them – as if access to vaccines takes precedence over whether they have been shown to be safe.
The Washington Post quoted Dorit Reiss, a professor at the University of California College of the Law, who accused the HHS of “Claiming vaccines have risks the data doesn’t show” and of “trying to overstate vaccine risks,” seemingly unaware of the absurdity of her criticism. If there is a lack of data for vaccine risks, it could be because there haven’t been placebo trials to produce such data.
Kennedy recently told Daily Wire host Michael Knowles that “everything is going to change” regarding the development of vaccines, for which much of the public has concern.
He pledged to “fix” the Centers for Disease Control’s current flawed VAERS (Vaccine Adverse Event Reporting System) online mechanism, which Kennedy noted vastly underreports vaccine adverse events.
Pointing out that vaccines are “the only product that’s exempt” from pre-licensing safety testing, Kennedy noted that the protocol has instead been to document injuries “afterward.”
However, “they have a system that doesn’t capture them. In fact, CDC’s own study of its own system said it captures fewer than 1% of vaccine injuries,” Kennedy said. “It’s worthless, and everybody agrees it’s worthless.”
“Why have we gone for 39 years and nobody’s fixed it?” he wondered, promising, “We’re gonna fix it.”
Mental Health
Headline that reads ‘Ontario must pay for surgery to give trans resident both penis and vagina: appeal court’ a sign of the times in Canada
From LifeSiteNews
Gender ideology so entrenched, surgical mutilation is no longer considered fringe
If you’d like a glimpse of what 10 years of progressive rule has done to Canada in a single sentence, I submit to you this April 24 headline: “Ontario must pay for surgery to give trans resident both penis and vagina: appeal court.”
Imagine reading a headline like that in, say, 2010. You’d wonder what country you were living in — that is, if you weren’t trying to figure out what you just read. But in Canada in 2025, this stuff isn’t fringe. It’s establishment.
The Ontario Court of Appeal, the province’s top court, issued a ruling this week stating that the province must pay for a “penile-sparing vaginoplasty” for a resident who identifies as transgender but does not identify “exclusively” as either male or female and thus would like to possess both a penis and a vagina.
According to the Post, “a three-judge panel of the Ontario Court of Appeal confirmed a lower court’s ruling that the novel phallus-preserving surgery qualifies as an insured service under the Ontario Health Insurance Plan.” In case you’re tempted to write this off as an aberration at the hands of a handful of activist judges, this ruling is the third unanimous decision in favor of the “patient,” identified in court records as “K.S.”
“K.S. is pleased with the Court of Appeal’s decision, which is now the third unanimous ruling confirming that her gender affirming surgery is covered under Ontario’s Health Insurance Act and its regulation,” K.S.’s lawyer, John McIntyre, told the Post. K.S., as it turns out, identifies as neither male nor female … but uses female pronouns:
The legal battle between K.S., whose sex at birth was male, dates to 2022, when the Ontario Health Insurance Plan (OHIP) refused her request to pay for the cost of surgery at a Texas clinic to construct a vagina while sparing the penis, a procedure this is not available in Ontario, or anywhere else in Canada. K.S. uses female pronouns but does not identify as either fully female or fully male.
Previously, saner generations would have no idea how to interpret the preceding paragraph, but gender ideology has made fools of us all. OHIP attempted to argue that “because the vaginoplasty would not be accompanied by a penectomy, the procedure isn’t one specifically listed in OHIP’s Schedule of Benefits and therefore shouldn’t be publicly funded” and also that the surgery is “experimental” in Ontario and thus can’t be covered.
But K.S., who has a male member but would also like a neo-vagina, appealed to the Health Services Appeal and Review Board, which overturned OHIP’s decision. OHIP appealed to the Divisional Court but lost; the latest appeal, heard November 26, was also rejected because a “penectomy,” the removal of the penis, was “neither recommended by K.S.’s health professionals nor desired by K.S.,” according to the court’s decision.
I wonder if the judges thought that they’d be ruling on whether a man who identifies as neither a man or a woman was entitled to obtain a vagina while retaining his penis when they were going to law school.
The court stated that K.S., who is in his early 30s, “has experienced significant gender dysphoria since her teenage years, as well as physical, mental and economic hardships to transition her gender expression to align with her gender identity.” Of course, K.S. isn’t “transgender,” per se — because he doesn’t identify as the opposite sex, even though he uses the pronouns of the opposite sex. He wants to be … both, somehow. And he wants the taxpayer to pay for it.
As the Post reported:
K.S.’s doctor submitted a request to OHIP for prior funding approval for the surgical creation of a vaginal cavity and external vulva. The request made it clear that K.S. wasn’t seeking a penectomy. In a letter accompanying the request, her doctor said that because K.S. is “not completely on the ‘feminine’ end of the spectrum” it was important for her to have a vagina while maintaining her penis, adding that the Crane Center for Transgender Surgery in Austin, Tx.,” has an excellent reputation” for gender-affirming surgery, “and especially with these more complicated procedures.”
The surgeries, depending on which are performed, range in cost “from US $10,000 to $70,000.” The court also ordered Ontario to pay K.S. $23,250 after dismissing OHIP’s appeal; the province has until June 23 to seek leave to the Supreme Court of Canada.
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