Canada is the only country with a universal public healthcare system that does not include universal prescription drug coverage. The resulting patchwork — provincial programs, employer plans, and a residual population of 3.5 million residents with no drug coverage at all — has been documented as a cause of preventable hospitalisations, avoidable deaths, and significant economic inefficiency for four decades. The legislation that began to close that gap passed in 2024 after minority government negotiations that made pharmacare a confidence-and-supply condition.

The Canadian Drug Agency, newly empowered as a national formulary negotiator, used bulk purchasing leverage to secure prices an average of 27 percent below previous provincial rates for the first-phase formulary covering diabetes medications including insulin and metformin, and the full range of Health Canada approved contraceptives. Coverage is available to any Canadian resident without existing drug coverage, at no cost at point of dispensing from any participating pharmacy.

First-year uptake exceeded projections: 3.2 million residents registered for coverage, of whom 1.1 million had previously been rationing or skipping prescribed medications due to cost. Emergency department visits for diabetic ketoacidosis — a preventable crisis caused by insulin rationing — fell 22 percent nationally in the program's first year, a reduction the Canadian Medical Association attributes substantially to improved insulin adherence.

Phase two, covering cardiovascular medications and a psychiatric drug formulary, is legislatively committed for January 2026. Full universal coverage across all therapeutic categories is projected by 2030 under the current funding framework, subject to federal budget allocations.

"We always covered the hospital when people got sick," said Health Minister Mark Holland. "We just never covered the medicines that stopped them getting there."