Targeted Pharmacare Reforms Could Deliver Access Without a $40 Billion Price Tag

September 18, 2025 – With 97 percent of Canadians already having access to some form of drug coverage, a new Conference Report by the C.D. Howe Institute finds that a fiscally responsible approach to universal pharmacare should focus on closing gaps in prescription drug coverage rather than replacing plans with a single-payer system.

In “Access and Affordability: Building Fiscally Responsible Pharmacare Systems,” workshop participants consisting of policymakers, industry leaders, and health experts found that first-dollar universal pharmacare – estimated to cost almost $40 billion annually – would be unsustainable within an already underfunded system and could disrupt coverage for the 27 million Canadians currently benefiting from private insurance. Instead, these healthcare stakeholders agreed on targeted reforms such as strengthening catastrophic coverage, expanding existing provincial programs to fill access gaps, or copying Quebec’s more financially stable mixed model style.

“The keys to a successful program revision are strong coordination with private insurers, clearer public communication, and better provincial integration,” said Rosalie Wyonch, workshop convenor. “While there was debate around the best path forward, participants agreed the reform must be fiscally responsible, collaborative, evidence-based, and, above all, ensure open access for Canadians.”

As the deadline for Canada Drug Agency’s procurement strategy approaches this fall, the report calls on the federal government to clarify its long-term intentions for pharmacare and to support reforms that strengthen – rather than replace – Canada’s mixed public-private model.

Read the Full Report

For more information, contact: Rosalie Wyonch, Associate Director of Research, C.D. Howe Institute; Raquel Schneider, Communications Officer, C.D. Howe Institute, 647-805-3918, rschneider@cdhowe.org.

The C.D. Howe Institute is an independent not-for-profit research institute whose mission is to raise living standards by fostering economically sound public policies. Widely considered to be Canada’s most influential think tank, the Institute is a trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based and subject to definitive expert review.

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