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The Trudeau government is edging closer to announcing its proposals for some kind of national drug insurance, but it’s still unknown what will be in the box labelled “Pharmacare” – or when it will be made public.

Last week, Ottawa’s advisory council on the implementation of national pharmacare released its interim report. At a mere eight pages, it was heavy on goals and thin on details. But the fact that Health Minister Ginette Petitpas Taylor and Finance Minister Bill Morneau were brought in to unveil it suggests that doing something big on pharmacare remains a Liberal priority.

The pharmacare advisory council’s final report, scheduled to land before the start of summer, could set up pharmacare as a key plank in the Liberal election platform. This fall could see Liberals, New Democrats and Conservatives pitching three sharply different visions to voters.

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The New Democrats want a pharmacare plan that looks and runs like medicare: comprehensive, government-funded and covering every Canadian. The Conservatives appear to favour sticking with the status quo, which is a drug-insurance system built around private insurers, while perhaps adding some targeted spending or tax breaks to bring down the number of Canadians without insurance.

And what do the Liberals want? That’s unclear.

Pharmacare, if it’s designed right, can help to address two major problems: the high and rising cost of drugs, which is squeezing governments, businesses and average Canadians; and the fact that as many as one in five Canadians lack drug insurance or are underinsured.

The first of those issues hits Canadians’ pocketbooks. In 2015, Canada’s per capita drug spending was 62 per cent higher than Britain’s and 136 per cent higher than Denmark’s. Canada has a poor record of setting prices for patent medicines, and of negotiating reasonable prices with pharmaceutical manufacturers.

The second issue hurts Canadians’ health. Studies suggest that about one in 10 Canadians sometimes can’t afford to take their medicines as prescribed.

When medicare was created in the 1960s, it was limited to covering the cost of visiting the doctor or going to the hospital. That has never changed. Canada remains a rare country with a universal health-care system that doesn’t include coverage for medicine dispensed outside of a hospital.

But since the 1960s, drugs have gone from the periphery of health care to its centre. In 2017, Canadians, insurers and governments spent $39.8-billion on pharmaceuticals. Drugs are now the second most expensive part of the health-care system, costing more each year than physician services.

The advisory council on pharmacare says its final report will recommend a national drug plan whose first principle will be to “ensure that all Canadian residents have access to prescription drugs based on medical need, without financial barriers to access.”

At the same time, it says that whatever system it proposes must deliver “value-for-money and the sustainability of prescription drug costs.”

In other words, the Liberals’ advisory committee is promising that its vision for pharmacare will be about making sure that every Canadian has drug insurance, while simultaneously preventing drug costs from breaking the bank.

As many as one in five Canadians may have inadequate or no drug insurance – but at least four out of five have insurance through their employer, or through government for groups such as seniors. The status quo is one of extensive but incomplete coverage, combined with poor cost control.

It’s possible for Canada to do a lot better on both of those scores. The question the Liberals will have to answer is whether they want to achieve universal coverage and lower drug costs by tinkering with the status quo – a system built around workplace plans offered by private insurers – or whether they’re going to aim for something more radical: namely, folding a whole universe of private drug insurance into medicare.

The latter would spell big changes for Canadians’ drug coverage, and it would only be possible after tough negotiations with the provinces.

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Pharmacare, whatever its variety, should aim to deliver a large and positive impact, while minimizing the side effects. Primum non nocere, goes an old medical aphorism that’s equally valid for politics. First, do no harm.

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