National Pharmacare Update: What You Need to Know in 2025

National Pharmacare Update: What You Need to Know in 2025

As of October 10, 2024, the Pharmacare Act has officially been passed into law, marking the beginning of a government-provided healthcare initiative in Canada. This significant shift aims to transition from broad private insurance coverage to a much narrower government program. However, the rollout of this initiative comes with notable limitations that Canadians must be prepared for.

What’s Covered?

The initial phase of the national Pharmacare program starts with coverage for contraceptives and diabetes medications. While this marks an important step towards universal pharmacare, the reality is that the coverage is far more limited than what Canadians currently receive through private plans.

For example, only about 15% of diabetic medications and supplies currently covered by private insurance will be included under the government program. This has raised concerns among patients and healthcare professionals alike about accessibility and affordability for those who require specialized treatments.

What This Means for You

The transition from private to public coverage is being phased in gradually, with ongoing announcements expected through November 2025. One of the most controversial aspects of the new law is that, as written, it does not allow for supplemental private insurance to cover non-covered medications. This means that if the government plan does not include a specific medication, there is no private insurance option to step in and provide additional support. That needs to change.

Why You Should Get Involved

With so many decisions yet to be finalized, 2025 is a crucial year for Canadians to voice their concerns and influence the direction of the Pharmacare program. Committees have been formed to determine additional aspects of coverage, but at this stage, newer specialty drugs are unlikely to be included.

We encourage everyone to visit protectmyplan.ca to send an email to your Member of Parliament, advocating for greater flexibility in the program. If you believe in the importance of supplemental private coverage, now is the time to speak up and ensure that all Canadians have access to the medications they need.

Stay Informed

The Benefit Guys will be closely monitoring the evolution of the Pharmacare program and providing updates as they become available. Last week we attended a National Pharmacare broadcast that had people involved with the plan design. We received all of the current information. There wasn't much new. For sure we were advised to get involved and get our clients involved in the evolution of the National Pharmacare Program. If you have questions about how these changes will impact you and your family, don’t hesitate to reach out to us for guidance.

Change is happening—make sure you’re informed and involved in shaping the future of healthcare in Canada.