In 2024, the federal government passed legislation paving the way for the country’s first‑ever national pharmacare program — a historic milestone for health equity in Canada. Within a year, four provinces and territories signed agreements to deliver the first phase of pharmacare covering a range of diabetes and contraception medicines, with broader participation still needed today to ensure consistent access across Canada.
Heart & Stroke has long called for a national, universal pharmacare program. Read on to learn why pharmacare is so critical and what a strong, equitable program should deliver for people in Canada.
Q: Why do people in Canada need a national pharmacare program?
A: Canada is the only country in the world that has a universal healthcare system that does not have universal coverage for prescription drugs outside of hospitals. In fact, 7.5 million Canadians have insufficient or no coverage, that’s roughly 1 in 5 Canadians!
Lack of coverage is causing people to take risks with their health. Recent polling found nearly one-quarter of Canadians (22%) have reported splitting pills, skipping doses, or deciding not to fill or renew a prescription due to cost.
Q: Why is this issue so important for Heart & Stroke?
A: Diseases of the circulatory system are the leading causes of death for people in Canada. These diseases — including heart disease, stroke and vascular cognitive impairment—claim a life in Canada every five minutes. In 2024, Canadian pharmacies dispensed roughly 111 million prescriptions for medications to treat cardiovascular disease — making it the second highest disease category of prescription drugs.
Universal coverage of diabetes medications and contraceptives is a great first step in the implementation of the national pharmacare program. Diabetes is an important risk factor for heart disease and stroke. People with diabetes are more likely to develop heart disease at a younger age and three times more likely to die of it.
We need better prevention, treatment and management of heart disease and stroke. One of the ways we can achieve that is through improvements in access to medications by implementing a national, universal pharmacare program.
Q: Why is it important for people who are at risk of or who have experienced heart disease or stroke to have access to prescription medication?
A: Prescription drugs are an important component for treating and managing a lot of different heart and brain conditions. When used properly, they can save lives. But it isn’t just about people who have experienced something already. For example, medication for high blood pressure, which is the number one risk factor for stroke and a major risk factor for heart disease, can help prevent serious health problems later on.
And we know that 16% of Canadians have gone without medication for heart disease, cholesterol and high blood pressure due to cost.
Making sure that people have access to medication they need will lead to better health outcomes, less time spent in hospitals and decreased costs for health care.
Q: What is the issue with the current system? Don’t most people have prescription drug coverage already?
A: There are two critical problems with how things are right now. The first is a question of equitable access. The second is long-term sustainability.
On the matter of equitable access, the current system leaves a lot of gaps. Women, recent immigrants and racialized Canadians are more likely to be unemployed and less likely to have jobs that offer extended health benefits such as drug coverage.
Additionally, not taking medication because of cost is much more common among Indigenous people, people aged 18-44 years, people with lower health status and people with lower incomes.
Indigenous people also face numerous other challenges accessing prescription medications. Many face long delays or are even denied when they try to access drugs through the Non-Insured Health Benefits (NIHB) Program administered by the federal government.
Sustainability is also a critical issue. Heart & Stroke recommends the development and implementation of an equitable and universal pharmacare program that doesn’t just address access to medication but also helps to lower drug costs by increasing buying and negotiating power and reducing administration.
Canada’s healthcare system would also benefit because non-adherence to prescriptions — which would likely be reduced with a universal program — has been associated with significant increases in mortality, hospitalizations and costs.
It is estimated we lose up to 640 people in Canada every year to ischemic heart disease because they can’t afford their medication.
Q: What does the national pharmacare program mean for me right now? Will I get coverage for my medications?
A: Canada’s national pharmacare program is being rolled out in phases. The first phase focuses on essential medicines for diabetes and contraception, starting with provinces and territories that sign agreements with the federal government. If you live in a participating province or territory and take medications included in this first list, you may see new or improved coverage.
For many people, this first phase won’t yet cover all the medicines they need. But it’s an important first step toward a national, universal program designed to ensure everyone in Canada can access essential prescription drugs based on need and not ability to pay.
Q. What should the next phase of a universal national pharmacare program look like?
A: Heart & Stroke recommends that the federal government’s next phase of pharmacare include the expansion of the program in a fiscally prudent way. Specifically, this would entail the creation of a list of essential medicines, including prescription drugs for heart conditions and stroke. As a starting point this should include cardiovascular drugs commonly used by people living with diabetes - whose primary medications are covered under the initial phase of national pharmacare - such as blood pressure and cholesterol-lowering medications.
- See our position statement on improving access to medicine.