Public v private insurance coverage for new drugs in Canada, 2018-2023, 7th Edition


Public v private insurance coverage for new drugs in Canada, 2018-2023, 7th Edition

Brett J Skinner, PhD, Canadian Health Policy Institute (CHPI)

This paper is corporately authored and edited based on proprietary template models and methods that are intended to facilitate regular updates. The design and content are a cumulative reflection of the diverse contributions collectively attributable to the CHPI affiliated researchers who may have variously participated in updating each edition. Data sources, methods and editorial presentation may evolve from previous editions.

This study uses data from IQVIA Inc. The analysis, conclusions and opinions expressed in this paper do not necessarily reflect the views of the data supplier.

Canadian Health Policy Institute (CHPI) (2024). Public v private insurance coverage for new drugs in Canada, 2018-2023. Canadian Health Policy, APR 2024. ISSN 2562-9492

Canadian Health Policy Institute (CHPI) Inc. All rights reserved. Unauthorized reproduction or distribution of this article in whole or in part is strictly prohibited.

OPEN ACCESS to this article was sponsored by CHPI’s Canadian Access to Innovative Medicines (CA2IM) research program.


[This paper has been revised to reflect new data as of 22 APR 2024.]

About the Study

The study compares the availability and wait times for insured access to new medicines in public and private drug plans. It identifies causes of limited availability and excessive waits, and it recommends practical policy options.

Focus on New Medicines
Drug insurance should provide financial protection from unexpected and unaffordable costs of accessing necessary medicines. Many prescription drugs are priced low enough (relative to other household expenses) to be affordable as an out-of-pocket expense. New innovative medicines representing the latest treatment advances, first-in-class therapies, or targeted therapies for rare diseases can be expensive and unaffordable without insurance. Therefore, it is important to measure the quality of benefits provided under drug insurance plans according to the coverage of new medicines.

Policy Relevance
The parliamentary cooperation agreement between the federal Liberals and the NDP has revived proposals for a universal single-payer national pharmacare program. The federal government recently announced it would work with the provinces to fund universal prescription drug benefits for contraceptives and diabetes medications. It is the first step toward a national pharmacare program that will replace existing public and private drug plans. The limited scope of coverage in existing public drug plans is indicative of what Canadians can expect from national pharmacare. The results of this study forewarn that national pharmacare will reduce access to new medicines for Canadians currently covered under private plans.