Caroline Ishii | CUPE Staff
Sarah Ryan | CUPE Staff
Aline Patcheva | CUPE Staff

Nearly three million Canadians can’t fill their prescriptions because they can’t afford them. 

CUPE recognizes this isn’t good enough. Our prescription drug coverage shouldn’t be based on our job, work hours, or employer. It should be a universal right under our public health care system. 

Private insurance plans may exclude part-time and low-wage workers who are more likely to be Black, Indigenous, or racialized, thus perpetuating inequalities. And even with insurance coverage, workers can face steep deductibles and co-payments, making prescription drugs unaffordable. 

Universal pharmacare — which CUPE has been a strong advocate for — would mean everyone can access the medication they need to stay healthy.

On September 12, 2022, CUPE hosted a national webinar titled “Pharma profits or health justice? Mobilizing for universal pharmacare”. It was an opportunity for members and allies to learn more about the crucial need for an equitable and accessible public program. Participants heard from Elizabeth Kwan, senior researcher at the Canadian Labour Congress (CLC), Colleen Fuller, researcher, writer, activist and president of REACH Community Health Centre in Vancouver, Frédéric Brisson, CUPE Regional Vice-President, Quebec, and Don Davies, MP for Vancouver Kingsway and NDP Critic for Health. 

Why does pharmacare matter?

According to Elizabeth Kwan, the current insurance coverage of prescription drugs is very uneven across the country. It is based on where people live, where they work, and their income, not on their needs. This creates an unfair and unjust system.

“Inadequate prescription drug coverage affects everyone, in all provinces, at all income levels. But it especially affects low to middle-class families, young people, women, newcomers and racialized people,” said Kwan. “With private insurance, it is a situation of ‘you get what you pay for’. With universal public pharmacare, everyone will get accessible, affordable, and fair prescription drug coverage.”

Canada is the only developed country with universal health care that does not provide universal prescription drug coverage.

Considering that Canada is paying the fourth highest drug prices in the world, Kwan explained there are severe consequences for the public:

  • 1 in 4 households is affected by not being able to afford prescription drugs;
  • 7.5 million Canadians cannot afford medication because they don’t have insurance, or their medication is not covered by their insurance;
  • 1 million people cut back on food and heating to pay for medication.

The case for universal pharmacare is clear, and the support is broad. Since the 1960s, five separate national commissions have recommended that prescription drugs be included in Canada’s universal health care system. In a 2020 poll, 9 in 10 Canadians were supportive of a national pharmacare program.

The importance of public research, development and production of medicines and vaccines

Like Kwan, Colleen Fuller believes public investment is needed for public research, development, manufacturing and distribution of medicines and vaccines.

Fuller gave as an example the critical role that the Connaught Laboratories at the University of Toronto played in public health efforts to ensure a diphtheria vaccine was available and affordable to everyone. During the late 19th century, diphtheria posed a lethal threat to people in Canada and was the number one cause of death in children under 14. 

The Connaught Labs were established in 1914 to produce the diphtheria vaccine and other essential public health products, including rabies and smallpox vaccines. They produced the diphtheria vaccine as a public service for free distribution through provincial health immunization programs across Canada, laying the foundation for our public health immunization programs. By 1940, Toronto and Hamilton became the world’s first diphtheria-free cities.

For its part, the Canadian government saved money because the vaccine was made by a publicly-owned pharmaceutical company at low production costs, so they were not forced to buy the vaccine on the competitive international market. Subsequent global sales also helped to offset costs.

In 1921, Dr. Frederick Banting, a Canadian surgeon, and Charles Best, a medical student, discovered insulin at Connaught Labs as well. With this discovery, Canada contributed to the world of medicine, licensing manufacturers worldwide to produce insulin and using the royalties to fund scientific research in Canada. 

Fuller regrets that in 1984, the laboratories were privatized by the Conservatives. Back then, only 20% of the drugs and vaccines Canadians used were imported — today it is 85%. “We are paying a very high price for the lack of an infrastructure in Canada that would enable that public investment we are already making to benefit Canadians. Now, we are paying twice for the drugs we use — once at the development end, and once at the cash register,” she said.

Fuller recommends that we use our public investments for public research here in Canada, as well as for manufacturing and distribution. “Given the horrible experience with the COVID-19 vaccine and getting it into Canada in the first place, there has been more discussion about actually setting up a public manufacturer,” she explained.

Where are we now with pharmacare?

Elizabeth Kwan emphasized that we are living through unprecedented times of social and economic volatility in Canada, and globally. Wages falling behind and soaring inflation rates make affordability the number one solution to keeping our families healthy.

She described how the current state of our public health care system results from many years of government underfunding and staff shortages, and provinces and territories have not stepped up.

“Inflation and affordability issues keep us awake about how to keep ourselves and our families healthy,” said Kwan.

“In slowing down the economy, there will be more job losses, with people losing private drug coverage, and wages will continue to fall behind. This is not a great scenario,” CLC Senior Researcher Elizabeth Kwan added.

NDP Health Critic Don Davies agreed, explaining that Canada was able to achieve substantial social programs under two consecutive Liberal minority governments. “We are at a unique moment in history to fight and win universal pharmacare with the NDP leading the charge,” he said, referring to the supply and confidence agreement reached with the Liberal government in March 2022.

And while the NDP-introduced universal pharmacare legislation was defeated in February 2021, the NDP is using all their clout in this minority parliament to advocate for Canada’s health care system. The new agreement requires a Canada Pharmacare Act by the end of 2023, a national formulary of essential medicines, and a bulk buying program by June 2025. This will set the stage for affordable medication for all. 

Pharma profits or health justice?

Experts add a word of caution: not every pharmacare system would result in affordable medication for all. A fill-in-the-gaps or hybrid pharmacare plan like the one in Quebec would keep drug costs unaffordable for many. Indeed, maintaining the patchwork of private and public coverage keeps profits sky-high for insurance companies and big pharma. 

A hybrid plan would also entrench the confusing patchwork of more than 100 government-run drug insurance programs and more than 100,000 private drug insurance plans. 

Frédéric Brisson is very aware of these issues, having worked in the Quebec health care system for over 15 years. Between 2017 and 2021, as president of CUPE Quebec’s Provincial Council of Social Affairs, he helped negotiate the group insurance plan for nearly 40,000 public health care workers. According to him, the current hybrid pharmacare model in Quebec is not working, namely because it does not take into consideration each person’s ability to pay.

During the webinar, Brisson gave as an example an early childhood educator: “The vast majority of them work less than 20 hours per week at a salary that is between 22 and 26 dollars an hour, which represents approximately $1,450 per month clear in their pockets. A family insurance premium for a single parent can cost $280 per month. So, they have about $1,200 left in their pocket to pay for rent, gas, food, and the 20% of the drugs that we have to pay directly at the pharmacy… there is not much left,” he deplored.

With the current hybrid plan, drug costs in Quebec are some of the most expensive in the world.

In a recent CUPE poll, 77% of Quebecers said they would like the Quebec government to work with the Canadian government on a universal drug insurance plan and 80% believe such a plan would improve the health of all. In addition, 43% of those polled said that purchasing drugs has an impact on their household budget. For all these reasons, workers are organizing for a pharmacare program that puts people before profits. 

Meanwhile, right-wing pundits and corporate lobbyists are mobilizing against a truly universal pharmacare program. Big pharmaceutical and insurance companies are getting organized to protect their bottom lines. 

How can we fight back?

The labour movement in Canada has been working with allies on a pharmacare campaign for a few years now and Kwan urges CUPE members and activists to keep the momentum up and send a message to their Member of Parliament asking them to support a universal pharmacare program.

For Fuller and Brisson too, mobilization on this issue is critical. Unions play a huge role in the discussion, as do national and provincial health coalitions. Fuller adds that we need to encourage organizations, including community health centres and gig workers, to speak up and we must amplify their voices. 

We must combine forces in solidarity and act as a collective family to stand up to corporate greed and protect what is at stake — the safety and well-being of our loved ones and our communities. Together, we are stronger than ever, and the moment to fight back is now.

Learn from the experts, watch the replay of the Pharma profits or health justice? Mobilizing for universal pharmacare webinar on CUPE’s YouTube channel.