ENGLISH
• SUMMARY
SUMMARY
• Short Title
Short Title
• Interpretation
Interpretation
• Canadian Pharmaceutical Policy
Canadian Pharmaceutical Policy
• Purpose
Purpose
• Cash Contribution
Cash Contribution
• Criteria for Payment
Criteria for Payment
• Condition for Cash Contribution
Condition for Cash Contribution
• Defaults
Defaults
• Federal-Provincial Arrangement
Federal-Provincial Arrangement
• Regulations
Regulations
• Report to Parliament
Report to Parliament

SUMMARY

Short Title

Short title

1 This Act may be cited as the Canada Pharmacare Act.

Interpretation

Definitions

2 The following definitions apply in this Act.

cash contribution means a cash contribution that may be provided to a province under any other Act of Parliament.‍ (contribution pécuniaire)

drug insurance plan means, in relation to a province, a plan or plans established by the law of the province to provide for coverage of the cost of insured drugs and any related dispensing fees.‍ (régime d’assurance médicaments)

health care practitioner means a person who is entitled under the law of a province to prescribe drugs.‍ (professionnel de la santé)

insured drug means a prescription drug or any supplies prescribed by regulations made under paragraph 18(a).‍ (médicament assuré)

insured person means, in relation to a province, a resident of the province other than

• (a) a member of the Canadian Forces;

• (b) a person serving a term of imprisonment in a penitentiary as defined in Part I of the Corrections and Conditional Release Act; or

• (c) a person who has not completed the minimum period of residence or waiting period that may be required by the province for eligibility to its drug insurance plan.‍ (assuré)

Minister means the Minister of Health.‍ (ministre)

resident means, in relation to a province, a person who is ordinarily resident in the province.‍ (résident)

Canadian Pharmaceutical Policy

Policy

3 It is declared to be the policy of the Government of Canada to facilitate access to prescription drugs without financial or other barriers in order to protect and promote the physical and mental well-being of Canadians.

Purpose

Purpose of this Act

4 The purpose of this Act is to establish criteria and conditions that must be met before a cash contribution may be made in respect of public drug insurance plans.

Cash Contribution

Cash contribution

5 Subject to the other provisions of this Act, a cash contribution may be made to each province for each fiscal year.

Criteria for Payment

Criteria for payment

6 In order that a province qualify for a cash contribution for a fiscal year, its drug insurance plan must, throughout the fiscal year, satisfy the criteria described in sections 7 to 11 respecting the following matters:

• (a) public administration;

• (b) comprehensiveness;

• (c) universality;

• (d) portability; and

• (e) accessibility.

Public administration

7 (1) In order to satisfy the criterion respecting public administration,

• (a) the drug insurance plan of a province must be administered and operated on a non-profit basis by a public authority appointed or designated by the government of the province;

• (b) the public authority must be responsible to the government of the province for that administration and operation; and

• (c) the public authority must be subject to audit of its accounts and financial transactions by the authority that is charged by law with the audit of the province’s accounts.

Designation of agency permitted

(2) The criterion respecting public administration is met even if the public authority referred to in subsection (1) has the power to designate any agency

• (a) to receive on its behalf any amounts payable under the drug insurance plan of the province; or

• (b) to carry out on its behalf any responsibility in connection with the receipt or payment of accounts rendered for insured drugs, provided that it is a condition of the designation that all those accounts are subject to assessment and approval by the public authority and that the public authority must determine the amounts to be paid in respect of those accounts.

Comprehensiveness

8 In order to satisfy the criterion respecting comprehensiveness, a drug insurance plan must provide for full coverage of the cost of all insured drugs prescribed by a health care practitioner and of any related dispensing fees.

Universality

9 In order to satisfy the criterion respecting universality, a drug insurance plan must entitle every insured person of the province to be covered by the plan on uniform conditions.

Portability

10 In order to satisfy the criterion respecting portability, a drug insurance plan

• (a) must not impose any minimum period of residence or waiting period of more than three months before residents are covered by the plan;

• (b) must provide for and be administered and operated so as to provide for the payment of amounts for the cost of insured drugs provided to insured persons while they are temporarily absent from their province of residence on the basis that

  • (i) if the insured drugs are provided in Canada, payment for the drugs is at the rate that is approved by the drug insurance plan of the province in which the insured drugs are provided unless the provinces concerned agree to apportion the cost between them in a different manner, or

  • (ii) if the insured drugs are provided outside Canada, payment is made based on the amount that would have been covered under the drug insurance plan of the insured person’s province of residence for similar drugs prescribed in that province; and

• (c) must provide for and be administered and operated so as to provide for the payment, during any minimum period of residence or waiting period imposed by the drug insurance plan of another province, of the cost of insured drugs prescribed to persons who have ceased to be insured persons by reason of having become residents of that other province as though they had not ceased to be residents of the province.

Accessibility

11 In order to satisfy the criterion respecting accessibility, a drug insurance plan

• (a) must provide for insured drugs on uniform conditions and on a basis that does not directly or indirectly impede or prevent, by charges made to insured persons or otherwise, reasonable access to those drugs by insured persons; and

• (b) must provide for payment for insured drugs in accordance with a tariff or system of payment authorized by the law of the province.

Condition for Cash Contribution

Condition

12 In order that a province may qualify for a cash contribution, the government of the province must, at the times and in the manner prescribed by the regulations, provide the Minister with the prescribed information that the Minister may reasonably require for the purposes of this Act.

Defaults

Referral to Governor in Council

13 (1) If the Minister is of the opinion that a drug insurance plan does not satisfy all the criteria described in sections 7 to 11, or that a province has failed to comply with section 12, the Minister must, subject to subsection (4), refer the matter to the Governor in Council.

Conditions

(2) The Minister may refer the matter to the Governor in Council only if

• (a) the Minister has consulted with the minister responsible for health care in the province in accordance with subsection (3); and

• (b) the province has not given an undertaking satisfactory to the Minister to remedy the default within a period that the Minister considers reasonable.

Consultation process

(3) Before referring the matter to the Governor in Council, the Minister must

• (a) send a notice of concern with respect to any problem foreseen, by registered mail, to the minister responsible for health care in the province;

• (b) seek any additional information available from the province with respect to the problem through bilateral discussions and make a report to the province within 90 days after sending the notice of concern; and

• (c) if requested by the province, meet within a reasonable period of time to discuss the report.

When no consultation can be achieved

(4) The Minister may act without the consultation referred to in paragraph (2)‍(a) if the Minister is of the opinion that sufficient time has passed since reasonable efforts were made to achieve consultation and that consultation will not be achieved.

Order reducing or withholding contribution

14 (1) If, on the referral of a matter under section 13, the Governor in Council is of the opinion that a drug insurance plan does not satisfy all the criteria described in sections 7 to 11, or that a province has failed to comply with section 12, the Governor in Council may, by order,

• (a) direct that any cash contribution to that province for a fiscal year be reduced in respect of each default by an amount that the Governor in Council considers appropriate, given the gravity of the default; or

• (b) direct that the whole of any cash contribution to that province for a fiscal year be withheld.

Amending order

(2) The Governor in Council may, by order, repeal or amend any order made under subsection (1) if the Governor in Council is of the opinion that the repeal or amendment is warranted in the circumstances.

Notice of order

(3) A copy of each order made under this section, together with a statement of any findings on which the order was based, must be sent without delay by registered mail to the government of the province concerned, and the Minister must cause the order and statement to be tabled before each House of Parliament on any of the first 15 days on which that House is sitting after the order is made.

Commencement of order

(4) An order made under subsection (1) must not come into force earlier than 30 days after the day on which a copy of the order has been sent to the government of the province concerned.

Reimposition of reductions or withholdings

15 If a drug insurance plan continues to fail to satisfy all of the criteria described in sections 7 to 11, or if a province continues to fail to comply with section 12, the Minister must reimpose, for each succeeding fiscal year, any reduction or withholding of a cash contribution to the province under section 14 for as long as the Minister is of the opinion, after consultation with the minister responsible for health care in the province, that the default is continuing.

When reduction or withholding imposed

16 Any reduction or withholding of a cash contribution under section 14 or 15 may be imposed in the fiscal year in which the default that gave rise to the reduction or withholding occurred or in the following fiscal year.

Federal-Provincial Arrangement

Drug agency

17 The Minister may, with the approval of the Governor in Council, enter into an arrangement with one or more provincial governments to establish an independent drug agency, whose mandate is, among other things, to

• (a) assess the clinical effectiveness and the cost effectiveness of prescription drugs compared to other treatment options;

• (b) advise on which prescription drugs and supplies should be insured by a drug insurance plan;

• (c) negotiate prices and supply arrangements of prescription drugs with manufacturers;

• (d) provide advice to health care practitioners and patients on how best to use prescription drugs; and

• (e) using fact-based evidence, monitor the safety and clinical effectiveness of prescription drugs.

Regulations

Regulations – Governor in Council

18 The Governor in Council may make regulations for the administration of this Act and for carrying its purposes and provisions into effect, including regulations

• (a) prescribing the prescription drugs that are to be insured by a drug insurance plan and the supplies that are essential for the proper administration of those drugs; and

• (b) prescribing the information that the Minister may require under section 12 and the times at which and the manner in which that information must be provided.

Report to Parliament

Annual report by Minister

19 (1) As soon as feasible after the end of each fiscal year but no later than December 31 following the end of that fiscal year, the Minister must make a report respecting the administration and operation of this Act for that fiscal year, including all relevant information on the extent to which the drug insurance plans of the provinces have satisfied the criteria, and the provinces have satisfied the conditions, for payment of cash contributions under this Act.

Tabling in Parliament

(2) The Minister must cause the report to be tabled before each House of Parliament on any of the first 15 days on which that House is sitting after the report is completed.