Nine months after the Pharmacare Act (C-64) received Royal Assent on October 10, 2024 , just four provinces and territories have signed bilateral agreements with the federal government. Those agreements are valued at $928 million over four years starting in 2026.

The Pharmacare Act is meant to provide universal access to Diabetes medication and contraceptives, making those pharmaceuticals free at the point of access for people covered by public health insurance. In order to implement that vision, the federal government needs to sign funding agreements with the provinces, who are responsible for administering health plans.

Manitoba, British Columbia, Prince Edward Island and Yukon are participating in the federal program, covering nearly 7.5 million people. The remaining nine provinces and territories without agreements are passing up valuable federal health care funding—which could be providing free medication to residents paid for by the federal government.

With so few jurisdictions enrolled in pharmacare, four out of five Canadians are not benefiting from the program. The gap is leaving a patchwork of coverage across the country.

A person in Manitoba benefits from free contraception, saving them hundreds of dollars each year, while someone in Alberta has to shoulder this cost on their own. A resident of British Columbia has their diabetes medication covered publicly, but loses that benefit if they have to move to Ontario.

The Pharmacare Act stipulates that the program must be “guided by the Canada Health Act.” The Canada Health Act includes universality and portability as two of its five central principles, which cannot be fulfilled until all provinces join the landmark pharmacare program.