Carney vs. Pharmacare: When Liberal Nation-Building Hits the Pause Button

Carney does not have the electoral mandate to undermine the nascent pharmacare program.

Why did the Liberal government under Mark Carney become non-committal on completing the rollout of pharmacare—a crucial national social program introduced by the Liberals themselves just last year?

In October 2024 Canada took the first step in filling a longstanding void in the country’s universal healthcare system by passing the National Pharmacare Act. This milestone was historic as it culminated decades of advocacy by unions, medical associations, patient groups and various other civil society organizations in favour of pharmacare, and allowed Canada to finally drop the dubious distinction of being the only OECD country that didn’t include pharmaceutical coverage as part of its public healthcare system.

With passage of the legislation, the government could begin signing agreements with each province and territory to lock-in funding for diabetic and contraceptive drugs and devices, the first two areas targeted for universal coverage. Moreover, the law set a foundation for future comprehensive coverage by requiring a national formulary of essential medicines, mandating the Canadian Drug Agency to develop a bulk purchasing strategy, and establishing a committee of experts to advise on an expanded, universal, single-payer plan.

In February 2025, the Liberal government—then still led by Justin Trudeau—signed the first bilateral agreement with Manitoba. And in March, the government signed three more—with British Columbia, PEI, and Yukon—though by the time Yukon’s agreement was reached on March 20, Mark Carney had already been sworn in as Prime Minister following his Liberal leadership win. In a positive development, moreover, the Trudeau government excluded corporate representatives from the committee of experts called for in the legislation.

Big business and Conservative opposition

Unsurprisingly, drug companies and insurers were none too pleased. A national pharmacare plan would give the government tremendous negotiating power and lead to much lower drug prices in Canada, eating into the excessive profits big pharma has become accustomed to. Under the guise of caring for the needs of patients, they have prematurely— and almost comically—called for “pharmacare reform” even though the new national plan just became law and is still rolling out. And they’ve lobbied hard to stall the program, warning that a universal drug plan could reduce coverage, prevent access to newer medicines and hurt innovation.

Never mind that the Patented Medicine Prices Review Board has shown that the most popular antidiabetic drugs in Canada sell for as much as twice the price they are sold for in comparator countries (including the UK, France, Germany and Japan). And that, as a result, buying those drugs in Canada costs an extra $703 million.

Initially, corporate profiteers found an ally in Conservative leader Pierre Poilievre. His party voted against the pharmacare legislation and Poilievre stated, even months after the vote, that he would continue to “reject the radical plan”.

However, tantalized by the prospect of becoming Prime Minister and seeking the support of unionized workers, Poilievre changed his tune a few months later, during the run up to the April 2025 federal election. Despite his past hostility to the program—in fact, to virtually all new social programs—Poilievre said he would in fact keep the national pharmacare plan (along with the new dental care plan) were he to become prime minister.

Carney’s chicanery begins

After Carney announced his intention to enter the race to replace Justin Trudeau as Liberal leader in January 2025, he stayed largely silent on the future of dental care and pharmacare—both of which were still being fully rolled out. Of course, it was reasonable to assume that Carney would support both programs given that both had just been introduced by the preceding Liberal government itself, albeit with NDP pressure and support. Even so, his silence was curious and hard to ignore.

It was only on February 25, weeks after campaigning for the top job, that Carney clearly stated his support for pharmacare. At the English leaders’ debate that evening he unequivocally stated that he would “absolutely keep in place the progress that the government has made on crucial things such as on child care, on dental care and pharmacare because that helps those who are most vulnerable.”

He then mentioned pharmacare again in his victory speech on March 10, following the leadership vote. But this time, it was possible to detect a changing position:

So, when I am fighting for a strong economy, I am fighting for: Good Canadian health care for everyone; Strong support for our seniors, who built this country; Child care for young, hard-working families; Dental care and pharmacare for everyone who needs it. (emphases added)

Note the different way Carney spoke about health care versus pharmacare. Health care is “for everyone” as is of course the case with our universal system. But in Carney’s new formulation, pharmacare would perhaps not be for everyone. Instead, it would be “for everyone who needs it”—contrary to the clear language in the pharmacare law envisioning a universal, single payer system.

Not coincidentally, this fill-in-the-gaps approach Carney hinted at is precisely what pharmaceutical and insurance corporations want, as it helps avoid national, bulk purchasing of drugs that would dramatically drive prices down, as it has in other countries with national pharmacare plans. And it ensures insurance companies can continue selling plenty of profitable policies for private drug coverage.

In the words of Canada’s drug industry lobby, the government should “consider a pharmacare strategy that strengthens coverage for under-insured and uninsured Canadians” and “focus on filling coverage gaps, rather than making sweeping changes…”

This alternate approach is being pushed by a range of right wing pundits and think tanks. Clearly, big pharma and private insurers see Carney—who spent 13 years working at Goldman Sachs—as potentially receptive to their profit-centric pharmacare model.

Carney effectively signaled in that leadership victory speech that he would be willing to reopen the long debate on pharmacare that has prevented progress in Canada for decades. A debate that had just been democratically adjudicated through the passage of the National Pharmacare Act by parliament, following a comprehensive report and recommendations by the 2018-19 Advisory Council on the Implementation of National Pharmacare. It bears noting again that both the legislation and the advisory council were proposed by the Liberals themselves, and the council was led by Dr. Eric Hoskins, a former Ontario Liberal health minister.

In the face of this changing language, Carney’s campaign nonetheless continued to dangle the notion that progress on pharmacare was safe throughout the federal election campaign. In an official release on April 21, for example, his campaign stated that “Carney’s plan to unite, secure, protect, and build Canada, includes comprehensive measures to build and protect our health care system …. expanding on his previous commitment to protect dental care and pharmacare.”

Summer of shenanigans

This set the stage for the following months of prevarication, obfuscation and inaction. Since the bilateral agreement with Yukon was announced on March 20, the government has to date reached no further agreements with the remaining seven provinces and two territories. This means that existing bilateral agreements only ensure coverage for about 17% of Canada’s population.

When questioned about the lack of progress on pharmacare in July, Liberal health minister Marjorie Michel was non-committal and retorted that the government is new and the context had changed—effectively abandoning Carney’s promise to defend pharmacare. Carney’s spokesperson later added “​​that we wouldn’t cut or abolish any of the existing deals”, cynically implying that Carney’s campaign pledge to defend pharmacare was somehow compatible with freezing the program’s national rollout. This message was reiterated in August, when Michel’s office told media outlets that the government “will continue to protect the four signed pharmacare agreements.”

All this raised alarm among healthcare advocates across the country and led the Canadian Health Coalition, unions and other advocacy organizations to crank up the pressure on the Carney government: when Liberal MPs and staffers arrived in Edmonton for the party’s retreat on September 8, they were greeted by several large billboard ads featuring Carney’s face, calling on the Liberals to follow through on national pharmacare.

Then, at a press conference on September 11, Carney was pressed about the fate of pharmacare and finally reaffirmed support, effectively contradicting Minister Michel’s statements from the summer: “We are committed to keeping the project, that process going—pharmacare for diabetes and for birth control—and achieving the agreements with the outstanding provinces, if I can put it that way, as quickly and as equitably as possible.”

Given the Carney government’s ambiguous, confusing and shifting positions on pharmacare over the last six months, however, it remains to be seen if his government will in fact negotiate in good faith and ensure new agreements share the spirit of the four existing ones.

Carney’s right wing values

Given Carney’s campaign pledges and the very real need of Canadians for drug coverage, he should have concluded all outstanding pharmacare agreements by now. More to the point, he does not have the electoral mandate to undermine the nascent pharmacare program.

And given that a central part of the current pharmacare plan is the provision of contraceptive coverage, Carney is doing women a massive disservice—all the more astonishing when considering that he rode to victory in April’s election by winning substantial support from women voters.

The foot dragging on pharmacare also stands in sharp contrast to the government’s plans for increased military spending. In his 2025 official platform, Carney promised to boost spending to the “2% NATO target by 2030 at the latest”, but in June, not even two months after becoming elected, Carney announced that military spending would in fact hit the 2% target by March 2026—just about nine months later. This would require an additional $9.3 billion in spending. Meanwhile, the 2024 budget allocated a mere $1.5 billion over five years for national pharmacare.

While Carney has spoken repeatedly about nation-building, it appears he’s perfectly comfortable with ditching a key Liberal nation-building initiative in the realm of health and social services. If the current pharmacare plan survives, it will have been saved through public outcry, and perhaps the pressure tactics of the opposition NDP.

The last few months provide an important lesson and reminder for Canada’s progressive movement: Carney is, at his core, a neoliberal.

As he boasted earlier this year, Conservative Prime Minister Stephen Harper once tried to hire him as his Finance Minister. And although having spent years advocating for climate action from corporations and governments, Carney’s been quick to abandon green initiatives now that he’s leading the government.

Even so, he is constrained by his party’s minority status in parliament. This is critical and it means that despite having a shallow commitment to his (claimed) progressive values, he can still be successfully pressured to continue advancing initiatives like pharmacare.