As Canada navigates the evolving drug coverage landscape, private drug plans remain a cornerstone of access, innovation and economic growth.
Indeed, private drug plans are more than just a benefit for employees; they’re a critical driver for the Canadian health-care system and the economy, according to Joe Farago, executive director of market access and interim lead of government and stakeholder relations at Innovative Medicines Canada.
“Canada’s private drug system is one of the major reasons why most global pharmaceutical manufacturers bring drugs to Canada,” he said during a session at Benefits Canada’s 2025 Face to Face Drug Plan Management Forum.
“Although national pharmacare appears to be stalled under the current government, it’s still a long-term threat to the viability of private drug coverage because there’s legislation that indicates it’s intended to be funded via a single public payer.”
In addition, evolving U.S. drug pricing policies could impact Canada’s access to new drugs, said Farago, which may have significant implications on whether or when pharmaceutical companies will bring new drugs to Canada.
While Canadian private plans typically provide faster and broader access to new medications, he noted new drug assessment programs, product listing agreement negotiations and increasing use of prior authorization are slowing drug access through private plans.
According to Benefits Canada’s inaugural Drug Plan Opinion Survey, plan sponsors expect their members will be able to access new medications within six months of Health Canada approval. However, research from Innovative Medicines Canada shows that, on average, it actually takes 12 to 18 months for new specialty, oncology and rare disease drugs to be reimbursed by private plans.
Download Benefits Canada‘s inaugural Drug Plan Opinion Survey here.
New government programs, such as Ontario’s accelerated drug funding programs for cancer drugs and the Pan-Canadian Pharmaceutical Alliance’s early negotiation pathway, are reducing patient wait times by nine to 11 months for public drug reimbursement, said Farago. Although these innovations will enhance public access, he noted private plans must also find ways to streamline and accelerate the listing of new drugs so private payer coverage continues to be both competitive and valuable. He also suggested further efficiency could be achieved through electronic prior authorization processes, which currently take around five weeks to process.
“I think everybody in the room agrees with the significant importance of the private drug benefits system and that there’s an opportunity to collaborate to preserve its value.”
Read more coverage of the 2025 Face to Face Drug Plan Management Forum.