Over to you, Prime Minister Justin Trudeau.

That's essentially what Ontario's premier, health minister and advocates of universal drug coverage are saying in the wake of the province's surprise announcement that it will cover the costs of prescriptions for youth 24 and under starting next year.

They are hoping the provincial move will galvanize Ottawa to commit to creating a pharmacare program for all Canadians.

Doris Grinspun, head of the Registered Nurses' Association of Ontario, said Thursday's provincial budget announcement "absolutely puts pressure" on the prime minister.

"Good things that are based on evidence spread," she said in an interview.

Ontario Premier Kathleen Wynne, Health Minister Eric Hoskins and Finance Minister Charles Sousa are patting themselves on the back for the move.

But the provincial Liberals aren't giving up on trying to convince Trudeau to introduce a national program.

"I will continue that important advocacy," Hoskins said at the legislature shortly after the provincial budget was tabled.

When asked what the message to Trudeau was, he said: "I think if there is one message today it's that this is possible."

"It's doable," Hoskins said, and Ontario will prove it.

Patchwork of provincial plans

Hoskins, who worked as a doctor before entering politics, said on Friday that he's been advocating for better access to medications since before he graduated from medical school in 1985.

Indeed, calls for universal drug coverage have been made, but not answered, since the 1960s. More than one royal commission on health care has recommended a national pharmacare program.

The push for pharmacare, however, is not without its opponents, with some arguing that a public drug program would be too costly and would limit access to new drugs. Opponents also argue that a public drug plan would force some Canadians to accept narrower coverage than they can already access privately. 

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Federal health minister Jane Philpott and Ontario's health minister Eric Hoskins met in January with their counterparts to discuss opioid addiction. Hoskins has lobbied Philpott to get on board with a national pharmacare program. (Darryl Dyck/Canadian Press)

Currently, outside of medications that are paid for while patients are in a hospital, drug coverage in Canada is a patchwork of public and private plans.

Public plans vary by province. Some only cover patients who meet certain age or income requirements or have certain medical conditions. Private insurance and benefit plans, paid for individually or through employers, come with deductibles, co-pays and limitations on what is covered.

Canadians can see a doctor without handing over cash or a credit card — but filling a prescription at a pharmacy written by that doctor can be a heavy financial burden.

Natalie Mehra, executive director of the Ontario Health Coalition, said in an interview that Ontario's expanded plan, estimated to cost $465 million per year, translates into pressure on Parliament Hill.

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How should we pay for prescription drugs? Advocates want to see a national drug plan, but opponents argue it would be too limited and too costly. (iStock)

"Pharmacare is right at the top of the public agenda in terms of health care reform," said Mehra, whose group advocates for a strong public health-care system.

"This hopefully will catapult it over the fence and really start to make it a living reality as we move into the next mandate of whichever federal government we have."

The current federal government has shown little interest in making pharmacare a priority.

That's in part why Ontario went ahead and acted, Hoskins explained Friday. He said after the last meeting of federal and provincial health ministers last fall it became clear Ottawa wasn't going to move on it anytime soon.

Federal focus on drug costs

Federal Health Minister Jane Philpott's office said she wasn't available for an interview Friday but pointed to comments she made to CBC's The Fifth Estate in January.

When asked in an interview with Mark Kelly why the Trudeau government won't commit to pursuing pharmacare, she answered that her priority is to first drive down the costs of prescription drugs.

"The step the prime minister has asked me to take during this mandate that I am absolutely, firmly committed to doing is getting those prices down," said Philpott.

"It would be irresponsible of me and irresponsible of our government to lock in a commitment to universal, public-paid pharmacare paying the prices now that we do," she also said.

Joel Lexchin, a physician and drug policy expert who helped author the Pharmacare 2020 report, which calls for a public drug plan, said Philpott's position is a "misplaced" one.

Creating a national pharmacare program would in itself bring drug prices down because of the bulk purchasing power that it would provide, he said.

Big change requires 'critical mass'

Lexchin isn't convinced Ontario's new program will pressure Trudeau's government to act.

Big provinces like British Columbia and Alberta would have to get on board, he said, and then the federal government might feel some heat.

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The country's health ministers met in January in Vancouver. Some supporters of universal drug coverage say Ontario alone cannot effectively pressure the federal government to introduce a national plan for all Canadians, more provinces have to follow Ontario's lead. (Darryl Dyck/Canadian Press)

The smaller Maritime provinces, which don't have the population base and budgets of larger provinces, might demand help from the federal government to match what other provinces are providing for their residents.

"You need some kind of critical mass to be able to do it," said Lexchin, a retired York University professor. "Ontario alone, despite its population, I don't think is enough."

Wynne said she is expecting to talk about Ontario's plan when she meets with her counterparts this summer.

Danielle Martin, a Toronto doctor and author who has advocated for universal drug coverage, said she hopes the move in Ontario is "the beginning of something much bigger."

Once in place on Jan.1, 2018, Ontario will be paying for drugs for young people under 25, and some seniors and low-income residents — but what about everybody else?

That's where the federal government could act, and at the very least fill in the gaps in coverage, Martin suggested.

The House of Commons health committee is studying the idea of national pharmacare and is expected to release a report with recommendations this fall.

Monika Dutt, chair of Canadian Doctors for Medicare, said she wants to see action, not just a report.

"We really need them to step in," Dutt, a family doctor in Nova Scotia, said. "It needs federal leadership."