2026 Health Care Outlook: Sandra Hanna, Neighbourhood Pharmacy Association of Canada

By Sandra Hanna, CEO of the Neighbourhood Pharmacy Association of Canada

One word to sum up Canada in 2025: economy. A close second: bipartisan. Together, both dynamics promise to work in community pharmacy’s favor.

In late 2024, the governing Liberal Party was fracturing, and a Conservative government seemed likely. Then Donald Trump was re-elected as U.S. president, and “tariff” was among the first words from the Oval Office. The Liberals made a dramatic comeback for one reason: Canadians wanted economist Mark Carney, the new Liberal leader, to sit across from Trump.

As noted by former federal cabinet member Jean Charest (now a member of the Council on Canada–U.S. Relations) at Neighbourhood Pharmacies’ annual EXPO event in May 2025, Carney held more federal-provincial-territorial (FPT) meetings during the first five months of his leadership than had occurred in the previous 20 years. And that was back in May. While formal collaboration continues to evolve, there is growing alignment around the imperative to strengthen Canada’s economic resilience — an objective that increasingly depends on effective coordination across federal, provincial and territorial governments.

Regulatory Reboot

That economic focus is translating into concrete regulatory priorities, particularly in health care, where pharmacy is increasingly recognized as a frontline destination for primary care.

Across Canada, pharmacies have rapidly expanded their scope of practice and the clinical services they deliver, from immunization and prescribing for common ailments to chronic disease management. Public confidence has kept pace. Recent public opinion research commissioned by Neighbourhood Pharmacies shows that 84% of Canadians are satisfied with expanded pharmacy services; one in three now views a pharmacy as their first destination for non-emergency, lower-acuity care; and seven in 10 want these services expanded further — a clear signal of both trust and unmet demand.

This progress has been enabled by sustained engagement with governments and regulators, demonstrating pharmacy’s ability to deliver safe, efficient care at scale. To fully operationalize this potential, regulatory frameworks must evolve alongside practice.

In that context, the FPT commitment to remove regulatory trade and labor-mobility barriers aligns with long-standing priorities for Neighbourhood Pharmacies to strengthen the pharmacy workforce — addressing supply through labor mobility and improved recognition of internationally trained pharmacists, while enabling teams through wider adoption of technologies such as e-prescribing and cross-jurisdictional central fill.

Pharmacare

National pharmacare remains on the agenda. In early 2025, four of 13 provinces and territories had signed on to the previous Liberal government’s first-dollar, single-payor pharmacare for drugs and devices in two categories (diabetes and contraception). Two provinces implemented in 2025. Neighbourhood Pharmacies worked closely with governments to share pharmacy and patient experiences, helping shape further rollout. With a new economic focus, it’s not too late to adopt a more feasible, less disruptive “fill-the-gaps” model that builds on the current public-private system.

PBM Playing Field

While pharmacy benefits managers are well known to U.S. readers, their role and regulation in Canada are only now under sustained scrutiny. Outside FPT matters, the Competition Bureau of Canada is expected to complete its abuse-of-dominance investigation of PBM Express Scripts Canada in early 2026. We hope its findings will validate calls for PBM regulation to prevent conflicts of interest and increase transparency.

In November 2025, Canada’s largest province moved ahead with “any willing provider” legislation for preferred pharmacy networks (PPNs), ending closed networks. It includes a standardized process for patients to opt out of PPNs and still receive coverage. The devil is in the details, and Neighbourhood Pharmacies will monitor closely how this unfolds.

Vision for Pharmacy

Before the elections of Carney or Trump, we made important headway in educating policy makers of the irreconcilability of a system that funds pharmacy’s growing contributions to health care primarily through markups associated with drug prices. Through consultations on national pharmacare and reforms to the Patented Medicine Prices Review Board, Neighbourhood Pharmacies’ consistent messaging on the unintended consequences of lower drug prices helped mitigate the economic impact on pharmacy.

Reasonable, equitable funding for services — separate from remuneration for the distribution of medications and medical devices — is necessary to give pharmacy operators the stability to scale services fully and sustainably. Only then will governments achieve the highest return on investment for taxpayers’ dollars, throughout the health care system.

Watershed moments may be coming in Nova Scotia and Quebec, where negotiations to renew agreements for expanded services are under way. Nova Scotia’s pharmacy-led primary care clinics may influence scope and fees for all pharmacies, while Quebec’s pending agreement will support a new scope of practice granting greater pharmacist autonomy.

Economy may be the pivotal word in Canada today. To that we say: Health care is the economy. Healthy people drive a healthy economy, and a thriving pharmacy sector is a necessary piece of that equation — as an economic driver, a critical employer and a vital health care provider.

Sandra Hanna is CEO of the Neighbourhood Pharmacy Association of Canada.