Drug coverage in Canada is a patchwork; an inequitable inefficient and unsustainable patchwork with no coherence or purpose. Some people think that we can solve the problem by adding more patches, but the core of the problem is that it is a patchwork. For the working population, access to medicines is still organized as privileges offered by employers to their employees. Universal pharmacare would not only provide better access to needed prescription drugs, but also eliminate waste, ensure value-for-money and help improve drug safety and appropriate prescribing. Opponents fear that a universal pharmacare plan would ration drugs, and impede drug access for some patients. However, these claims misunderstand the reality of drug coverage, pricing and access. Opponents propose, instead, to “ fill the gap” of current drug coverage by implementing catastrophic coverage, which would serve commercial interests without maximizing health outcomes for the Canadian population. In spite of overwhelming evidence and consensus in the academic community in favour of universal pharmacare, the battle is far from over.

This commentary considers two editorial pieces, written by Hajizadeh and Edmonds, and Lewis, which address universal pharmacare in Canada. The pieces focus on the social inequities of the existing system and the challenges of successful implementation. After identifying the significant strengths of both articles, this commentary then delves into the reasons why universal pharmacare may not be the solution, and identifies numerous thorny issues that will complicate the implementation of such a publicly funded program. Both discussions point to the need for caution and transparency going forward.

Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have individually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada.

Canada's federal government intends to take steps to implement national pharmacare so that all Canadians have prescription drug coverage they need at an affordable price. Relatively limited funds have so far been pledged to support national pharmacare, which raises the question: what kind of program is envisioned? Since the government has already introduced regulations intended to reduce new drug prices drastically, national pharmacare seems likely to be a basic system designed to assist low-income Canadians with accessing primary care medicines. What Canadians actually need is a system that provides access to the medicine considered appropriate by the patient and their healthcare provider for the patient's specific condition. Equitable national pharmacare will not be achieved if patients are denied access to new high-cost specialized medicines that can improve or extend their lives, any more than if patients who cannot afford basic drugs are not helped.

The movement for a national pharmacare plan in Canada is growing, but at the same time the multinational pharmaceutical companies and their supporters are critical of such a move. The three major arguments that they make are that all that is needed is to “ fill in the gaps, ” ie, cover those who currently are uninsured or underinsured, that private drug plans are superior to public ones because they cover a larger number of drugs and that Canada cannot afford pharmacare. This commentary examines each of these arguments and makes the case that none of them is valid and that it is time to get on with implementing pharmacare.

Policy decisions about healthcare coverage in Canada and the United States in the 1960s placed two virtually identical systems on different evolutionary paths in the physician and hospital sectors. However, prescription drug coverage remained outside Canada’ s single-payer model, and employer-based coverage continued to be the norm for the workforce population, as is the case across the broad healthcare system in the United States. As a result the current debate about pharmacare in Canada mirrors in political microcosm the larger debate on universal health insurance among American Democrats. In each case the near-term prospects for a single-payer plan appear slim.

We are grateful for the very interesting and insightful commentaries written by Lexchin, 1 Tuohy, 2 Acri né e Lybecker, 3 Rawson, 4 and Gagnon5 in response to our editorial, "Universal Pharmacare in Canada: A Prescription for Equity in Healthcare. "6 In his commentary, Lexchin1 rightly highlights the numerous advantages to universal pharmacare in Canada, and that the main arguments against universal pharmacare (eg, pharmacare would be too costly, private insurance coverage would suffer, or only certain gaps in insurance coverage need filling) do not outweigh the strong arguments in favour of the regime. . .

One of the glaring gaps in Canada’ s universal healthcare system is the low level of public financing of prescription drugs-42. 7% of total spending in 2018. At the federal level there is renewed interest in moving towards universal coverage, supported by a recently commissioned report on how to achieve it. It will take superb political navigation to extract Canadian pharmaceutical policy and practice from the grasp of interests that profit handsomely from the status quo. This perspective suggests the conditions under which a genuinely fair, effective, and efficient pharmacare plan can emerge.

Introduction: The aim of this study was to investigate the fraction rate of Pro Taper Universal and Neoniti rotary files during the preparation of simulated severely-curved root canals.Materials & Methods: A total of 70 resin blocks with simulated severely-curved canals were randomly divided into two groups and prepared with Pro Taper Universal and Neoniti files. Each set of files was used for cleaning and shaping five canals; the files were sterilized after each application. Afterwards, the number of deformed and fractured files was recorded.Results: Deformation was reported in 11.4% and 19% of Pro Taper and Neoniti files, respectively (P>0.05). Also, fraction was found in 11.4% of Pro Taper files, while no fracture was reported in the Neoniti group; overall, no statistically significant difference was found between the groups (P>0.05).Conclusion: Based on the present findings, there was no significant difference between Pro Taper Universal and Neoniti files with respect to the incidence of deformation or fracture during the preparation of severely-curved canals.

Postmodernism represents skepticism toward metanarratives and universal ideologies that dominated the modernist era. The study focuses on three key postmodernist concepts - alternative assessment, process syllabi, and self-directed learning. Alternative assessment emphasizes evaluating the learning process over summative testing. Process syllabi focus on the learning experience rather than rigid outcomes. Self-directed learning enables student responsibility in setting learning goals and processes. This paper examined the effects of postmodernist educational concepts on improving Iranian EFL learners’ autonomy. A quasi-experimental pre-test/post-test design was utilized with 60 intermediate level Iranian EFL students divided into an experimental and control group (n=30 each). The experimental group received instruction utilizing the three postmodernist concepts over 14 weeks, while the control group received traditional modernist instruction. Autonomy was measured using a validated questionnaire before and after the intervention. The results showed the experimental group demonstrated significant increases in autonomy compared to the control group. Paired sample t-tests revealed significant differences between pre-test and post-test autonomy for the experimental group across all three postmodern concepts - alternative assessment, process syllabi, and self-directed learning. This suggests postmodernist concepts that decentralize instruction and emphasize student process over outcomes can enhance Iranian EFL learners’ self-direction and responsibility for language acquisition. The study implies EFL syllabus designers and instruction should transition to postmodern models centered on individualized assessment, flexible syllabi, and student-guided learning to boost autonomy. Further research can expand sample sizes and explore additional postmodernist concepts across diverse demographics.