All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association. CMAJ Commentary © 2009 Canadian Medical Association or its licensors Online-1

The fact that 1 of the main treatment modalities in healthcare — prescription drugs used outside the hospital set-ting — remains outside the medicare envelope in 2009 perplexes many clinicians, academics and the general public. Canada has an overall public health care system, but the lack of coverage for prescription drugs is a gaping hole in the system with adverse consequences for many Canadians. Moreover, Canada lags behind many comparator nations in issues related to prescription access and affordability, the quality and safety of medication use, and the use of technologies such as e-prescribing that would help to improve the system (Table 1).1–3 The National Pharmaceuticals Strategy, part of the federal, provincial and territorial health accord signed in 2004,4 was an attempt for the participating governments to jointly develop and implement drug policy solutions. More specifically, the prime minister and premiers directed their health ministers to focus on 9 specific action items that dealt with issues related to acces