Prescription drug insurance in Canada is provided by a mixture of government and private plans. Government plans offer coverage to about a quarter of the population comprising seniors, social assistance recipients, children and some other groups, while private plans cover over two-thirds of Canadians paid for by themselves or cost-shared with employers, unions or associations. Nevertheless, a significant proportion of Canadians have no insurance. This situation has led to inequalities in patient access to medicines. Nigel Rawson discusses the current federal government plans to introduce a universal pharma care program to overcome these issues, but he reckons that one of the challenges will be its cost.