evidence: Once the initial essential medicines list is in place, to ensure remaining patient needs are addressed as quickly as possible, and to ensure a fair approach to expanding the formulary, the Canadian drug agency would use the prioritization framework (described earlier) to determine the sequence for adding drugs to the formulary. Starting from the essential medicines list, the national formulary would be expanded step-by-step until the comprehensive formulary has been achieved. As noted, assessing a broad range of drugs for clinical and cost-effectiveness and negotiating good prices and coverage conditions with manufacturers will take time. Given that we have waited for national pharmacare for over 50 years, it makes sense to take a little longer to get it right. We believe the essential medicines list can be ready for January 1, 2022, and a comprehensive national formulary should be in place no later than January 1, 2027. [...] - Essential medicines: The essential medicines list is based on the Canadian CLEAN Meds list developed by researchers at St. Michael’s hospital in Toronto. As of April 8, 2019, it included 136 primary care medicines (i.e., identified at the ATC 5 level) considered as being the most important for meeting the health needs of Canadians. In 2017, these drugs represented about 27 per cent of system wide drug spending and 42 per cent of overall prescriptions.