ABSTRACT: Canada's universal healthcare system is widely praised for its principles of equity and accessibility, yet it notably excludes prescription drug coverage, leaving millions of Canadians without access to essential medications. As of 2022, the country operates within a fragmented system of over 100 public and 100,000 private drug plans, resulting in significant disparities in access, particularly among low-income individuals and marginalized populations. This article explores the current state of pharmacare in Canada, emphasizing the challenges of affordability, accessibility, and sustainability within the existing framework. It reviews proposed solutions, including universal single-payer pharmacare and incremental "fill-the-gaps" approaches, drawing comparisons to successful international systems such as those in Australia and the United Kingdom. Universal pharmacare is projected to yield significant benefits, including reduced drug expenditures, administrative efficiencies, and improved population health outcomes. Policy recommendations emphasize the establishment of a national formulary, centralized drug price negotiation, and robust federal-provincial collaboration to ensure consistent and equitable access. While implementation requires substantial investment and coordination, universal pharmacare is essential to achieving health equity and fulfilling Canada's commitment to comprehensive healthcare. The findings underscore the urgent need for reform to bridge gaps in medication access and create a more sustainable healthcare system for all Canadians.