Smith announced the plan two years ago amid a national shortage of children's pain medication.

The province spent $70 million upfront to import five million bottles from Turkey-based Atabay Pharmaceuticals. But Alberta Health Services said Friday that Health Canada only approved 1.5 million bottles or $21 million worth of product.

That left a credit of $49 million.

Smith said this week the holdup is with Health Canada, which would have to approve a new suite of imports for the province to get its money's worth.

"We're waiting for Health Canada to work with AHS to identify the products, get the formulations, approve it, so that we're able to execute on it. Those things take time," Smith said in a year-end interview.

The premier said the province had to pay the $70 million upfront.

"They delivered a portion, and then the supply chains were restored, and we didn't need to fulfil it with the two products we'd initially ordered. So we have a credit on file with Atabay," said Smith.

The government and AHS declined to say what specific products they're seeking or when they might arrive.

"We want it to be delivered soon," said Smith.

Health Canada was unable to provide an immediate response.

AHS said the $70-million prepayment went to Edmonton-based medical supplier MHCare.

AHS did not address questions about how common it is to pay the entire contracting fee upfront with no apparent backstops to ensure fulfilment.

The costs of shipping, waste disposal and other administration tied to the deal were initially estimated to be an extra $10 million, but are yet to be finalized.

NDP Leader Naheed Nenshi said Smith's United Conservative government signed a deal that didn't follow normal procurement practices, and it backfired.

"The federal government had already signed a deal to get real Tylenol onto the shelves that arrived before the Turkish Tylenol," he told The Canadian Press.

"Albertans should be really angry, because we basically have given $80 million of taxpayers money that could have built schools."

Smith's government has stood by the decision to import the medication because, in late 2022, parents were desperate to find relief for their children at the height of the respiratory virus season.

The purchase has long been mired in difficulties. It was immediately beset by delays, as the province sought regulatory approvals and sorted out packaging and warning labels.

Pharmacists had to keep some of the medicine behind the counter to make sure customers who bought it were aware of the comparatively lower dosage.

Hospital neonatal units eventually stopped using it due to safety concerns.

The purchase also sparked questions about whether the province's relaxed ethics rules meant elected officials could be bought for the right price.

Multiple UCP cabinet ministers have said they accepted free tickets to Edmonton Oilers hockey games during the Stanley Cup playoffs.

They said they followed conflict-of-interest rules and denied any claims of disreputable behaviour.

Health Minister Adriana LaGrange has said AHS has identified what imported adult medications it could use, is in negotiations with Atabay and is working to get approval from Health Canada.

"Once those processes have been gone through, I will be happy to share exactly what those medications are," she said Thursday.

"My goal has always been to get products that we can use, get maximum value out of what's remaining on the books there, and that's what's happening."

This report by The Canadian Press was first published Dec. 6, 2024.