The presence of pharmaceutical waste in the environment is an emerging concern. The challenges of achieving high levels of scientific certainty concerning its impacts has motivated jurisdictions to adopt medications return programs (MRPs) to safely manage the public’s post-consumer pharmaceuticals (i.e. unused/expired drugs). There are several variables for governments to consider when implementing MRPs, particularly when based on extended producer responsibility (EPR). This comparative policy analysis examined regulatory MRPs in British Columbia and Ontario as cases to compare and evaluate. It developed 12 criteria for an optimal MRP consistent with EPR practices, including key performance measures, and applied them to evaluate the British Columbia and Ontario programs. It then explored Ontario’s revised MRP, launched in 2013, to determine if the positive and negative indicators from British Columbia’s long-standing program have been incorporated, and analyzed if policy lesson-drawing or policy convergence occurred in practice.