Bill C-64

Pharmacare Act

An Act respecting pharmacare

This enactment sets out the principles that the Minister of Health is to consider when working towards the implementation of national universal pharmacare and obliges the Minister to make payments, in certain circumstances, in relation to the coverage of certain prescription drugs and related products. It also sets out certain powers and obligations of the Minister — including in relation to the preparation of a list to inform the development of a national formulary and in relation to the development of a national bulk purchasing strategy — and requires the Minister to publish a pan-Canadian strategy regarding the appropriate use of prescription drugs and related products. Finally, it provides for the establishment of a committee of experts to make certain recommendations.

Pharmacare Act

[Chandra Arya, Liberal, Nepean, ON]

Madam Speaker, I am going to share my time with the member for Kingston and the Islands.

Bill C-64, the pharmacare act, is a transformative shift in our national approach to health care. We are taking a decisive step towards not just improving health care but also fundamentally redefining what it means to be a part of this great nation.

Health care is a cornerstone of Canadian identity, rooted in the belief that access to medical care should be based on need, not ability to pay. However, until now, this promise has been incomplete, because it has not fully covered medications.

Bill C-64 would establish a framework towards national universal pharmacare in Canada for certain prescription drugs and related products, including free coverage for contraception and diabetes medication. This is more than policy; it is a new chapter in our social contract.

This comes after our Canadian dental care program. That program reduced the financial barrier to accessing oral health care services for up to nine million uninsured Canadian residents.

Let us consider the significance of this moment. Many of our citizens, particularly the chronically ill and the economically vulnerable, have had to choose between medication and other essentials of life. This choice, which no one should ever have to make, has led to deteriorating health conditions, increased hospitalizations and, tragically, premature deaths.

Bill C-64 would also mandate that the Canadian Drug Agency works towards the development of a national formulary, develop a national bulk purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications.

Several G7 countries have implemented national pharmacare programs that vary in structure but share the common goal of improving access to medications. In the United Kingdom, the National Health Service covers most prescription medications, with patients paying a fixed prescription charge or obtaining an exemption. It has made medications free for children, the elderly and low-income individuals.

France operates a co-payment system in which patients are reimbursed for a significant portion of their medication costs based on the medication's necessity and effectiveness. Some essential medications are covered at 100%.

Germany features a statutory health insurance system that covers the vast majority of the population. Prescriptions require a nominal co-pay that is capped annually.

Similarly, Italy's national health system provides medications at low or no cost, depending on the medication's classification and the patient's income level.

Japan has a system where patients pay a percentage of the costs for their prescriptions. This is adjusted based on income, age and chronic health status, ensuring that no one is denied access because of financial constraints.

These G7 countries demonstrate a commitment to ensuring that essential medications are affordable. This reduces the financial burden on individuals and promotes better health outcomes across the population.

The United States and Canada have distinct health care systems that reflect differing approaches to health care management and funding. The U.S. health care system is predominantly privatized; health insurance is primarily provided through private entities. It is supplemented by government programs, including Medicare and Medicaid, for specific groups such as the elderly and low-income individuals. This system often results in higher out-of-pocket costs for individuals, depending on their insurance plans.

In contrast, Canada's health care system is publicly funded. Funded through taxation, it provides universal coverage for all Canadian citizens and permanent residents. Health care services in Canada are delivered through a single-payer system, meaning that the government pays for care that is delivered by private entities. This model aims to ensure that access to health care does not depend on one's ability to pay.

While both systems aim to deliver high-quality medical care, the Canadian system is generally more focused on equitable access, whereas the U.S. system offers a wider range of provider choices and faster access to elective procedures, often at a higher cost to the consumer. The U.S. system also features higher health care spending per capita compared with Canada, which has managed to control costs more effectively through its single-payer system.

As a diabetic, I would like to touch on the transformative change that promises to reshape the lives of the more than 3.7 million Canadians living with diabetes.

Diabetes, a chronic and complex disease, poses one of the greatest health challenges in our nation, impacting an enormous swath of our population across every age, socio-economic status and community. The burden of diabetes is not only a personal struggle but also a national concern. The profound physical, emotional and financial strain of diabetes is well-documented. This disease, if not managed properly, can lead to devastating complications, such as blindness, kidney failure, heart disease and even amputations. However, despite the availability of effective treatments, a staggering one in four Canadians with diabetes has reported that, solely because of cost, they have not adhered to their prescribed medical regimen. This is not a failure in health management; it is a failure in our health policy.

The introduction of the pharmacare act is a beacon of hope. This legislation is a crucial step towards eliminating the financial barriers that too many Canadians face in accessing essential diabetes medications. By ensuring that no one is left out because they cannot afford their medicine, we would not only improve individual health outcomes but also enhance our nation's health security. The importance of this act for the diabetes community cannot be overstated. Improved access to necessary medications would mean better disease management and control, which would significantly reduce the risk of severe complications. This is a direct investment in the health of millions of people, and the ripple effects would be seen throughout our health care system. Fewer complications from diabetes mean reduced hospital admissions, fewer medical emergencies and a general decrease in the health care burden on our system. We are not just providing medication; we are restoring opportunities and enhancing the well-being of millions of Canadians.

I would say to all Canadians living with diabetes that this legislation is for them. It is a testament to our belief that, together, as a united nation, we can tackle the challenges of chronic disease with compassion and resolve. Let us move forward with the assurance that our government is committed to their health and well-being. Let us embrace this change, not just for those living with diabetes, but for us all, for a healthier, stronger Canada.

To conclude, Bill C-64 lays out our plan for universal, single-payer coverage for contraception and diabetes medications. Through our bilateral health agreements with the provinces and territories, the Canadian dental care plan and now pharmacare, we are delivering on the promise that every Canadian deserves better health care.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, one of the great failings of the Canadian medical system is that we stopped at the moment we brought in universal health care, which Canadians believe in and want, and did not go further in bringing forth the pharmacare every other G7 country has.

Considering what we are seeing now with right-wing provincial governments, such as Doug Ford leaving community after community in Ontario with ERs closed on the weekends and the fact that they will hire privatized nurses at huge costs while underfunding the public system, is the hon. member concerned that we are going to see the likes of premiers Danielle Smith, Scott Moe and Doug Ford try to kill a really important initiative to help Canadians? How will we prevent them from doing that?

[Chandra Arya, Liberal, Nepean, ON]

Madam Speaker, the hon. member is right that the health care system is not perfect today. A lot of challenges are being faced, and the responsibility lies with the provinces.

The federal government has taken enormous steps to improve the health care of the country as a whole. We have allocated $198 billion, mostly to the provinces and territories, to deliver better health care. My wish is that the provinces step up and shoulder their part of the responsibility to develop quality care for all residents.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Madam Speaker, I will follow up that question with some facts about Saskatchewan. Its provincial government is deeply engaged in assisting, as an example, its seniors get the medications they need if they do not have their own third party plan. My mother is a senior.

This program would not be sufficient and would be far more expensive than the care we have. There is a possibility that third party providers that exist now would throw up their hands, and no longer provide the kind of care that over 90% of Canadians are already receiving, to allow this program to exist in its stead. In challenging the provincial government in an area that is its responsibility and in which it is doing good work, is the member suggesting that maybe Canadians expect and fear this reality?

[Chandra Arya, Liberal, Nepean, ON]

Madam Speaker, health care is important for all Canadians. It is the responsibility of all levels of government to work together collaboratively so Canadians get the quality health care they deserve.

Unfortunately, certain provinces are not in a very collaborative mood when it comes to dealing with the federal government, which has taken enormous steps during the last several years to provide additional funding to the health care system.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Madam Speaker, I know my hon. colleague suffers from diabetes, so I am certainly interested in hearing his perspective as to why we are focusing on the two areas of diabetes and contraceptives at this point. Why are we seeing the prioritization of diabetes and contraceptives in this bill?

[Chandra Arya, Liberal, Nepean, ON]

Madam Speaker, there was a certain period of time in my life in Canada when I did not have any prescription coverage; therefore, as a diabetic myself, I understand personally how important it is that this sort of support is given to people who do not have coverage available to them.

As I mentioned in my speech, this is the first step towards dealing with that. We have to start somewhere. Diabetes affects a vast number of people. Coverage for contraceptives is available to about nine million Canadians, and diabetes coverage is available to about 3.7 million. This is a step towards a single universal pharmacare system in Canada.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, I am very pleased to stand today and speak in support of this bill to bring in the first stages of national pharmacare to this country. Pharmacare has figured as a commitment in the Liberal platform. I would go further and say that it is an extension, really, of an arc of social justice that began many decades ago with hospital insurance. Before we had medicare, we had hospital insurance. If someone went to the hospital they did not have to pay, but then they would have to pay if they went to see their physician. Then, of course, we brought in medicare.

On that score, I would like to come back to something that the member for Cumberland—Colchester said that made me think back to 50 or 60 years ago. He said, in reference to dental care, that the plan for dental care would result in the dentist focusing more on the relationship with the payer, the insurance companies, than on the relationship with the patient.

That was one of the main criticisms of medicare in 1970 when the federal and provincial governments were implementing medicare. At the time, many medical professionals, doctors, said it would not be good because it would bureaucratize their profession as they would have to deal with government bureaucracy and that would leave less time to deal with patients. In the final analysis, we saw that it was a more efficient system. Doctors know that they will get paid. They do not have to hire a bill collection agency to collect medical bills and so on. It is funny that we are going back to arguments that were raised 70 years ago when there was opposition, initially, to implementing medicare in this country.

I would like to go back, for a moment, to the pandemic, because I think it is important. The pandemic was a watershed moment in so many ways. I think it will take decades of analysis and doctoral theses, maybe, to really understand how the pandemic changed our world. However, the pandemic did something for public policy that I am not sure we think enough about. It showed us that we can deliver support to citizens in ways that we never thought possible. If one had asked the government before the pandemic to offer support directly to Canadians through the CRA, through payments based on attestation, one would have been shut down right away. The bureaucrats and politicians would have said that it was absolutely impossible.

We proved that it was possible in a crisis to bring financial support to Canadians in a very streamlined way, in a very direct way and in a very timely way. I think that gave confidence to government that it could deliver other services in a very efficient way. Dental care is one example of that. I would bet that if someone had said we could deliver dental care directly through dentists with an insurance company making payments to dental offices and so forth, people would have said we could not do that as lots of bureaucracy would be needed. However, the pandemic showed us that we can do things directly and efficiently.

That brings me to pharmacare and this initial building block of a national pharmacare system. We have heard the Conservatives raise the spectre of a national pharmacare system requiring immense amounts of bureaucracy, but we have learned from the past that these kinds of services with this kind of financial support can be delivered rather effectively.

Now, we know that provincial health care systems across this country are bogged down in bureaucracy. We have seen some of the tragic consequences of that, but when we are talking about the delivery of drugs, each province has a very efficient and effective pharmacy network that already liaises with governments and with private insurance companies, such that when one gets a prescription, the pharmacist already knows that one is covered by a private insurer, or if one is not covered by a private insurer, they know that one is covered by the government system. There is already a very efficient infrastructure in place to deliver national pharmacare with the help of the infrastructure set up within the provinces, so I do not believe this idea that national pharmacare is going to create a heavy burden of bureaucracy.

The member for Cumberland—Colchester talked about the so-called blue seal program that his party is putting forward as a way of recognizing credentials for foreign-trained doctors. Our government is already doing that. Taking away from the fact that it is already provincial jurisdiction to recognize credentials, we do not hear any objections from the other side about invading provincial jurisdiction when we talk about recognizing credentials. The recognition of credentials is, in fact, something that is done by provincial colleges of medical professionals. All of a sudden, the invasion of provincial jurisdiction does not seem to enter into the picture.

However, the point is that, if we want to do that kind of thing, we are still going to need some bureaucracy. We are going to have to have some government employees who are coordinating something. That is just the way it is in modern governments. Sometimes I fear that the Conservatives do not understand the realities of modern governments, but I will not get into all of that right now.

In terms of the role of the federal government when it comes to pharmaceutical products, let me go back to the CERB. It is conventional wisdom that it is the provincial governments that deliver social assistance in this country, yet during the pandemic I did not hear any provincial governments complaining that we were providing CERB to citizens in need. I did not hear it then. All of a sudden, it is back in the picture.

Back to pharmaceuticals, the federal government is deeply involved in the pharmaceutical industry. It does inspections of pharmaceutical companies. The Patented Medicine Prices Review Board has a role in determining the prices of pharmaceuticals. Health Canada is involved in approving drugs for safety and medical devices. This idea that there is this clean-cut distinction between the federal government and the provinces when it comes to those kinds of products is, I think, a bit of a stretch.

That being said, I am not in the government but I think I can speak on behalf of the government. The federal government is not seeking to manage more things. We have lots of responsibilities. If the provinces can do something well, why not? If the provinces can achieve the goals that we have set, based on what Canadians want, then why not? The federal government is not seeking to manage all aspects of pharmacare, but I think that we are responding to the wishes and priorities of Canadians in proposing this plan.

I would like to come back to another argument that was raised by the Conservatives in this debate. Somehow, in a kind of twisted logic, it was suggested that national pharmacare is going to cause inflation. I do not understand that, but I could be wrong. Maybe I have a blind spot and I do not see all of the logic of the argument, but how can providing free drugs to Canadians who need drugs fuel pharmaceutical price inflation?

Pharmacare is an affordability measure. The Conservatives claim to care so much about affordability, but every time we want to do something on affordability, whether child care, pharmacare or dental care, they vote against it. I do not think they care about affordability.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Madam Speaker, I have a couple of points on the things I have heard this morning.

Of course, the NDP is talking about cuts that were there during the Harper era. If one were to look at the amount of money from the budgets over the years, when the Liberals first took power, that was the first time that it had ever ducked below the 3% floor that was given. That statement is certainly one that they talk a lot about, but it is incorrect.

The other question I would like to ask the member has to do with the formularies that the provinces already have. In order to get drugs approved, we go through the federal system, but then it goes into the provinces and they make the decisions on how much they can afford to cover. This is different around the country.

I am wondering if the member is at least curious about what the consequences will be when that decision comes from the federal government versus the provinces, whose responsibility it is to deliver health care.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, the whole issue around pharmacoeconomics is very complex because governments look at the potential benefits of drug use versus the costs, and it becomes a budgetary and political decision. What we are doing with pharmacare is providing more funding so we can surmount these political and budgetary obstacles to providing Canadians with the drugs they need for free.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, I have been listening intently to my Conservative colleagues, who promise something and then oppose it. For example, they really pushed for the suicide hotline and then voted against it. They tried to cut off the funding for it. One wonders why they do these things.

I was noticing the Conservative deputy leader was a lobbyist for AbbVie. This is a pharmaceutical company that jacked up the price of medications for senior citizens by 470%. We know who the Conservatives work for. They are not there for seniors. They are not there for ordinary people. They are freaked out that, if people have access to medication and the Conservatives get into power, they are not going to be able to rip off seniors to benefit the lobbyists, who are pretty much running the national Conservative Party and certainly the deputy leader. This is why we have seen their complete unwillingness to take on grocery price hikes, because the member in Stornoway's boss is a Loblaws lobbyist.

I would like to ask the member what he thinks about a party that would go along with jacking up medication for senior citizens by 470% to benefit its friends.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, the first thing I would say is that I hope those individuals will not end up working in the health minister's office. That would be a tragedy, of course. However, what is important is that we have a lobbyist registration system and that lobbyist registration system ensures we have the kind of information the hon. member has taken good care to collate and to share with the House and with Canadians.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I am wondering if the member can expand on his comments regarding the recognition of credentials. The Conservatives are going around misleading Canadians by indicating that they have this grand blue seal program. It is as if they are going to form government and all the individuals who have credentials would get their credentials recognized. It is as if these individuals would just need to write a Conservative exam and miraculously they would be able to work in health care across Canada, across the provinces and so forth.

Would the member not agree that is exceptionally misleading to a very vulnerable component of our communities?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Madam Speaker, I agree. They are not just doing that with the blue seal program. They are doing it with climate change by suggesting there is some kind of magic bullet that does not cost anybody anything and we can magically get rid of greenhouse gas emissions. Yes, they need to be more forthcoming—

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

You guys can't even be honest with each other.