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

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I want to acknowledge that today is the fifth anniversary of the National Inquiry of Missing and Murdered Indigenous Women and Girls, Two-Spirit and Gender-Diverse People. We need to acknowledge today that the government is failing to address the genocide against indigenous people, and that is failing both indigenous people and all Canadians. I certainly hope that the government prioritizes those calls for justice, knowing that to date we have only achieved two of the 231 calls for justice.

Today we are here to speak about Bill C-64. Today is, as my leader, the member for Burnaby South mentioned, historic. It is not just historic because of pharmacare. I do want give a shout-out to the Edmonton Oilers, who are now going to the Stanley Cup finals as of yesterday. It was a very big day.

I also want to start by saying how grateful I am to our leader. Our leader, the member for Burnaby South, has been a strong advocate for pharmacare for years. Instead of just being an advocate, he rolled up his sleeves, got to work, worked with the Liberals and he forced the Liberals, against all their historic votes, to put this framework in place.

I am so grateful to be a New Democrat today. I am so grateful to work with such a strong leader. I am also extraordinarily grateful to all the advocates who have done so much for decades to move this forward.

I want to start by talking a little about one of my constituents, Pat. He came into my office, and he had a challenge. We are really proud of health care in Canada. Canadians should be proud of our public health care system. However, when Pat came into my office and talked to my team and I, he told us that he had been able to see a doctor and he had been referred to a specialist. The specialist was able to give him treatment. The problem was that the medication for his treatment cost $400, and he did not have that $400. While our health care system is a point of pride, thanks to the health care system that Tommy Douglas developed, Pat was able to get part way there, but he was unable to get the treatment that would actually help him. It was never supposed to be this way.

When Tommy Douglas envisioned our health care system, pharmacare was always supposed to be part of that system. We know that Canada is the only country that has a medicare program that does not include pharmacare. It does not make any sense that we will treat Canadians to a certain point, but that we will not get them over the finish line without access to medication.

Today is an opportunity to make pharmacare a reality for millions of Canadians and to lay the groundwork to create a fully universal pharmacare system for all Canadians. It is truly historic.

Pat is not alone. A few months ago, I sat and listened to Albertans share their challenges and experiences at a pharmacare round table in Edmonton. One after another, Edmontonians stood up and they talked about how the lack of prescription coverage had affected their lives, how they had to juggle their bills and how they had to worry about groceries, utilities and rent, on top of their prescriptions. They had to make choices about which of those things they can afford.

As members of Parliament, sitting in this place, every one of us has a health care plan that covers our medication. However, for so many Canadians who do not have that access, this is game-changing. This is the difference between paying their rent and taking care of their health at the same time.

It was not just lower-income Canadians who were speaking out for pharmacare. Business leaders and health care professionals were all speaking about how important pharmacare was for them and why they wanted the government to move fast on this.

I spoke to a paramedic who shared his experience providing emergency care and transportation to hospital for people who could not afford their prescriptions, people who would be doing well if they had taken their medications appropriately, if they had not thought about cutting their pills in half, if they had not thought about taking a pill every second day. Those decisions that people are making are impacting their health, which in the long run have large costs on our health care system as well.

Doctors are so frustrated that their patients are not getting better because they cannot afford the treatment. Small business owners, despite paying more than minimum wage, can not possibly pay their employees enough in order to afford their medications.

A couple months ago, I sent out a mailer on pharmacare, as we all do in this place. I wanted to know what people in Edmonton thought about pharmacare. The response from constituents in Edmonton Strathcona was overwhelming. Ninety three per cent of people indicated that they were in favour of a universal pharmacare program and only 5% indicated that they were unsure or opposed. This mirrors national polls that put support for implementing a national pharmacare program to provide equal access to prescription drugs for everyone in Canada at 87%.

Last year, an Alberta-wide poll found that 74% of Albertans supported universal pharmacare. As the president of the polling company noted, the overwhelming support in Alberta for a federal program like this was surprising. He said, “Getting three-quarters of a population to agree with any piece of public policy these days, it is a bit astounding. It's very popular in Alberta.” He added that approval of the idea largely crossed all demographics and all regions of the province. Canadians understand and they know that we must care for one another. We must take care of each other, and universal pharmacare is a promise to take care of each other.

This legislation is not the end point; it is just the beginning but a very important beginning. We need the bill to create the mechanism for a full-fledged universal pharmacare system that covers all Canadians. No matter how young or how old, no matter where they live and no matter how they make their living, all Canadians have the right to prescription drug coverage, and this legislation is critical in getting it for them. The legislation is always going to be critical, but, right now, with coverage for contraceptives and diabetes medication, these two classes of drugs would impact millions of Canadians.

For example, nearly four million Canadians are affected with diabetes, a disease that impacts every aspect of their lives. In my province of Alberta, individuals with diabetes have had to fight the provincial government repeatedly to ensure they get the care they need and deserve. The bill would means that people living with diabetes may finally be able to put those battles aside and finally have hope for their future. By treating diabetes with devices and supplies on the same terms as the prescription medication, this legislation would save diabetics hundreds, if not thousands, of dollars each year.

With regard to contraceptives, we know the impact of contraception on women across the country and how vitally important this is. Manpreet Gill, the president of the Edmonton Zone Medical Staff Association and associate professor in the division of General Clinical Medicine at the University of Alberta, has written about the importance of contraceptive coverage to health and especially health care in Alberta. Dr. Gill states:

The cost of hormonal therapy (including for birth control) and intrauterine devices (IUDs) is a barrier for Albertan women to receive medically necessary care....

It also perpetuates unfairness in the system, resulting in unplanned and unwanted pregnancies. Universally available contraception would reduce the number of abortions, reduce economic stress on young and poor women and improve child and maternal health. It is estimated that 40 per cent of pregnancies in Canada are unplanned and it seems obvious that those who cannot afford contraception cannot afford to have a child.

The current patchwork system in Alberta is blatantly unfair. First, it is obvious that birth-control costs are primarily borne by women while men bear no such equivalent costs....

Secondly, while it is true that private plans cover birth control, it is worth considering two facts that this reveals. One, birth control reduces the costs to a private health plan, that’s why it is offered, and two, those that most [have that] need [are unable to] access...it.

As a woman, as a mother and as a mother of a daughter, I want my daughter, and every daughter in our country, every daughter in this world, to have access to the entire range of reproductive health care, including contraceptives. A system that provides access to some, those who can afford care, while denying access to others is not a system that I can support. Reproductive health care is health care, period.

Finally, I want to thank all the advocates across Canada who have worked so hard and so long to create this legislation. I want to thank Chris and the powerful advocates at Friends of Medicare in Alberta, who have worked not months, not years, but decades for this universal pharmacare. I want to thank the Canadian Labour Congress, the Alberta Federation of Labour and all the labour leaders, organizers and members across Canada who have put the needs of all Canadians, regardless of union membership, at the forefront of their campaigns for pharmacare.

We are here today because of the hard work of so many Canadians and so many leaders in our country. I continue to be delighted and honoured to work with all those leaders to ensure we get this over the finish line.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, the Bloc Québécois appears not to be answering the question. A vast coalition of two million Quebeckers told the Bloc Québécois to vote in favour of Bill C-64. Its members are critical of Quebec's existing plan.

I am quoting them because it is important. I am referring to the Union des consommateurs, the Fédération interprofessionalle de la santé du Québec, the Centrale des syndicats démocratiques, the Confédération des syndicats nationaux and the Fédération des travailleurs et travailleuses du Québec, which, on behalf of two million Quebeckers, are calling on Bloc Québécois members, who are members for Quebec after all, to listen to them and take action by passing Bill C‑64, which the NDP introduced in Parliament.

Let us be clear. I am quoting a coalition that the Bloc Québécois seems unwilling to listen to.

We are asking the federal government not to give in to the provinces and territories that are asking for an unconditional right to opt out with full financial compensation.

This coalition is saying that we need to pass Bill C‑64 and we need these negotiations.

Why does the Bloc Québécois insist on blocking this bill and refuse to listen to Quebeckers who want it to pass?

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, as my colleague has clearly demonstrated, Bill C‑64 is much more the expression of an election agreement than of a bill. Why? That would be because a bill of this scope would have required prior coordination, at least with the nation that put a system in place 30 years ago.

Here in the House, the Quebec nation has been symbolically recognized on two occasions, but the moment that that has a legislative impact, it is out of the question. The National Assembly unanimously agreed that it wanted the right to opt out with full compensation to improve its plan. What is so hard to understand about that? My colleague clearly demonstrated that.

The worst part is that, in addition to the first phase of the bill, the government intends to implement something with no accountability. Has anyone ever seen a Canadian prime minister lose their seat in an election because of health care? It has never happened. Why? Because health care has never been their jurisdiction. In Quebec, however, governments have fallen over health care.

The government wants to meddle in the affairs of others, and with no political accountability, to boot. What does my colleague think about that?

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I am quite fond of the member, but she just said that we need to listen to Quebeckers.

However, as the Bloc Québécois members should know, the largest coalition in Quebec's history, namely two million people under the umbrella of all the central labour unions, the Centrale des syndicats du Québec, the Centrale des syndicats démocratiques, the Confédération des syndicats nationaux, the Fédération des travailleurs et travailleuses du Québec, the Union des consommateurs and all the allied groups around the Fédération de la santé et des services sociaux, is calling for us to pass this bill, Bill C‑64.

The coalition members have been very critical of the current program in Quebec, including the fact that there are user fees for the drugs and many people are not covered. There are a lot of problems with the current situation. This broad coalition that the Bloc Québécois seems to refuse to listen to, says the following:

We are asking the federal government not to give in to the provinces and territories, which are asking for an unconditional right to opt out with full financial compensation.

The coalition members want to have the NDP's public, universal pharmacare program.

I have a very simple question. Why is the Bloc Québécois refusing to listen to Quebeckers?

[Marilène Gill, Bloc, Manicouagan, QC]

Mr. Speaker, I have risen three times today because I was so eager to speak.

I am pleased to speak today at third reading of Bill C-64. We have been debating this bill for a long time. Clause-by-clause study took place last week, but we do need to wind up the debate at some point.

Before continuing with my speech, I would ask my colleagues to respect my right to speak and not talk over me.

First, to make things clear, if they are not already, the Bloc Québécois's position has not changed one iota: We are against Bill C-64.

I would like to remind my colleagues of the purpose of the bill. Obviously, a bill can have several different purposes, depending on which side we are on. Sometimes it may seem like a bill has a noble goal, but that may not be the case.

I would like to talk about something that is totally obvious to me but that people tend to forget when we get into these debates. Bill C‑64 addresses one of the 27 items in the agreement that the Liberals reached with the NDP in 2022 to stay in power by forming a sort of coalition with the NDP. This may have been in the NDP's best interests, although maybe it will want to argue that point.

I would like to remind the House of the wording of the second item in this agreement: “Continuing progress towards a universal national pharmacare program by passing a Canada Pharmacare Act by the end of 2023”.

They want to “continu[e] progress”. We often hear similar phrases in the House, phrases like continuing to move forward, continuing progress or continuing to do something. That is all very vague, in my opinion. I would imagine that pretty much anything we do is progress, even the bill we are currently discussing. Perhaps that covers the disagreement there was between the Liberals and the NDP on this issue.

As members know, the Liberals dragged their feet on introducing this bill. This bill was in the works for years. They were talking about it in 2022. It was introduced on February 29. They could not agree on the cost of the measure. Of course we would like to see a pharmacare act, but perhaps not at all costs, if my colleagues will pardon the pun.

This bill was introduced on February 29, at the very last minute, to save the agreement and to save the Liberals. I might add that it was also to save the NDP. I must say that I did not hold my breath at the time.

A moment ago, I talked about the purpose of the bill. I think that this bill was introduced purely for the purpose of garnering votes. It could have been introduced sooner, but there was an agreement. The NDP would not want to bring the government down. That is why I was not surprised when the bill was introduced this year, one year away from the election, just before the budget.

I also get the feeling that it may have been because the government is short on ideas. I have spoken many times about the government's lack of vision. It has been eight, almost nine, years since the government came to power. It will have been 10 years by the time the election comes around.

I have noticed that the House is copying the debates taking place south of the border. Take the debates over contraceptives and diabetes medication. It is not that I am not happy to see my colleagues across the aisle and next to me tackling the official opposition, to use a soccer term, here in the House over a woman's right to do what she wants with her own body. I was not unhappy about that. However, it is being done for the purpose of gaining votes. There is one party in the House that wants to limit women's rights. This may resonate with some people, even me, but it should not be done for that purpose alone.

In fact, maybe it was entirely arbitrary. The government did not know what to do, what to propose. It desperately wanted pharmacare, but it had no idea what it really wanted to do, so it thought about what could help it win votes. It figured that it could take certain debates from the U.S. bipartisan system and copy them here to pit the good guys against the bad guys.

In short, I am not saying that these billions of dollars that will be spent by the government are a form of pre-election advertising, but that is what it looks like. Again, Quebeckers and Canadians need to be aware of the partisan agenda hidden behind this bill. There is a hidden objective.

I think it takes a certain kind of courage to oppose a bill that seems virtuous. That is what we are being told: If we do not vote in favour of the bill, it is because we are against it. I, of course, am 100% in favour of a woman's right to choose and all methods of contraception. I am a member of the Bloc Québécois. I speak on behalf of Quebec. I am not against the provinces' positions. I do not mind if they decide that the federal government can interfere in their jurisdictions. That is their choice, and I respect it. At the same time, that is not what I want for Quebec. That is why the Bloc Québécois proposed the following amendment in committee:

Despite subsections (1) and (2), a province or territory may elect not to participate in national universal pharmacare, in which case that province or territory remains unconditionally entitled to receive payments in order to maintain the accessibility and affordability of the prescription drugs and related products already covered by its public pharmacare.

Our amendment concerns the ability to opt out with full compensation from the pharmacare program. It was not debated because we could not debate it in committee during clause-by-clause study of the bill. It was not rejected either. I would say that what happened is even worse: It was ruled inadmissible. I wish I could avoid talking about the reasons the committee chair ruled the amendment inadmissible, but I think it is important to go over them because this is just another clear demonstration of bad faith, in my opinion, and the federal government's disregard for the jurisdictions of the provinces and Quebec.

It was argued that the amendment required a royal recommendation, which is false. What we were told is that it will generate additional costs and that, since we are an opposition party, it requires a royal recommendation. I hate to say it, but that is absolutely false. The amendment did not require a royal recommendation, because the funds had already been committed by the government. The Bloc Québécois's amendment was therefore legitimate and admissible.

This is not the only time that government members have made arguments that do not hold water and that are merely a pretext to interfere in Quebec's jurisdiction. The government did the same thing in the case of Bill C-35, which deals with the child care program. As far as I am concerned, this is not only a sign of disrespect toward Quebec, it is basically an insult, because over the decades, Quebec has built a social safety net that is the envy of North America. We have pharmacare, as well as dental coverage for young people. We have free education and early childhood centres. We have made some huge social advances.

In this case, the federal government is digging in its heels and refusing to allow Quebec to opt out unconditionally with full compensation. As I see it, Ottawa is refusing to recognize Quebec's decades of leadership in this area. The same thing happened with child care centres and Bill C‑35. What is more, the federal government is doing all this without having jurisdiction over this area or having any expertise in care and social services. Quebec is being denied something we have every right to request by a government that lacks both expertise and jurisdiction. The government has no compunction about turning us down, but at the same time, it has to follow our example with a view to “continuing progress”, as they put it so eloquently. I have no problem with the federal government continuing progress, but I do not want this progress to come at Quebec's expense.

As I said before, Quebec already has a public pharmacare plan for part of the population that the government introduced nearly 30 years ago. I need to repeat this because I think some people have trouble hearing it. This is not the case with everyone, but in the House, it is true of nearly the majority. As far as Canada is concerned, it is trying to catch up. It is behind by 30 years, so now it is encroaching on our jurisdiction. It may be more. We also have a private plan offered by employers, to which workers contribute as well. No one in Quebec lacks pharmacare coverage. People need to stop spreading falsehoods.

The choice was made by Quebeckers. It was not Ottawa that made this choice, it was Quebec. Our plan is also paid for by Quebeckers. The federal government did not give a red cent for this plan. We know what is right for us. We do not need someone else to tell us. We are capable of taking care of ourselves. We do not need paternalistic Ottawa trying to manage a pharmacare plan in Quebec without expertise, without legitimacy and without experience.

I keep thinking that what the Bloc Québécois is asking from the federal government is simple and it makes sense. We are asking the federal government to take care of its own responsibilities, such as foreign affairs, defence and fisheries. It seems to me that the federal government has enough responsibilities. It has more than enough things to take care of.

Perhaps that is not sexy enough for the government. I should ask that question. Is that sexy enough for the government? Health and education are the two areas that affect people the most. Of course, health is a matter of major importance. We talk about the things we care about. If we are not alive, then nothing else matters, obviously. Health is important. These are the two budget items that are most important for Quebec.

The government knows that, for years now, its health transfers have been insufficient. They are shrinking down to nothing. It knows all that. If the government reduces the transfers, the burden will fall heavily on Quebec and the provinces. Who gets the blame when there is a shortage of care and services? Quebec and the provinces, obviously.

Jean Chrétien understood this well. He bragged to the G7 that all he had to do to balance the budget was reduce health transfers. He said that Canadians would look for someone to blame, but that they would not blame the federal government, because health is under Quebec's and the provinces' jurisdiction. They are the ones who would be cutting health care and education. For him, it was simple: Canadians would take it out on the provinces. The federal government would be able to achieve a balanced budget, and no one would hold anything against it. The provinces would pay the price, both literally and figuratively.

It always comes down to this, unfortunately, but as a separatist, I have no other choice. I am a separatist and I am pragmatic. It always comes down to the fiscal imbalance. The federal government collects more money than it needs to fulfill its responsibilities, while the provinces and Quebec are not collecting enough to manage their own jurisdictions. They are short of money, which gives the federal government an opening to spend money on things under Quebec's and the provinces' jursidiction.

It is unbelievable. It is like the federal government is stealing from the provinces and Quebec. It is strangling them. If they meet certain conditions, it will back off and let them breathe again.

We would not thank anyone who is strangling us for stopping. We understand that interference is always done with a purpose. I mentioned this earlier, but it is still the same thing with the government and its minions.

The federal government swoops in like a saviour, slapping its flag on cheques, which it tosses around like confetti, and the cavalry of government members run around, trumpets blaring, trying to solve the problems it created itself. In fact, the more I think about it, the more I like that image. It has definite educational value. However, although we may be laughing over it, it is a hard fact.

While the government is gaily running around, it has forgotten why it was elected. Perhaps it does not know. Perhaps it has forgotten. When a government has no vision, it may take a peek in the neighbour's yard, looking for direction.

Again, interfering in areas of provincial and Quebec jurisdiction has a purpose for them. In fact, the purpose is twofold in this case: one, to keep the government in power, and two, to prepare for the next election.

Until we gain independence, Quebeckers will have to fight to make sure this government respects us, respects our expertise and experience and gives us what is ours, meaning our money and, of course, control over our own jurisdictions. It will also have to respect the fact that we have our own pharmacare program.

Quebeckers are capable of discussing amongst ourselves, at home, and improving our pharmacare plan with our experts, based on our experience and our wishes. It is not up to the federal government to tell Quebeckers what to do. We refuse to let our own tax money be used against us and at our expense.

One way to respect us is to vote down Bill C‑64. I may be a member of the Bloc Québécois, but I am not the only one who says so. The Quebec National Assembly has said it too. Christian Dubé, Quebec's health minister, pointed it out the day before the bill was introduced. We do not want this bill. We do not want the federal government to encroach on areas of Quebec's jurisdiction. I would remind the House that the National Assembly alone speaks for all Quebeckers.

In closing, I would therefore like to let the voices of Quebeckers be heard through the unanimous demands of the National Assembly for compensation to be paid to Quebec. That is what the Bloc Québécois has asked for, because the Bloc Québécois speaks on behalf of Quebeckers. The motion unanimously adopted by the National Assembly on June 14, 2019, reads as follows:

THAT the National Assembly acknowledge the federal report recommending the establishment of a pan-Canadian pharmacare plan;

THAT it reaffirm the Government of Québec's exclusive jurisdiction over health;

THAT it also reaffirm that Québec has had its own general prescription insurance plan for 20 years;

THAT it indicate to the federal government that Québec refuses to adhere to a pan-Canadian pharmacare plan;

THAT it ask the Government of Québec to maintain its prescription drug insurance plan and that it demand full financial compensation from the federal government if a project for a pan-Canadian pharmacare plan is officially tabled.

That was back in 2019, so the Quebec government made its position clear quite some time ago. Today, I am still trying to be a voice for the National Assembly. I hoped that the federal government would respect Quebec's decision to refuse to join the federal plan, for example, in the motion put forward at the committee studying Bill C‑64. We respect the provinces that want to take part in the program set out in the bill, since coverage is rather inconsistent across Canada, but in Quebec, everyone is covered by a pharmacare program.

It is up to us to decide what we want to do next. It is not up to the federal government.

The House resumed consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the third time and passed.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Mr. Speaker, it is interesting how calling out the failures of the NDP not only offends New Democrats, but offends Liberal members of Parliament. It truly is telling of the level of absurdity that this place has descended into, when simply calling out the failures of this so-called confidence and supply agreement, this coalition, this poorly negotiated agreement that has propped up one of the most corrupt governments in Canadian history, that NDP and Liberal members would become so offended when we bring forward some things, including talking about the history of those parties. I will be happy to address some of the failures specific to the Liberal Party here in short order, for that member specifically, but it seems like that they do not want to hear those things because they are simply offended that somebody would dare question their pre-eminence.

I will get into the substance of Bill C-64 in just a moment, because the context of it is so important. The Liberals, backed up by the New Democrats, do not want an opposition in this place. That is why the Liberals bought off the NDP. That is why we see so often that the Bloc Québécois are quick to go with them. They want an audience, not an opposition. This is a sad state of affairs. This place has a long democratic tradition, where we should be able to discuss the affairs of the nation and have meaningful debates. Whenever somebody suggests very valid points of criticism, such as those I brought forward to the previous Liberal member, like our concerns about the impact that Bill C-64 would have on the coverage of many Canadians, the government's response has been to ask us to trust it. Many Canadians over the last nine years have clearly communicated their concerns to me and many of my colleagues. I know that many Liberals are hearing the same thing. As I have travelled across the country, in airports or in communities that, in some cases, are represented by Liberals, I have heard from individuals saying they have lost trust not only in the Liberals, but also in the way that the Liberals, propped up by the NDP, have conducted themselves over the last number of years. There is an erosion of trust in our institutions.

For the government to ask us to trust it is not good enough, when there a real risk that 97% of Canadians, who do have some form of drug coverage currently, may be at risk of losing some of those benefits. That is a real concern for so many Canadians. In this circumstance, the government has promised much and has truly delivered very little. Government members will stand up and bluster about how great this is and whatnot, but when it comes to what Canadians actually need, they are failing to deliver.

A clear proof point on that front comes from the government's work with provinces. The Prime Minister was quick to brag about going around the provinces to deliver his agenda. However, when it comes to the history and the way that this federation was built, health care is provincial jurisdiction. Now, the federal government does play a role in the federal health transfer. We have seen on that front that there is a litany of failures. In fact, the Prime Minister promised to tear up the previous agreement that would have actually resulted in more funding dollars, because it was tagged to inflation, than the agreement that the Prime Minister went around the backs of different provinces to sign. He was quick to talk and puff up his chest, yet he has not met with premiers since those initial discussions, despite saying it was so important to meet with the premiers nearly a decade ago.

We have even seen how different provinces are treated differently. There are some provinces that the Prime Minister has been quick to suggest the government is happy to work with and other provinces that they may not like the party that those people in that province elected. It is not a conversation around whether they should or should not like a particular political party. The government is quick to dismiss any province that would bring forward legitimate concerns. When the government tries to go around the provinces, it ends up ultimately putting Canadians and the care that Canadians expect and deserve at risk.

There is no question that we need to address some of the challenges when it comes to health care. That is why Conservatives have been talking so significantly about some of these things, including making sure that Canadians have access to care, especially when there is a shortage of family doctors. There are so many doctors who are not eligible to work in Canada today because there is no clear process for recognition. The solution to that is very simple.

We need leadership that will bring the country together, to figure out that path forward so that what could be tens of thousands of doctors could actually get to work delivering the care for Canadians, following that Hippocratic oath that they took when they entered medical school. That would be good news for everybody because it would address a shortage. It would increase productivity. One of the challenges, and it is interesting because one does not hear the Liberals talk very much about this, is that we have a massive productivity challenge in our country. When one has wait-lists, when one has long processing times, and this is not limited to health care but includes permitting for houses, benefits, name it, if there is a delay, it has a negative effect on productivity. However, it is specifically impacting productivity on our national workforce when it comes to health care.

Canadians are being forced to wait. A constituent of mine waited three years for a hip replacement because they were in their 40s. Because of the processes and the hoops that they had to jump through, they had to stop working and there were family challenges associated with that. Again, these other parties do not want to hear some of this stuff, because they would rather simply stand on an empty promise than actually address the real challenges that are facing our constituents. When it comes to productivity, if we can address some of those things, we will see our national productivity increase, and we will provide more doctor and nurses. It makes sense that one has a nurse that is trained at an institution and has the training that is required to deliver the quality of care that is acceptable in this country.

The proposal that the Leader of the Opposition has brought forward, which he has called the blue seal plan, would give certainty in a process that currently has no certainty. That is just common sense. For somebody who is looking for opportunity, looking for a future, looking to build what used to be known as the Canadian dream, which has been so much eroded under these Liberals, there would be certainty.

A physician, a nurse or another health care provider could come to this country and have certainty. What the Leader of the Opposition has talked about is that within 60 days they would be given the thumbs-up or thumbs-down so they could get to work or at least know then, going forward, what upgrading and what training needed to be done so that they could deliver that care that, obviously, they want to give to Canadians.

It is truly a shame that there are so many talented immigrants in this country who are not able to do the work that they trained so hard to do. That is an absolute disgrace, yet, with some political will, some collaboration and working with provinces, as opposed to pitting them against each other like what the Liberal government does on a daily basis, we could see solutions and better outcomes for Canadians.

There are serious concerns that I hear about, and I know many of my colleagues do as well. Because of the potential impacts of the passing of this bill, there would be an erosion or outright dismantling of private drug plans. That includes publicly funded drug plans that are delivered by private companies, as everybody in this place, and all public servants, the 400,000 of them or so, are experiencing, as well as with provincial and other levels of government.

In this process, we have not heard clarity. The Liberals will say that they addressed that at committee. Yes, it was asked. The questions were asked, but the answers were not given in any way that would provide certainty.

What does this mean? The bill talks about being single-payer, which may be simply fanciful language from the Liberals to appease their coalition partners in the NDP and means nothing. I would suggest that this is just as bad, because it is abusing the democratic process and just speaks to the poor negotiating tactics of the leader from Burnaby South, but we will leave that, because I think I addressed that appropriately in the beginning of my speech. This could practically mean that private companies would then be changing the way that they deliver those specifics. It would put employee benefits at risk, including when somebody signs up for a job. When somebody signs a contract for work, the benefit package is a part of the compensation package.

The Liberals have not done their job or their homework in terms of making sure that all the i's are dotted and the t's are crossed, as the saying goes. What they are doing could put some of those things at risk and directly impact the ability of Canadians from coast to coast to coast to access the drugs they already have.

That could mean simple issues, such as the pharmacist saying, well, this certain drug is not covered, but this one is, or outright not being able to get it covered altogether. This can be a huge issue in some cases. Further, it could scrap coverage plans, and there is no question that it will force Canadians onto the government plan. We see this as well when it comes to the dental care plan.

We have yet another example where there is big talk but little in terms of actual deliverables for Canadians. In fact, it is interesting. When we listen to the Minister of Health, he talks about how many people have signed up for the program. Even last week, he said how many people had registered for potential appointments. The language he used was truly a cop-out.

If the government want to deliver health care for Canadians, then it should get to work and work with provinces to ensure that provincial plans can be complemented and whatnot. However, that is not what the Liberals did. They signed an agreement, seemingly on the back of a napkin, to keep the NDP happy. This does not fulfill the promises and the objectives that they so publicly brag about.

The result is a very real potential that, in terms of outcomes, Canadians will not be better off after the Liberals have tried to fix the problem. This is the case when it comes to drug coverage, as we are debating today; when it comes to dental care, as has been and will continue to be debated; and when it comes to so many of the other things that the Liberals have promised.

What is the solution? Well, first and foremost, we need leadership in this country that will bring provinces together to address the challenges we face in ensuring that Canadians can get the health care they need. That includes mental health care. This is incredibly relevant when it comes to this conversation because the Liberal Party promised that there would be a Canada mental health transfer, yet we are now several years into a mandate and that promise has not been delivered on. I guess it was not negotiated on the back of a napkin in this confidence and supply agreement.

This speaks to how little the Liberals care about ensuring that Canadians have access to the care they actually need. We need leadership in this country so we can make sure that every Canadian can, in fact, have those better health outcomes and that Canadians can, once again, start to trust the institutions that we have worked so hard to pay for over multiple generations in this country.

I look forward to being able to answer questions on this and ultimately ensure that we get answers for Canadians.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Mr. Speaker, I want to thank the member for Don Valley East, who had the honour of serving in the provincial legislature. He will remember when we worked together to create OHIP+, which started providing universal access to pharmacare for young people, which was a game-changer. It was unfortunate that Doug Ford gutted that program.

The member for Don Valley East is absolutely right. Our number one job and responsibility to Canadians is to make sure that we make their lives easier, and the way we make their lives easier, whether it is affordable child care or seniors being able to access a dentist or dental hygienist to look after their oral care, is to have programs available to make their lives better. That is what we all hear at people's doors. Those are the kinds of things people are concerned with, and that is the job we have been given.

In particular, in this Parliament, as we come out of the once-in-a-lifetime pandemic that we all lived through, so many structures within our society have been shaken as a result of the pandemic that we have to do this extra work, whether it is through Bill C-64 bringing pharmacare into our country, through $10-a-day child care, a Canadian dental care program or the unprecedented investment that we are making in our public health care system to ensure that Canadians know that their government is actually paying particular attention to their day-to-day needs, and this is exactly what we are doing.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, it is my privilege today to begin the debate at third reading stage of Bill C-64, an act respecting pharmacare. The legislation, as people know, is a priority for the government. It would establish the fundamental principles for implementing a national pharmacare program in Canada. Additionally, it would outline our plan to work with participating provinces and territories to deliver universal single-payer coverage for various contraceptives and diabetes medications.

This is an important step toward a national universal pharmacare system, as well as a historic event in the evolution of health care in Canada.

The core principles outlined in the bill are accessibility, affordability, appropriateness and universality. Accessibility ensures that Canadians can access pharmaceuticals regardless of location or income, while affordability aims to minimize financial barriers.

Appropriate use prioritizes patient safety and health outcomes, while ensuring the sustainability of the health care system.

Last, the legislation would advocate for universal coverage across Canada. These principles would shape our collaborative efforts with provinces, territories and indigenous communities to establish national universal pharmacare.

Our government has repeatedly and consistently demonstrated our commitment to public health care. Budget 2023 announced $200 billion over 10 years to better support the health and well-being of Canadians with a strong and effective health care system. More recently, in budget 2024, we committed $1.5 billion over five years to launch the new national pharmacare plan. The plan would help provide support for Canadians seeking access to contraception and for those living with diabetes. Let me focus some of my time on contraception.

Canada has more than nine million women of child-bearing age, who account for nearly a quarter of our population. For many of them, access to safe and reliable contraception is essential.

It would grant them the autonomy to be intentional about their family planning and pursue their aspirations for the future. This may involve advancing their education or their careers, delaying starting a family until they feel prepared or choosing not to have children at all. Affordability has been recognized as the primary obstacle in accessing birth control. This can lead to individuals' not using it consistently and may discourage them from opting for the most reliable method available.

Consider oral contraceptives as an example. This type of birth control is priced at roughly $25 per month and carries a typical use failure rate of 9%. Compare this to IUDs, which cost up to $500 per year. Although IUDs are a higher initial investment, they provide coverage for five years and have a use failure rate as low as 0.2%. Women should be able to make the choice between different types of contraception, regardless of whether they can afford it.

Many Canadians are just simply not in a position to pay for these upfront investments. For example, a young, part-time worker who does not have drug coverage from their employer would struggle to pay for a $500 IUD. With limited income from sporadic employment, which is typical for many young adults, even the monthly prescription cost can present a significant financial burden. This is the reality for many Canadians, and it is a reality I have heard from some of my constituents in Ottawa Centre.

One study indicated that women and girls from lower-income families tend to use less-reliable contraceptive methods or opt out of using contraception altogether. This disparity emphasizes how socio-economic factors intersect with access to reproductive health care, identifying gaps in our health care system and perpetuating cycles of systemic inequality. Additional research has even shown us that providing contraception through public funding can actually result in public cost savings. The University of British Columbia estimates that implementing no-cost contraception has the possibility of saving the B.C. health care system around $27 million per year.

Recently, I had the opportunity to meet with Planned Parenthood Ottawa in my community of Ottawa Centre. Our conversation focused on a broad range of issues, but in particular we spoke of the impact Bill C-64 would have on the health of women here in our community. What became clear to me in that conversation was that contraception is not merely a matter of personal choice. It is an integral aspect of health care. It is a fundamental aspect of reproductive health, and it plays a pivotal role in advancing gender equality.

It was also made clear to me that, by ensuring affordable access to contraception, this legislation would advance gender equality. Preventing unintended pregnancies would enable more Canadians to participate in the economy, which would result in greater prosperity for all. This is crucial for building a more equitable society where everyone has the opportunity to thrive.

I want to thank Planned Parenthood Ottawa for the good work it does, day in and day out. I was really happy to speak to its representatives recently to let them know of a funding grant it is receiving to continue doing this important work in our community. I am thankful for them for meeting with me and for educating me further on the impact Bill C-64 would have on women here in our community and across the country.

Moving on to the impact on diabetes, we can apply the same cost-saving principle that I was speaking to in the case of contraception to medications that treat diabetes. Diabetes is one of the most prevalent chronic disease in Canada, impacting 3.7 million individuals at present. There are projections that this number will continue to grow.

Many of us know someone with diabetes and have seen the devastating effects it can have on a person's quality of life. While diabetes has no cure, treatments are available to control it.

These treatments are not always affordable or accessible to those who need them. We know that 25% of Canadians with diabetes have identified that the cost of their medications has impacted their ability to stick to their treatment plans. Neglecting proper management of this disease can result in devastating consequences.

When we made the announcement introducing Bill C-64, I was honoured to join the Minister of Health and many community advocates, who have been working in this area for some time, at the Centretown Community Health Centre, which is also located in my community of Ottawa Centre. Prior to the announcement, we met with some of the social workers, the primary health care practitioners and nurses who work at the Centretown Community Health Centre, which is a fabulous institution in my community. In fact, I used to serve on the board of the Centretown Community Health Centre some time ago.

When we met, we talked about the impact of this legislation. With regard to diabetes, we spoke to a specialist there who told us countless stories of individuals who she meets, and treats, who ration their diabetes medication. They are unable to afford the cost of their medication due to their current circumstances. It was made clear that, when diabetes is not properly managed, it can result in severe complications, such as heart attacks, strokes, blindness and even amputation.

In 2018, the total cost incurred by the health care system due to diabetes was estimated to be around $27 billion, a figure that we can expect to increase to $39 billion by 2028. These figures emphasize the urgent need for effective measures to mitigate the impact of diabetes and its associated costs on both individuals and the health care system as a whole. Independent of the legislation, the Government of Canada revealed its plan to collaborate with the provinces and territories to establish a diabetes devices fund. This initiative aims to guarantee that individuals with diabetes will have access to the essential medical devices and supplies they need to manage their treatment, including syringes, glucose-monitoring devices and insulin pumps.

This, along with the framework outlined in Bill C-64 for universal single-payer coverage for first line diabetes medications, would prevent any person living with diabetes in Canada from having to ration their medication or compromise their treatment. These actions will benefit all Canadians by helping diabetics control their disease, making it less costly to treat over time.

I want to address the concerns that pharmacare might affect private drug coverage, something that came up in the conversation when we were considering this bill at committee. Bill C-64 does not mention private drug insurance or regulate any of its activities. I want to be really clear about that. Our work with provinces and territories to offer universal single-payer coverage for contraception and diabetes medications would benefit all Canadians needing those drugs, regardless of their insurance status. Since the initiative is focused, benefits provided by private insurance are expected to remain unchanged. That choice remains in place.

As the two examples just mentioned show, the high cost of medication has become a pressing concern for too many people in Canada. For them, access to affordable medication is still a major challenge.

When medicare was first introduced in the 1960s, prescription medicines played a smaller role in the overall health care system. They were primarily administered in hospital settings, and those distributed beyond hospital confines were generally low in cost, but that is not the reality today.

Today, medicines are a vital and regular part of maintaining one's health. We know that roughly 1.1 million Canadians lack access to private or public drug insurance. That is approximately 2.8% of our population. In 2021, Statistics Canada found that one in five adults in Canada did not have the insurance they needed to cover the cost of the medication. In other words, 21% of adults in Canada face out-of-pocket drug costs that create a financial burden. This can lead people to forego their basic needs, such as food or heat, or even lead people to ration their medications or choose not to fill their prescriptions at all. Canadians should not have to choose between buying groceries and paying for medication. Being forced to make choices like these has serious consequences. Whether they are skipping meals or doses of medication, or opting to go without, sets off a chain reaction of adverse effects on the health of individuals and can heighten the strain on our health care and social support systems.

We can do better and we must do better. While it entails a financial commitment, the alternative, which is not investing in our pharmacare, would result in far more severe health and financial repercussions, as we can see with the two examples I presented earlier.

It is worth also noting that Canada has one of the highest per capita rates of prescription drug usage globally. Despite recent improvements, the elevated drug costs and the fragmented nature of drug coverage pose significant barriers for many individuals in Canada when it comes to accessing the prescription medications they need. In acknowledgement of these concerns, in December 2023, our government announced plans to advance the establishment of a Canadian drug agency, in short the CDA, with an investment of $89.5 million over five years, starting in 2024-25. The CDA will be built from the existing Canadian Agency for Drugs and Technologies in Health in partnership with provinces and territories. The Canadian Agency for Drugs and Technologies in Health publicly announced its transition to the CDA on May 1.

Canada's drug agency, or CDA, will play a central role in leading and coordinating initiatives designed to improve the sustainability and readiness of Canada's drug system for the future. Bill C‑64 sets out three main tasks for the CDA.

Initially, the agency would prepare a preliminary list of prescription drugs and related products to guide the establishment of a national formulary. This formulary would outline the range of prescription medications and associated products that Canadians should be able to access under the universal, national pharmacare.

Additionally, Bill C-64 would entrust the agency with formulating a national bulk purchasing strategy for prescription drugs and related products in co-operation with partners and stakeholders, including provinces and territories. This plan would explore methods to lower the cost of prescription drugs, which could help alleviate financial pressures for both individuals and the health care system. The agency would be required to finalize both the preliminary list and the strategy no later than the first anniversary of the day on which this act receives royal assent.

Last, the agency would aid in the publication of a pan-Canadian strategy concerning the appropriate utilization of prescription drugs and related products. This report would be released within one year of the bill receiving royal assent. Canada's drug agency would also be obligated to provide updates on the progress of implementing the strategy every three years.

As we know, national universal pharmacare cannot be accomplished without the contributions of the provinces, territories and indigenous peoples.

Given Canada's size and diversity, each province and territory has unique needs and specific challenges.

To establish a national pharmacare program that is both effective and fair, it is crucial to foster strong collaboration between the Government of Canada and all partners. Each stride toward national universal pharmacare will be made hand-in-hand with these partners. Future funding to support pharmacare will be allocated to provincial and territorial governments by way of bilateral agreements. This funding would supplement, rather than replace, existing provincial and territorial investments on public drug benefit programs.

In the immediate future, we will draw insights from ongoing initiatives as we persist in our efforts to enhance accessibility and affordability for all Canadians through a national pharmacare program.

Since August 2021, for example, our government has been working with the Government of Prince Edward Island to reduce drug costs for patients through the improving affordable access to prescription drugs initiative. Since then, P.E.I. has expanded access to over 100 additional medications on its roster of covered drugs, including treatments for cancer, heart disease, migraine and multiple sclerosis, just to name a few.

As of June 1, 2023, P.E.I. lowered copayment costs to $5 for nearly 60% of commonly prescribed medications for its residents. As a result of this initiative, within the first nine months alone, P.E.I. residents have saved over $2.8 million in out-of-pocket costs for over 330,000 prescriptions.

In addition to the progress being made on a regional level, I am happy to also share some of the work being done on a national level to support our pharmacare efforts. Bill C-64 builds on the work we have done to make drugs for rare diseases more accessible.

In March 2023, we launched Canada's first-ever national strategy for drugs for rare diseases. Supported by federal funding of up to $1.5 billion over three years, this strategy aims to enhance accessibility and affordability for medications for rare diseases, ensuring they are in reach for those who need them.

It marks the beginning of a national approach seeking to meet the need for drugs used in the treatment of rare diseases.

As my time is winding down, I want to say in conclusion that, in Canada, it is our belief that everyone should receive prompt access to the health care they need, when they need it, irrespective of financial needs. This principle is a core Canadian belief, and we are dedicated to defending it.

Bill C‑64 is a major step forward in our commitment to guaranteeing all Canadians access to affordable, high-quality drugs.

Our plan for universal coverage of contraception and diabetes medications would be life-changing for individuals, families, society and our health care system. While there is a lot of work ahead, we have already made substantial progress, from regulatory modernization to enhancing access to drugs for rare diseases, establishing Canada's drug agency and collaborating with the provinces and territories.

Passing this legislation would allow us to build on this momentum. We stand at the threshold of a new era in Canadian health care. We should seize this opportunity to invest in a stronger Canada.

I thank members for their attention.

I encourage all members of the House to vote in favour of Bill C-64.

[Dan Vandal, Liberal, for the Minister of Health]

moved that Bill C-64, An Act respecting pharmacare, be read the third time and passed.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

moved that Bill C-64, An Act respecting pharmacare, as amended, be concurred in at report stage.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Mr. Speaker, I am very pleased to rise in the House to speak to Bill C‑64.

It is a great pleasure to join the debate today about the pharmacare legislation that is going to bring in the first steps of pharmacare in Canada, as well as to be the last person to give a speech before we actually vote on this important piece of legislation.

Quality health care, including access to prescription drugs, is vital to protecting and promoting the health and well-being of Canadians. Prescription medicines allow millions of Canadians to prevent and fight disease, manage chronic illness, ease pain and breathe better; in other words, they allow Canadians to live healthier and more productive lives. I must say, there are few issues that I hear more about than health care. It is a priority for my constituents.

With rising costs, some Canadians are facing difficult choices between paying for their prescriptions and covering essentials, such as food and heat. Nobody should be put in that circumstance. We need to ensure that prescription drugs are more accessible and affordable for Canadians, including those facing the greatest financial barriers to accessing medications. That is why our government has introduced the pharmacare act. The bill proposes foundational principles for national universal pharmacare and describes the government's intent to work with provinces and territories to provide Canadians with universal, single-payer, first-dollar coverage for a range of contraceptive and diabetes products.

When medicare was introduced in Canada in the 1960s, prescription drugs played a relatively limited role in health care. Most drugs outside of a hospital were inexpensive medicines for common conditions. However, in the intervening decades, the development of drugs has surged as pharmaceutical companies have pushed the science further in search of new treatments and cures. Prescription medicines are now an essential part of health care. As a share of overall health care costs, spending on prescribed drugs has risen from six per cent in 1975 to nearly 14% in 2022. This makes prescription drugs the second-largest area of health care spending in Canada, after hospital services.

Today, the landscape of prescription drugs available in Canada is robust and complex, with pharmaceutical companies launching dozens of new products every year. To support effective management, in government-run, public drug plans in Canada, as well as some privately run plans, a formulary is developed, which is a list of drugs and related products that are eligible for coverage under the drug plan. To develop the formularies, public plans consider both how well a drug works and whether these products offer good value for money relative to other treatment options. While there are over a hundred public plans in Canada, there is generally good alignment with regard to the list of drugs that are eligible for coverage across provinces and territories.

Many Canadians are only eligible for public drug coverage with high deductibles or premiums that provide little relief for more routine drug expenses, such as for prescribed contraception and diabetes medications. A national formulary would outline the scope of prescription drugs and related products that all Canadians should have affordable access to under national universal pharmacare.

In 2019, the advisory council on the implementation of national pharmacare, chaired by Dr. Eric Hoskins, recommended a national formulary service, one of the standards for national universal pharmacare. He proposed pharmacare coverage to be phased in, starting with a short list of essential medicines. In budget 2019, the government announced funding for a number of foundational steps towards national pharmacare, including the development of a national formulary. Back in 2022, the government announced continued progress towards this by introducing a pharmacare act and tasking the drug agency to develop a national formulary of essential medicines and a bulk purchasing plan. Preliminary work has already been completed, and a framework and process for developing a future national formulary was recommended.

The panel released its final report in 2022, including giving guiding principles for the formulary and a process for bringing it into place, as well as a sample list of commonly prescribed drugs and related products for three therapeutic areas with a high volume of drug use in Canada. These are cardiovascular disease, diabetes and mental illness. This list has been expanded by looking at equity-seeking groups to make sure that we are closing the gaps in access between different communities in Canada.

Actually, this foundational work is already having real-world impacts. In 2021, our government announced that it would work with the Province of Prince Edward Island on the improving affordable access to prescription drugs initiative. Under this initiative, P.E.I. is receiving funding to add new drugs to its list of publicly covered drugs and to lower the out-of-pocket costs for island residents.

I just want to say that, with the legislation, P.E.I. residents have already saved $2 million in out-of-pocket costs on more than 230,000 prescriptions, and the savings continue. Our government remains firmly committed to taking the next steps in pharmacare, and the legislation today is going to help us do that by providing coverage for contraception and diabetes medicine. This is part of our overall approach to support the provinces to improve health care in Canada, including with a new deal we signed with all the provinces last year to provide better care, as well as making it easier to get access to such things as a medical practitioner in rural areas, including where I live, by providing student loan forgiveness for people to operate there.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Mr. Speaker, I am pleased to have another opportunity to address Bill C-64, an act respecting pharmacare. It is an act with respect to pharmacare, and yet it would cover only diabetes and contraception. As a member of the Standing Committee on Health, I can say that the bill, which is really more of a pamphlet than a real piece of legislation, has been the main focus of committee for the last month or so, about as long as it took for the government to draft the legislation.

It is important to make sure that Canadians know what the pamphlet really is and, more importantly, what it is not, since many people are under the impression that Bill C-64 would mean free medications for all Canadians. This is absolutely not the case. Despite what the NDP-Liberal coalition is claiming, the pamphlet would do very little to improve the lives of the majority of Canadians, and overall it could have more negative impacts than positive.

One huge issue that I have with Bill C-64 is the way that it was rammed through Parliament so quickly. Typically when legislation comes to committee, we are given ample time to hear from witnesses and to read all the briefs, submissions and recommendations from stakeholders on the legislation. This is extremely important, as there are many groups that have valuable insight and input on issues as major as pharmacare. We on this side of the House believe that they all deserve to be heard and considered, yet due to closure on what Canadians think should be a piece of legislation intervening in provincial domains, it was rushed through.

When it comes to matters that would potentially affect a huge portion of the population, due consideration must be given to the opinions of experts. This is not an issue that should be handled by “Ottawa knows best”, which the Liberal-NDP coalition so often does. The Liberals think they know better than the professionals who are said to be the most impacted by the pharmacare pamphlet, so they are fine with pushing the weak legislation through. Why is that? It is because they want to be able to tell Canadians that they gave them universal pharmacare, even though that is blatant misinformation because what the bill would provide is anything but universal.

There were 10 hours of committee time to hear from witnesses with respect to Bill C-64, which was not nearly enough time to cover all the industries, organizations and individuals who would be affected by the poor piece of legislation before us. My inbox was inundated with emails from groups that were pleading with the government to have a chance to give their input at committee. However, because the NDP-Liberals were so desperate to ram Bill C-64 through Parliament, their voices were not heard.

It astounds me that the costly coalition is trying to tout the pamphlet as being historic and groundbreaking, when the Liberals neglected to listen to the very people who would be most impacted by the shoddy work of the file. Many groups who were fortunate enough to appear at committee said they were not consulted by the NDP-Liberals before or during the development of the pharmacare pamphlet. In what world is this acceptable?

It is not just the medical field that the NDP-Liberal coalition failed to consult in advance. One of the biggest industries that would have to deal with all of the changes caused by Bill C-64 is the insurance industry. We were fortunate to be able to hear from some industry representatives on the matter at committee. Mr. Stephen Frank, president and chief executive officer of the Canadian Life and Health Insurance Association, made some important observations.

Mr Frank said, “The Minister of Health has stated that people who have an existing drug plan are going to continue to enjoy the access they have to their drugs. If that's the minister's intent it's not...clear from this bill. As many of the questions reinforced today, its text is ambiguous, it repeatedly calls for universal, single-payer, pharmacare in Canada with no mention of workplace benefit plans. Read in its entirety the bill could result in practical, and even legal, barriers to our ability to provide Canadians with the drug benefits that they currently have.

“For the majority of Canadians, therefore, this plan, as it's currently written, risks disrupting existing prescription drug coverage paid for by employers, limiting choice, and using scarce federal resources to simply replace existing coverage while leaving a huge gap for uninsured Canadians who rely on other medications beyond diabetic drugs and contraceptives.”

There are a number of different drug insurance plans out there: government-sponsored plans, employer-sponsored plans, association-sponsored plans and private plans. The Conference Board of Canada found that 36.8 million Canadians, or 97.2%, are eligible for some form of prescription drug coverage. The Canadian Chamber of Commerce indicates that the uninsured population is 1.1 million, or 2.8%, and 3.8 million are eligible but not enrolled. That is basically 4.9 million, a little over roughly 10% of the population, yet Statistics Canada in 2019 indicated that 86.2% of Canadians are covered by at least one type of drug insurance.

When an issue as important as access to medications and prescriptions comes up, it is the minister's job to ensure that all policies are clear and comprehensive and that all possible implications have been considered. Obviously, this is not being done with Bill C-64.

Another witness who appeared at committee and had concerns about the clarity of this bill was Carolyne Eagan, the principal representative for the Smart Health Benefits Coalition. She stated, “thousands of our advisers have received thousands of phone calls and engaged discussion with the misperception that people can go ahead and cancel their plan and essentially replace it by the free plan, not knowing what is on that list of coverage and who it's intended for.

“My own mother, who's turning 80 this year, got her letter. She was completely confused and figured she would cancel her plan and have free coverage with everything included. Luckily, I'm in the business and could explain it to her.

“It is a risk and there's a great risk of employers and Canadians thinking they would lose access to a longer list of medications where their health is stable on the treatment plan that they have been prescribed. Losing that access puts everything at risk. It puts the sustainability and health of Canadians and families, and our workforce and productivity, at great risk.”

This is alarming to say the very least. How many seniors in this country are going to lose their private insurance plan because the NDP-Liberal coalition failed to be clear about what the pamphlet would actually do and cover? How many seniors might have already cancelled their plan? What will stop employers from cancelling the benefit plan they offer and telling their employees to use universal pharmacare, which covers medication for only two things?

These are the questions that were asked at committee, yet the minister was unable to answer. Even more alarming is that only 44% of new drugs launched globally are distributed in Canada, and only 20% of them are covered by public plans. According to a study by Innovative Medicines Canada, which, by the way, asked to present at committee and was denied.

The fact of the matter is that the minister came to committee and gave blatant misinformation to Canadians, telling them that everything is going to be okay and that they must just trust him. After nine years of the Prime Minister's ruining our country, it is absurd that he is expecting public trust. The NDP-Liberal coalition has broken promise after promise, and somehow the minister thinks that he deserves or is entitled to something as sacred as the trust of Canadians.

One of the briefs that was received at committee was sent by Chris MacLeod, a 54-year-old lawyer who has cystic fibrosis. This disease is one that hits home very personally, and I am grateful to Mr. MacLeod for sharing his experiences with public drug plans in this country. He stated that unfortunately Bill C-64 looks like it could be another major barrier to access for patients, especially those with rare diseases, and that notably, the federal government's attempt to force substandard public formulary coverage on everyone across the country could prove to be a disaster, with potentially deadly consequences.

People who live with diseases like cystic fibrosis do not deserve to have their life made even more difficult because of incompetence with respect to the bill. The bottom line is that most Canadians already have solid drug plans that they are happy with and they do not want to have them replaced.

[Julie Dzerowicz, Liberal, Davenport, ON]

Mr. Speaker, Bill C-64 would establish the framework of a national universal pharmacare program here in Canada. It is phase one of the proposed program, which would include prescription drugs and free coverage for contraceptives and diabetes medication, and we are hoping to expand the program.

As well, there are additional elements that would complement the national pharmacare program, which is our national strategy for drugs for rare diseases. Again, it is starting with a $1.5-billion investment over three years. I believe our intention is that we will be expanding it in the years to come.

[Julie Dzerowicz, Liberal, Davenport, ON]

Mr. Speaker, it is a real pleasure for me to stand once again today to speak to this very important bill. Bill C-64 is an act respecting pharmacare.

The bill contains three key sections. One, it would establish a framework toward a national universal pharmacare in Canada for certain prescription drugs and related products. Two, it provides that the Canadian drug agency work toward the development of a national formulary to develop a national bulk-purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications. The third section is that, within 30 days of hopefully this bill receiving royal assent, the minister would establish a committee of experts to make recommendations regarding the operation and financing of national, universal, single-payer pharmacare.

The bill, along with other investments made by our government, would help millions of Canadians who are struggling to pay for their prescription drugs. Since this bill was introduced, we have heard many facts about access and affordability of prescription drugs within Canada. We know that Statistics Canada data from 2021 has indicated that one in five Canadians reported not having enough insurance to cover the cost of prescription medication in the previous 12 months.

We know that having no prescription insurance coverage was associated with higher out-of-pocket spending and higher non-adherence to prescriptions because of cost. We know that this results in some Canadians having to choose between paying for these medications or for other basic necessities, like food and housing. This is why we have consistently made commitments toward national pharmacare and have focused efforts on the key areas of accessibility, affordability and appropriate use of medications.

Let me start with the pharmacare act, which references the foundational principles of access, affordability, appropriate use and universality. We have heard a lot about these four principles this evening, but it is important to continue this conversation. Bill C-64 recognizes the critical importance of working with provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal, single-payer coverage for a number of contraception and diabetes medications.

This legislation is an important step forward to improve health equity, affordability and outcomes, and has the potential of long-term savings to the health care system. In our most recent budget, budget 2024, we announced $1.5 billion over seven years to support the launch of national pharmacare and coverage for contraception and diabetes medications. I would like to highlight the potential impact the two drug classes for which we are seeking to provide coverage under this legislation would have on Canadians.

We have heard of stories or know of someone in our constituency who is struggling to access diabetes medications or supplies due to lack of insurance coverage through their work, or of an individual who has limited insurance coverage so they cannot choose the form of contraception that is better suited for her.

For example, let us talk about a part-time, uninsured worker who has type 1 diabetes and is also of reproductive age. For this individual to manage her diabetes, it would cost her up to $18,000 every year, leaving her potentially unable to afford the $500 upfront cost of her preferred method of contraception, a hormonal IUD. With the introduction of this legislation, this individual would save money on costs associated with managing her diabetes and would be able to access a hormonal IUD at no cost, with no out-of-pocket expenses, once the legislation is implemented in her province.

Studies have demonstrated that publicly funded, no-cost universal contraception can result in public cost savings. Evidence from the University of British Columbia estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Since April 1, 2023, B.C. is the only province in Canada to provide universal free contraceptives to all residents under the B.C. pharmacare program. In the first eight months of this program, more than 188,000 people received free contraceptives. That is wonderful.

With respect to diabetes, it is a complex disease that can be treated with safe and effective medications. One in four Canadians with diabetes has reported not following their treatment plan due to costs. Improving access to diabetes medications would help improve the health of some of the 3.7 million Canadians living with diabetes and reduce the risk of serious, life-changing health complications, such as blindness or amputations.

Beyond helping people with managing their diabetes and living healthier lives, we also know that, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs on the health care system due to diabetes and its complications, including heart attack, stroke and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028, as estimated by Diabetes Canada.

The bill demonstrates the Government of Canada's commitment to consulting widely on the way forward and working with provinces, territories, indigenous peoples, and other partners and stakeholders to improve the accessibility, affordability and appropriate use of pharmaceutical products by reducing financial barriers and contributing to physical and mental health and well-being.

Beyond our recent work under Bill C-64, I would like to highlight one or two initiatives, depending on my time, that the government has also put in place to support our efforts towards national pharmacare.

On a national level, our government has launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years. As part of the overall $1.5-billion investment, our government will make available up to $1.4 billion over three years to willing provinces and territories through bilateral agreements. This funding would help provinces and territories improve access to new and emerging drugs for Canadians with rare diseases, as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases.

I would also like to highlight another initiative under way, which involves the excellent work by P.E.I. through a $35-million federal investment. Under this initiative, P.E.I. is working to improve the affordable access of prescription drugs, while at the same time informing the advancement of national universal pharmacare.

The work accomplished by P.E.I. has been remarkable. Since December of last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to $5 for almost 60% of medications regularly used by island residents. I am pleased to share that through this initiative, P.E.I. residents have saved over $2.8 million in out-of-pocket expenses as of March of this year.

Finally, on December 18, 2023, the Government of Canada announced the creation of Canada's drug agency, with an investment of $89.5 million over five years, beginning this year. Built from the existing Canadian Agency for Drugs and Technologies in Health, and in partnership with provinces and territories, the CDA will provide the dedicated leadership and coordination needed to make Canada's drug system more sustainable and better prepared for the future, helping Canadians achieve better health outcomes. I am pleased to share that as of May 1, CADTH has been officially launched as Canada's drug agency.

In closing, we can see the extraordinary amount of work that has been and will continue to be dedicated to our commitments related to national pharmacare that focuses on accessibility, affordability and appropriate use of medications.

Bill C-64 represents the next phase of helping Canadians receive the medications they need, and we look forward to working with all parliamentarians to ensure its successful passing.