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.

Government Business No. 39—Proceedings on Bill C-64

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I listened attentively to the health minister's speech. He talked about, at one point, finding common ground and finding solutions. He recited every single anecdote in this speech that he did in his second reading speech on the bill.

This bill, Bill C-64, only got three days of debate in the House, and it was then sent to committee. Now, we have a programming motion, so it is a guillotine or gag order attempting to be imposed on the House of Commons to order a committee of the House to dispense with the bill after something like 10 hours of consideration at committee. If we are talking about finding common ground and finding solutions, then we should allow the House and its committees to do their work instead of ramming things through.

I wonder if the minister could explain why, in the programming motion, he is not obliged to testify before the committee.

[Mark Holland, Liberal, Minister of Health]

moved:

That, notwithstanding any standing order, special order, or usual practice of the House, Bill C-64, An Act respecting pharmacare, shall be disposed of as follows:

(a) during the consideration of the bill by the Standing Committee on Health,

(i) the committee shall have the first priority for the use of House resources for the committee meetings,

(ii) the committee shall meet between 3:30 p.m. and 8:30 p.m. on the two further sitting days following the adoption of this order to gather evidence from witnesses, provided that any meeting on a Friday may start at 12:00 p.m. for a duration of not more than five hours,

(iii) all amendments be submitted to the clerk of the committee by 4:00 p.m. on the second sitting day following the adoption of this order,

(iv) amendments filed by independent members shall be deemed to have been proposed during the clause-by-clause consideration of the bill,

(v) the committee shall meet at 3:30 p.m., on the third sitting day following the adoption of this order to consider the bill at clause-by-clause, or 12:00 p.m. if on a Friday, and if the committee has not completed the clause-by-clause consideration of the bill by 8:30 p.m., or 5:00 p.m. if on a Friday, all remaining amendments submitted to the committee shall be deemed moved, the Chair shall put the question, forthwith and successively without further debate on all remaining clauses, amendments submitted to the committee as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill,

(vi) a member of the committee may report the bill to the House by depositing it with the Clerk of the House, who shall notify the House leaders of the recognized parties and independent members, and if the House stands adjourned, the report shall be deemed to have been duly presented to the House during the previous sitting for the purpose of Standing Order 76.1(1);

(b) not more than five hours shall be allotted to the consideration of the bill at report stage, and at the expiry of the time provided for the consideration of the said stage of the bill, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred; and

(c) not more than one sitting day shall be allotted to the consideration of the bill at the third reading stage, and 15 minutes before the expiry of the time provided for Government Orders that day, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred. (Government Business No. 39)

Madam Speaker, it is my pleasure to rise to talk about Bill C-64, which is an opportunity for us to move forward with pharmacare in this country. In the first order, the bill represents the best of what Canadians should expect from the House, which is different parties working together to find common ground and solutions.

I will start by thanking the member for Vancouver Kingsway for his work in what were often challenging conversations and negotiations, but which led to an exceptionally important bill that is going to do incredible good across the country. As well, I want to thank the member for New Westminster—Burnaby, the House leader for the New Democratic Party, for his work as House leader and now as health critic. In all orders, when we are facing something as challenging as the protection of our public health system and making sure Canadians get the care they require, working in a non-partisan way to drive results is exceptionally important.

I will speak to what is at stake, say a bit about what we have been doing in health and then talk specifically to the legislation that is in front of us today.

It was a stark day for me yesterday because I had two very different kinds of conversations. One conversation was with somebody who was saying, in a roundabout way, that maybe it would not be so bad if our public health care system became private. It is important to focus on what that would mean for this country and why it is something that we should all be adamantly opposed to.

If we allow our system to become a private health care system, there would be a migration of dollars toward a private system and expertise, in which the private sector would take that which was easy and lucrative and leave that which was difficult or involved folks who did not have the means to be able to pay for those services. This would leave less money in a public system that would be dealing with the most expensive problems and the most intractable issues. Over time, we would then see more and more migration of that which was easier into the private system, which would mean that people who do not have the means could not afford the same kind of care.

In a very practical sense, that ends up in the following type of situation: I had an opportunity to be in the United States with my partner for a weekend, and we witnessed a man collapse. It was clearly a person with not a lot of means. He fell unconscious to the ground. We went to his side and called 911. When he became conscious, his first thought was not about his health or worrying about what had just happened to his physical body; his concern was how he was going to be able to afford what just happened to him. I thought about the phone call I made to 911 and whether this was what this man even wanted, because now he has to think of exorbitant health costs to get the care he needs.

Even those who do not fundamentally care about whether their fellow citizens, regardless of their financial circumstances, get the same level of care as everybody else in the country, even if we cannot compel people's morality to care about the circumstance of whether somebody in their own community gets the same level of medical care that they do, the reality is that when somebody does not go to a hospital to get checked for something that is minor, because they do not have money, then it becomes something major. We are then left with the existential question, when that person becomes so sick that they are on death's door, of whether we just let them die or whether we pay the exorbitant costs that we have allowed to accumulate through not having a system that took care of those problems in the first place.

For the prognosticators of doom about our health system, for those who push the idea that we should just allow it to deteriorate and not make the investments or say that it is too difficult, they have to be honest about the future they are painting for Canadians in this country and the type of health care system that they would be left with. It is one where only the affluent have the opportunity to get the care they need. We can imagine a world where nurses cannot afford the care and services they require, but the affluent they are serving do. I do not think that is a society we want to be in.

That is why the investments we are making in health care are so critically important. The federal government has come to the table with nearly $200 billion to invest in partnership with provincial and territorial governments over the next 10 years. In the same spirit as the legislation, the question was not asked about one's partisanship or one's jurisdiction, because I do not think Canadians are interested. They want to see answers and forward progress.

I really want to commend the health ministers across the country because, over the last 10 months, as I had an opportunity to work with them to negotiate the agreements we signed, it was a spirit of co-operation and putting the health of Canadians first. It does not matter whether it was Adriana LaGrange in Alberta, Tom Osborne in Newfoundland and Labrador, a Conservative and a Liberal, or Adrian Dix, a New Democratic health minister in B.C.; they understand we have an important job to do and that we need to focus on what unites us and how we make things better.

The results were incredibly detailed health agreements that not only put money into the system but also showed exactly how that federal money is going to be spent. Thus, Canadians can view where those dollars are going to go to improve their health system and issues such as the health workforce, where we make sure that we have the doctors and nurses Canadians need and that everybody has a relationship with a doctor in this country. In addition, this enables us to put common indicators across the country so people can see the progress their province is making.

We know what is measured is achieved, and for the first time in our health system, these agreements put common indicators across the country so we can see the progress occurring in our health system and see what those investments are doing on key indicators identified by CIHI, which is an independent agency dealing with health data.

However, in dealing with the urgency of the now, let us recognize that our health system has been enormously strained. Throughout one of the darkest periods in public health that, certainly, we have known in our lifetime, health care workers were asked to do Herculean amounts of work. They were asked to rise to an occasion and do more than I think any reasonable person could be expected to do, but they met that hour and did it. As in health systems all over the world, instead of being met with a break, they were met with even more work, with burnout, with all kinds of mental fatigue and mental health issues as a result of the pandemic, with a backlog of procedures and with a health system that was even more overwhelmed.

What was remarkable about that period of time, going back to the spirit of co-operation, is that we made extraordinary progress. This was when the health system was fully aligned in the darkest moments of the pandemic, everybody was given more agency to practise at top of scope, jurisdiction was of distant consideration and people's immediate urgent health needs were first. We are dealing with that, with these workforce agreements and the work we are doing bilaterally with provinces and territories, but it is not enough to deal with the crisis of now. We have already made such huge progress. On where we were a year ago versus where we are now, that progress is evident through our whole system, but we recognize we also have to be upstream.

That brings me to another conversation that I had yesterday. I had the opportunity to be with the member for Ottawa—Vanier at a denture clinic in Vanier. Here is another example of parliamentary co-operation, where two parties came together and recognized an essential need in this country, which is that some nine million Canadians do not have access to oral health care.

We have now seen more than 30,000 seniors, just in the first few days of this dental program, receive care for the first time. I have been able to see what that means, in many instances by going into clinics. I will talk about what I saw in that denture clinic in Vanier. A denturist was talking about a senior who had not had their dentures replaced in 40 years; they did not have the money. This senior had no teeth and used a black apparatus to crush food in their mouth. One can imagine the dignity and the spiritual change in that person when they came in and realized that, after 40 years, they were finally going to get teeth in their mouth. The denturist being able to describe that moment, the pride they had in being able to deliver that service and give that senior that dignity, was absolutely extraordinary.

I had an opportunity in my own riding, just a few days before that, in Ajax, to meet with a senior. I never had a chance to meet him before. His name is Wayne. He sometimes goes by “Moose”. He was talking about himself and his wife. He had a need for partial dentures, and he had other oral health problems, as did his wife, which they had been putting off. In terms of what it meant to him to feel seen and to be able to get those issues taken care of, the truth is that we know it is not just a matter of dignity. It is not just a question of what kind of country we want to live in. What about the cost?

I think of Wayne and his inability to pay for the medical care that he needed for oral health care. Left untreated, Wayne could very well end up in a hospital room with an unnecessary surgical procedure, placing his life at risk. Imagine the staggering cost of that.

Dental care is not about some kind of boutique political intervention. It is fundamentally about making sure that people get the preventative care they need. It is part of the overall action that we are taking as a government, not only dealing with the crisis of the now, but also casting our eyes into the future and asking how we can work together.

Clearly the Bloc Québécois members have concerns about the jurisdiction issue, which I completely understand. It is a concern for me too. However, in my opinion, this is not a question of jurisdiction. It is actually a question of co-operation. There was one question that dominated my conversations with Quebec's health minister, Christian Dubé: How can the Government of Canada and the Province of Quebec work together to improve our health care system?

There are plenty of opportunities for us to work together in a spirit of co-operation to improve our health care system. It is easy to pick quarrels, point out differences and raise the issue of jurisdiction. However, I believe that for Quebeckers, what really matters is their health and government action.

Dental care is a great example of that. In Quebec, the Minister of Heritage has done extraordinary work in her riding. Almost all the providers in her riding have signed up, meeting a lot of that misinformation that was coming from the Conservatives with true facts. The experiences of those providers have been extraordinary. That is an example of us working together.

I said to Minister Dubé in Quebec that if they want to administer the program, it is no problem. Our care is about the patients, not about the jurisdiction. Our only requirements, if a one wants to take it over, is that one has to have at least the same level of care, number one, and number two, we are not going to give more to administer the program than it costs us to administer it. If it costs one more, that is something one has to bear on one's shoulders or look internally at how one is operating one's system.

That is an example of making sure that we get the care now and that we fix the question of jurisdiction later. For somebody who has a dental emergency, for a senior who does not have teeth in their mouth, they do not care about jurisdiction. They care about care and about getting it done. That is what we are focused on.

Before I come to pharmacare, one of the other things we are doing is about school food. When I was at Heart and Stroke, I had the opportunity to lead the Ontario mission and to be the national director of children and youth. One thing that was shocking to me was that when a child has one healthy meal, it can totally change their health outcomes. It does it for a couple of reasons. First, just the act of eating fruits and vegetables and healthy food has a transformative effect on health and prevents chronic disease and illness. Second, how does one learn if one is hungry? Third, one actually gets to develop a taste for healthy food that lasts one's entire life. Therefore, this is an extraordinary investment that is going to make a massive difference.

We are also taking action on marketing to kids with front-of-pack labelling and taking action with the $500-million fund to develop capacity for mental health services on the ground in communities across the country. I could go on and on, but I only have a short period of time to talk about the thing that we are here to talk about. I see the member for Vancouver Kingsway, and I want to thank him for this.

When we talk about contraceptives, it is incredibly frustrating to me that, over the last number of days, we have seen a march and a protest here to try to take away women's rights and take away their right to choose. We have seen over 80 Conservative members, I believe is the number, who have been endorsed because of their belief that they should take away a woman's right to choose, and that is fine. I am pro-choice, and there are members who are not.

However, what I do not understand is if someone is against a woman's right to make a choice about her own body, how can they also be against giving her contraception? What choice is she left with? Let us look at that very specifically. If a woman today is in need of contraception and does not have the money for it, what are they supposed to do? Maybe they can find the money for oral contraception, but it has a failure rate of 9%. An IUD has a failure rate of 0.2%, but it costs $500 up front. For the women who do not have the money to pay for it up front, they are left with a less effective tool to be able to have control over their sexual and reproductive health.

How, in the one order, can we say to a woman that they are not allowed to choose or make a choice for their body, but in the other order, say that we are not going to help them get contraception to be able to make a choice about their body that way either? In other words, they get no choice. What conversation is being had about sexual health? If someone is against giving contraception to women and against them having a choice over their body, then they would at least talk about sexual health.

For women, it is extremely important to know that their body is something that they should always have autonomy over. Sex is something that should feel empowering and should make them feel like themselves. It is something they should never be coerced or pressured into. It is something that they should never feel ashamed of. It is something that should feel pleasurable.

Pharmacare Act

[The Speaker, Liberal, Greg Fergus]

It being 3:17 p.m., the House will now proceed to the taking of the deferred recorded division on the amendment of the hon. member for Cumberland—Colchester to the motion for second reading of Bill C‑64.

Call in the members.

The House resumed from May 6 consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the second time and referred to a committee, and of the amendment.

Second reading

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, debate on second reading of Bill C-64 took place tonight without quorum, which means that Bill C-64 will have been considered without the constitutional requirement of quorum. In the event that Bill C-64 receives royal assent, I trust that the fact—

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, Bill C-64 is a classic example of the legislation the Liberal government has brought before this Parliament. Once again, it has over-promised and under-delivered.

When the leader of the NDP sold his party's soul and coincidentally guaranteed that he would receive a pension for his efforts, many people thought he got too little for it. New Democrats did not even get 30 pieces of silver, as they betrayed their ideal and the Canadian people.

What has this betrayal cost Canadians? Inflation continues at record levels, fuelled by the carbon tax. Housing costs have doubled. Health care has vanished. Food bank use is at record levels. The immigration system is broken. Our military suffers from neglect, and foreign governments try to influence our elections. The Liberal response is to shrug. Canada has become a joke on the world stage.

What does the NDP receive for this blind support of the Prime Minister and his disastrous policies? It receives a promise to look at what it would take to establish a national pharmacare program. It is not even that, really.

Canadians thought a pharmacare plan would cover their drug costs. For the majority of the country, this was not a pressing issue. According to The Conference Board of Canada, 97% of Canadians are already eligible for some form of drug coverage, although the final report of the advisory council on the implementation of national pharmacare indicated that 20% of Canadians receive what could be termed inadequate coverage. In December of last year, a Leger poll indicated that only 18% of Canadians thought the establishment of a national pharmacare program was a health care priority.

It may come as a surprise to the Liberals and the NDP, but Canadians are worried about rising prices on everything, due in large part to the carbon tax. When people are worried about being able to feed their family, pay the rent or mortgage and put gas in their car so they can get to work, they do not spend much time thinking about a drug plan that does not cover the medications they need.

Canadians were hoping the Liberals could get it right. That turns out to have been a false hope. On this issue, as on many others, the Liberals are proving once again to have no idea what they are doing. The Liberal idea of pharmacare is restricted to just two types of medication. If one suffers from heart disease, one is out of luck. Heart disease is the second-leading cause of death in Canada, but medication for it would not be covered.

The Liberals' approach to pharmacare reminds me of their approach to Canadian liquid natural gas, or LNG. When the chancellor of Germany came to Canada looking to buy Canadian LNG, the Prime Minister told him there was no business case for such exports. That was a huge surprise to those companies looking to expand their markets.

Not only is there a business case for Canadian LNG, but there is a moral one as well. In the aftermath of the Russian invasion of Ukraine, countries are looking to replace Russian LNG and have turned to Canada, only to be told by the Canadian government that it does not want to sell Canadian LNG. The Prime Minister needs to learn that when there is a customer willing to buy the product, there is indeed a business case to support it. If Germany and Japan and Greece want to buy Canadian LNG, why would we not want to sell it to them?

A previous prime minister asked farmers, “Why should I sell your wheat?” This tells buyers there is not a business case to sell them the product they are asking for, while at the same time offering Canadians a pharmacare program they did not ask for, a plan so flawed it is unlikely to work.

This is the government that promised a firearms buyback program four years ago. So far, it has not managed to launch it, yet it wants Canadians to believe it has the skills necessary to design and implement a pharmacare program. Put simply, what is being offered is not pharmacare.

It is just another Liberal election gimmick, a promise they will campaign on in 2025, hoping that voters will not look at how many promises they have already broken. Anyone who has looked at the current state of drug coverage in Canada is concerned by this attempt to create additional bureaucracy. We already have some public drug plans; they do not seem to be as good as the private ones. Private drug insurance plans cover many more different medications than public plans do. The difference varies by province, but, on average, private coverage is 51% more extensive than its public counterpart is. In Quebec, the figure is 59.6%. Then there are the delays. Once a drug is approved by Health Canada, it takes an average of 226 days for a private insurer to approve the coverage. By contrast, it takes 732 days for approval by Health Canada, or a little over three times as long, for a public plan to add a drug to its list of covered treatments. These figures do not paint a rosy picture of the ability of public insurance to meet the Canadians' needs.

The marriage contract between the Liberals and the NDP required that the bill come before us last year. It did not. It took the Liberals two years to come up with the legislation, a bill that seems to have been put together without much thought, just to meet a deadline. Given how weak the bill is, I can only imagine what the first draft looked like. Maybe it was just one line, such as “We promise to look at establishing a pharmacare program in the hopes people will vote for us before we have to deliver.” Wait, is that not what Bill C-64 is?

After almost nine years of misgovernment, incompetence and mismanagement from the Liberal-NDP coalition, Canadians have lost all faith in the government's ability to discharge its responsibilities. What is the cost of this national pharmacare program? With two years to look into it, the Liberals either did not think to ask or are afraid to tell Canadians just how much more they want to raise taxes to pay for a plan that would benefit almost no one.

The bill is a public relations exercise by an utterly desperate government that is disliked by more and more Canadians every day. The inability of the Liberals to deliver on their promises is well known. Already, two provinces have opted out of this program. There is no indication that other provinces are interested. One would have thought that, in attempting to create a national program in an area of provincial jurisdiction, the Liberals would have consulted with the provinces. One might have expected that they would have hearings and consultations with stakeholders to see what exists now, what needs to be improved and the best way to do that. As far as I can tell, all they did was ask the NDP the minimum they could promise to keep the NDP's support.

Can the Minister of Health tell us what impact the bill will have on the 27 million Canadians who rely on privately administered workplace plans? If he is an honest man, he cannot, because he does not know. There was no consultation with the insurance industries when the bill was being drafted. Maybe he felt there was no need to check the facts. A promise had been made by the NDP, and the Liberals had to deliver. The needs and wishes for the Canadian people were not worthy of consideration. What is not worthy of consideration is this sad attempt at legislation; Canadians deserve much better than that.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, before I begin, I would just like to give a shout-out to the Abbotsford Rugby Football Club, which won the provincial championships over the weekend. The division 1 side has faced a lot of adversity. Our fields were flooded during the big flood in Abbotsford a few years ago. This team has really built back. Big congratulations go to Coach Chambers and all members of the squad on the game-winning kick by Mr. Rowell. Congratulations to all the boys for their accomplishments.

Now, I turn to Bill C-64, an act respecting pharmacare. As my colleague, the hon. member for Cumberland—Colchester, said in the House in April, the half-baked pharmacare plan being debated is truly about preserving the costly NDP-Liberal coalition.

In order to ensure that the coalition survives the next fixed election date, so many members can lock in their pensions, the NDP has agreed to a pharmacare plan that covers only two categories of drugs, while costing a billion and a half dollars and adding even more bureaucracy and gatekeepers to the already extremely bloated federal government.

There are 97.2% of Canadians who already qualify for some form of prescription drug coverage. It is important that we work to ensure that the 1.1 million Canadians without coverage can access pharmacare, but the proposed system would leave them woefully under-insured and no better off. In the context of British Columbia, we already have coverage for contraceptives through our provincial government.

What we have in front of us today is not a universal pharmacare system, as the NDP-Liberal government has been campaigning. It is a diabetes medication and contraceptive coverage system.

The member for Ottawa Centre just said in his speech that in 2028, diabetes alone will cost the medical system in Canada over $40 billion. Even the money put forward in this bill is only a drop in the bucket, and I wish the members of the NDP-Liberal government would come clean about misleading Canadians about what they are doing, because all of us have had constituents come to our offices and ask when the universal drug coverage will kick in. I am sorry to say that it will not; this is a PR exercise by this government, and it is shameful.

Canadians know how much a promise from the Prime Minister means, and it is not very much. This is the same Prime Minister who promised to balance the budget, or rather, that it would balance itself. This is the same Prime Minister who promised a $4.5-billion Canada mental health transfer that is yet to be delivered. This is the Prime Minister who promised British Columbians a universal day care system at $10 a day. Good luck trying to find that in our lifetime.

This is the same Prime Minister who promised that interest rates would stay low for a very long time, right before spending more money than any government in Canadian history and driving interest rates higher than they have been in decades. This is the same Prime Minister who has led to all of our GST payments, on every purchase we make in Canada, solely servicing the federal debt. Let that sink in. Every time we buy something, the taxes that we pay are only paying for the mistakes of the member for Papineau.

The only goal of this bill, as we all know, is to appease the NDP and avoid an election the government knows it would lose.

Speaking of the New Democrats, they really ought to be ashamed of themselves for even agreeing to this plan. For decades, they have campaigned on a single-payer pharmacare system, and now that they finally have a sliver of power in this Parliament, they fold and accept a half-baked plan that would cost taxpayers billions while failing to provide coverage for the vast majority of medications Canadians rely on, which the NDP promised to deliver. Shame on them.

The leader of the NDP loves to say that he will win the next election and often starts phrases with “when I am Prime Minister”. If he truly believed what he was saying, why does he continue to prop up that failed government, and why did he agree to this plan, which fails to cover the vast majority of drugs and treatments? If they are going to do it, they should go all in and take a risk. They are not willing to take a risk, because it is just about covering their own butts and getting their pensions.

The bill could have negative—

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Mr. Speaker, I want to first thank the member for Nunavut, along with the member for Bruce—Grey—Owen Sound, for joining me on Sunday in support of Christie Lake Camp, which is a worthy organization in Ottawa, in my community, raising $20,000 to support kids from priority neighbourhoods. I must say the member for Nunavut is an excellent basketball player, so it was a great afternoon.

I agree with the member that we need to catch up with many countries that allow for free contraception. It is about the autonomy of women. It is making sure that women are able to make decisions about their own lives. By passing Bill C-64, we will take the very important step of making sure that Canada really values women and gives them the autonomy they deserve as equal citizens.

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

Mr. Speaker, I am thankful for the opportunity to speak about Bill C-64 and about how this represents a historic milestone in the evolution of the Canadian health care system.

This bill and other investments made by our government will help millions of Canadians who are struggling to pay for their medication.

I was very thrilled when the Minister of Health, and many other incredible Canadians who have been advocating for a pharmacare program in Canada, joined in my community of Ottawa Centre, at the Centretown Community Health Centre, where, toward the end of February, we made the announcement on Bill C-64, on covering diabetes and contraception medication. One could see the excitement among people when that announcement was made in my community.

In fact, I have been working on this issue for over a decade now, during my time as a member of provincial Parliament in Ontario. I was part of a Liberal government that brought something that we called OHIP+. That “plus” covered medications for young people, and then, we were moving on to cover medications for seniors. It was really unfortunate that the Conservative government under Doug Ford cancelled that incredible program because it allowed for care for so many Ontarians.

However, I am thrilled that we are taking this important step here at the federal level.

In 2021, Statistics Canada found that one in five adults in Canada did not have the insurance they needed to cover their medication costs. This means that over 20% of adults in Canada face out-of-pocket drug costs that create a financial burden. This can lead to people sacrificing their basic needs, such as buying groceries or heating one's home, in order to afford their medications. It can also lead people to ration their medications, causing them worse health outcomes. This is not acceptable and I do not think that this is the kind of country any of us want to have.

Choices like whether to fill a prescription have serious consequences. Whether skipping meals or skipping doses, the decision to go without can create a cascade of negative impacts on a person's health and can increase the burden on our health and our social safety nets.

We can and we must do better. That is why we introduced Bill C‑64 and proposed this first step toward universal pharmacare.

Our commitment to address the accessibility and affordability of medication can be seen with the various initiatives we have implemented with respect to national pharmacare. In addition to the introduction of the pharmacare act, which includes a commitment to work with provinces and territories to ensure universal access to contraception and diabetes medications, we also established a partnership with P.E.I. to improve the affordability of prescription medications, implemented the first-ever national strategy for drugs for rare diseases and established a Canadian drug agency.

Let me start with the pharmacare act, which outlines a way forward toward national universal pharmacare in Canada. Bill C-64 recognizes the critical importance of working with the 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 bill is an important step toward improving health equity, affordability and outcomes, and could help reduce health care system costs over the long term.

Coverage for contraceptives would mean that nine million Canadians of reproductive age would have better access to contraception, reducing the risk of unintended pregnancies and improving their ability to plan for the future. We are a government that has always and will always recognize that autonomy over one's body and the ability to control one's own sexual health is a matter of fundamental justice.

Contraception is a key component of individual autonomy. It is an essential component of reproductive health and contributes to advancing gender equality.

Cost has consistently been identified as the single most important barrier to accessing contraception and the cost is unevenly borne by women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions and often lack access to private coverage. Studies have demonstrated that publicly funded, no-cost universal access to contraception can lead to public cost savings. The University of British Columbia estimates that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Having safe, reliable birth control represents freedom and safety. However, these costs continue to be a barrier. With Bill C-64, we are taking action to remove the barrier.

The same cost reduction principle applies to diabetes medication. Diabetes is a complex disease that can be treated and managed with safe, effective medication.

However, one in four Canadians with diabetes have reported not following their treatment plan due to cost. Improving access to diabetes medications will help improve the health of 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, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs to 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.

Independent of the legislation, we have announced that we will work with provinces and territories on a diabetes devices fund. This fund would ensure that people with diabetes have access to the medical devices and supplies they need, such as syringes, test strips, glucose monitoring devices and insulin pumps. This, combined with the framework outlined in Bill C-64 for universal single-payer coverage for first-line diabetes medications, will help ensure that no person with diabetes in Canada is forced to ration their medication or compromise their treatment.

I previously mentioned our excellent work with P.E.I. and how this $35-million investment is focused on improving affordable access to prescription drugs while at the same time informing the advancement of a national universal pharmacare. The work accomplished by Prince Edward Island has been outstanding. Since 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 and cancer, and is saving millions of dollars in out-of-pocket costs for P.E.I. residents.

On a national level, we 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 investment of $1.5 billion, we are making up to $1.4 billion available to the provinces and territories over three years through bilateral agreements.

This funding will help to 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. This will help ensure patients with rare diseases have access to treatment as early as possible for a better quality of life.

I want to quickly mention that, in December of last year, we announced the creation of the Canadian drug agency, which will provide the dedicated leadership and coordination needed to help make Canada's drug system more sustainable and better prepared for the future.

This is an incredible opportunity for Canadians coast to coast to coast, working alongside provinces and territories, to allow for pharmacare, especially when it comes to contraception and diabetes. This is the beginning of building a more robust health care system that will work for all Canadians. I am excited to support this bill, and I encourage all my colleagues to do the same.

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

Mr. Speaker, I have greatly appreciated the comments of my colleague from the NDP. It has been a very spirited debate here. We are talking about the provinces, the jurisdictions, and also about equality of care across the country. I think that is where the federal government comes in. That is where legislation like Bill C-64 comes in to ensure that there is equality of access to pharmacare, specifically in the areas of contraceptive care and diabetes.

I would like to hear my colleague's comments on that issue.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Environment and Climate Change and to the Minister of Sport and Physical Activity]

Mr. Speaker, reproductive and sexual rights are human rights. Our government recognizes that, and we stand by it as a matter of principle. Members of the Conservative Party caucus can stand in the House and say they are not interested in pursuing anti-abortion legislation that would infringe upon women's reproductive rights; however, sadly, that conviction is far from a universally held one in the caucus. In fact, the entire caucus has been designated as anti-choice by the Abortion Rights Coalition of Canada.

I am proud to say that, on this side, we are walking the walk. We are leading by example and putting forward Bill C-64, an act representing pharmacare, which would provide universal access to prescribed contraceptives to Canadians. In collaboration with provinces and territories, we will support universal coverage of contraceptive medications and devices so that nine million Canadians of reproductive age will have access to the contraception that they need and deserve. This will ensure that Canadian women can choose whether they are going to have children. It will give them greater control over their bodies and their futures.

Currently, Canada is one of the only countries in the world where access to health care is universal but access to contraceptives is not. Women therefore have a more limited range of options, and are more likely to experience unwanted pregnancies, which can impact their lives.

Access to safe, reliable birth control is essential. It gives women the freedom to plan their families and pursue their long-term goals and dreams. Unintended pregnancies, on the other hand, can cause a great number of negative health and economic impacts on families. At present, coverage for contraceptives varies across the country. Most Canadians rely on private drug insurance through their employer for their medication needs, and some populations are disproportionately affected by the lack of coverage.

Women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions, often lack access to private coverage, and only a fraction of Canadians are eligible for prescription birth control at low or no cost through a public drug plan. When a person pays out-of-pocket for their contraceptive needs, regardless of whether they have coverage, cost has been identified as the single most important barrier to accessing contraceptive medications or devices that they require.

One study showed that women from low-income households are more likely to use less effective contraceptives, or no contraceptives at all. Cost is a significant obstacle to gaining access to more effective forms of contraception.

For example, oral contraceptives cost approximately $25 per unit, or $300 per year. In comparison, intrauterine devices, or IUDs, are often more effective and last up to five years, but they have an upfront cost of approximately $500 per unit. IUDs are a much more effective method of contraception, since they have a low failure rate of 0.2%, compared with that of oral contraceptive pills, which is 9%. Furthermore, they do not require daily doses to remain effective, which is a long-standing challenge with the pill.

At this time, I would also point out that women can have the choice, but sometimes, it is not so much a matter of choice; it is a matter of how a woman's body reacts to these various interventions. It really should be a matter of choosing not based on cost, but based on what works best for them. If someone is a young woman in their twenties, working at a part-time job that does not offer private coverage, accessing an IUD or other contraceptive method can be a big cost when trying to manage other basic life expenses, such as rent or grocery bills.

As colleagues can see, this is the reality that many Canadians are currently facing and trying to manage. We have decided to intervene and help. Bill C-64 would address the lack of access by working with provinces and territories to provide universal coverage of contraceptive medications and devices, so Canadians can access the contraceptives they need. Furthermore, some provinces are already paving the way; this is similar to how Saskatchewan led the way by implementing universal health care in the 1960s. Last year, British Columbia became the first province to provide universal access to contraceptives to their residents. Recently, Manitoba also announced a commitment to implementing universal contraceptive coverage in their province. I would join my colleague in clapping.

There is a certain trend I see, with certain provinces offering these services to Canadians. What is that common trend? I think we can leave it to our imagination, but it tends to be parties that are left of centre, that are more progressive and that are willing to step in and help where people need it most. Studies from the United Kingdom show that universal access to contraceptives provided a return on investment in health and social services of nine to one for every investment in universal contraceptive access.

In the Canadian context, 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.

We commit to working with those provinces and the others in Canada to ensure that everyone in Canada has universal access to contraceptives.

This new coverage, to be delivered by provinces and territories that enter into a bilateral agreement with the Government of Canada, means that Canadians would be able to receive the contraceptives they choose, no matter where they live or how much they earn. In turn, Canadians will be healthier; they will be empowered to make important life decisions, and they will not have to opt for less-effective or less-desirable methods of contraception because of the cost of this essential medicine.

We will work with provinces and territories to provide Canadians with universal coverage for contraception. This is just the first phase of a national pharmacare plan, which can show how much of an impact universal coverage for contraception and, indeed, more than just contraception, will have on the lives of Canadians and further enshrine reproductive choice in Canada.

In closing, we look forward to working with all parliamentarians to pass the pharmacare act so that all Canadians can have reproductive choice and rights and get the contraception they need and deserve.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, we know that almost four million Canadians have a form of diabetes, and we want to prevent their condition from deteriorating and their ending up in the hospital, which costs our hospital system even more. We want to prevent that, which is a big piece in Bill C-64.

Obviously, with contraceptives, we know that there are women out there who may not be able to afford the cost. We would be there to assist those individuals, especially the most vulnerable, in our country.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, since 2015, when I was first elected to this most honourable House, my focus has been on helping and ensuring the success of the residents of my riding of Vaughan—Woodbridge and of all Canadians, and that is what we continue to do. We continue to implement policies that strengthen our social system, including what is contained in Bill C-64, specifically for folks with diabetes and individuals in need of contraceptives.

Obviously, the rare disease strategy is something near and dear to my heart as I have a nephew who suffers from a rare genetic disease. I understand the issues that my brother and sister-in-law go through in taking care of my nephew. The issue of expanding pharmacare, expanding our national system and strengthening our social safety net is very near and dear to my heart.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, it is always a pleasure and an honour to rise in this most honourable of houses. This evening, I will be sharing my time with the hon. member for Milton.

Before beginning my formal remarks, I would say that, when I think of Bill C-64, an act respecting pharmacare, and the implementation of a piece of legislation that would obviously strengthen our health care system and the delivery of it, I would not be remiss to say that this is not only an excellent piece of legislation that would help Canadians, specifically those in need of contraceptives and the nearly 4 million Canadians dealing with diabetes, but also another sign of our government's strengthening of our social fabric and social system. It would build on other programs that we have implemented, including the Canada child benefit, which we know has lifted hundreds of thousands of children out of poverty and helps families every month. In my riding, nearly $80 million or $90 million a year arrives, tax-free and monthly. We know that the Canada workers benefit, which helps our working poor and those trying to make ends meet and get ahead, helps literally millions of Canadians. We introduced middle-income class tax cuts in 2015, raised the basic personal exemption amount and accelerated the pace. We know those are delivering $10 billion annually in tax relief to Canadians, as we speak.

More recently, the Canadian dental care program, which thousands of dentists have signed on for, is benefiting individuals in my riding of Vaughan—Woodbridge. In fact, in the heart of my riding at Weston Road and Rutherford Road, there is a big billboard, put up by one of the dentists in the community, stating that they welcome patients who are eligible and approved for the Canadian dental care program. This program is already helping thousands of residents in the riding of Vaughan—Woodbridge and in the city of Vaughan. The work that we are doing on Bill C-64 would continue to build on that work of helping Canadians to receive the services they need, which, in this case, is to improve health care.

With respect to health care, I was at the announcement with the Prime Minister and the Premier of Ontario, Doug Ford, when we announced a $3.1-billion bilateral agreement of health care funding for more nurses, more doctors and more health teams across the province of Ontario, a part of the $200 billion the federal government is committing to health care across this beautiful country.

I appreciate the opportunity to speak to the important work under way through Bill C-64 with regard to the Canadian drug agency, or CDA. The CDA is one of the key features contained in Bill C-64. On December 18, 2023, the Government of Canada announced the establishment of the CDA, which is to be built from the existing Canadian Agency for Drugs and Technologies in Health, in partnership with provinces and territories. The government committed $89.5 million over five years to establish the CDA, providing dedicated leadership and coordination to make Canada's drug system more sustainable and better prepared for the future. This investment would be in addition to the existing funding of $34 million per year to support CADTH's current work.

The CDA would build on CADTH's existing mandate and work, expanding to include new functions such as appropriate prescribing and use, data and analytics, and system coordination. Developing the CDA recognizes the organization's reputation of excellence, performance and results. It also ensures that we would be adding value to the system by building on what is already working with the CADTH.

Let me say a bit about how we got to this important milestone. Canada's pharmaceutical system evolves slowly over time, often responding to address new challenges as they developed. When medicare was first introduced in Canada in 1966, drugs used outside hospitals were primarily inexpensive medicines for common conditions. A growing number of specialized drugs are now helping to cure or manage a range of conditions, and rising rates of chronic disease have made prescription drugs a central part of our current health care system.

New pharmaceutical system organizations and functions have been created to manage the access and use of prescription drugs, but this has happened in an ad hoc and fragmented manner. Canada currently has over 100 public drug plans and 100,000 private drug plans, creating a patchwork of access and coverage for Canadians. Despite improvements in recent years, high prices and the patchwork of drug coverage leave many people in Canada facing barriers to access the prescription drugs they need when they need them.

Stakeholders in landmark reports have underscored the need for federal leadership in addressing these gaps. In recognition of concerns about the sustainability of the Canadian pharmaceutical system, budget 2019 provided $35 million over four years to establish the Canadian Drug Agency Transition Office, or CDATO, to provide dedicated capacity and leadership to work with provinces, territories and key partners on a vision, mandate and plan to establish the CDA. Since its establishment in 2021, the CDATO has conducted extensive engagement and analysis, holding over 400 meetings and round tables with a diverse range of stakeholders to understand the gaps and challenges in the pharmaceutical system and obtain advice on how to make improvements.

Extensive engagement has taken place with provinces, territories, patients, pan-Canadian health care organizations, health care professionals, industry insurers and international partners. Based on this engagement analysis, the CDA will build on CADTH's existing mandate and functions, expanding to include new work streams that better support patients and system sustainability, namely improving the appropriate prescribing and use of medications, increasing pan-Canadian data collection, expanding access to drug and treatment information, and reducing drug system duplication and lack of coordination.

Through our engagement, we learned that the appropriate prescribing and use of medications is a clear priority for many stakeholders. This is about ensuring that patients are prescribed the safest and most effective treatment for their outcomes and conditions. Each year, $419 million is spent on potentially harmful medications for seniors, and $1.4 billion is spent to treat harmful effects. However, there is no unified approach to guide and inform prescribers or patients on appropriate prescribing and use.

To date, we have launched an appropriate use of advisory committee involving patients, clinicians, experts and leading organizations in the field. The committee is advising on the development of a pan-Canadian appropriate prescribing and use strategy. Later this spring, the committee will issue its final report that will inform the work of the CDA to create and implement an appropriate prescribing and use program in collaboration with partners.

Stakeholders have also pointed to the need to improve pharmaceutical data and analytics to better understand the impact of drug treatments. However, there is limited ability to access, link or share drug data, which is siloed in different sources, such as hospitals, private drug plans, physicians' offices and jurisdictions. This fragmentation limits our ability to understand a drug or treatment's use pattern and effectiveness, including how it performs once it is being used by patients in the real world and how it compares to other available treatments.

We are working with several organizations in the health data field, such as CADTH, the Canadian Institute for Health Information, Canada Health Infoway, Health Data Research Network Canada and the pan-Canadian Pharmaceutical Alliance, to improve access to and use pharmaceutical data. Stakeholders also consistently emphasize the importance of incorporating patient equity and lived experience in the CDA's developments and operations. They noted that patient engagement in the pharmaceutical system is limited. Incorporating patient perspectives through engagement and governance were key recommendations for an organization that is transparent, accountable and meaningfully involves those who need it most, the patients.

We have also heard of significant challenges regarding system coordination. During the course of our engagements, most stakeholders highlighted at least one coordination-related issue that they face. Challenges include a lack of information sharing, confusion about roles or responsibilities or limitations to meaningful engagement. Our pharmaceutical ecosystem is managed by multiple organizations that have different purposes, priorities and areas of jurisdiction.

There is one organization mandated to convene players, focus the agenda, ensure efficiency and enhance collaboration. Because of this, there are both gaps and duplication in the system. Building from CADTH is a significant step in promoting system alignment. CADTH is a highly reputable organization with strong leadership and a shared federal, provincial, territorial governance model that works.

Through CDATO and CADTH's extensive partnerships and building on the work to date, we will build a CDA that is well positioned to convene key players and focus on promoting better outcomes for patients. We will develop an organization that has the capacity to adapt to the ever-changing pharmaceutical landscape. Our work to date reflects the significant input provided by stakeholders over the last three years. It also highlights a strong interest across the system to make meaningful improvements.

The CDA will support pharmaceutical system modernization in Canada and lay a strong foundation for future growth, including by providing the capacity to support the commitments outlined in Bill C-64, which is now before the House. The CDA will assume a leading role in the pharmaceutical system to ensure Canadians have better health outcomes and are well informed about the medications that they need now and into the future.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, a Conservative heckles across the way, and she is consistent with other Conservative members who say it is a provincial responsibility. That is the attitude. We can remember, at the beginning, I said that the Bloc does not surprise me. I understand why Bloc members do not support it. It is a separatist party. It would just as soon Ottawa hand over the money, then Quebec would take the money and develop the programming.

In contrast, the Conservative Party thinks it is a provincial responsibility. People need to be aware, because it is the same as the member's off-the-cuff heckle. I would suggest that it is not just a provincial responsibility. If the member truly understood the Canada Health Act and, more importantly, her constituents, she would quickly realize that it is not just a provincial responsibility.

Even when I was in the Manitoba legislature, I argued and articulated that health care is not solely the responsibility of the Province of Manitoba. I like to think that, at the end of the day, all provinces have a responsibility to follow the Canada Health Act. When I talk to people about the pharmacare program and Bill C-64, it is a positive discussion. I have yet to hear anyone, outside the Conservative Party, tell me that Ottawa moving forward with respect to a national pharmacare program is a bad thing. I cannot recall anyone saying that we should not be doing this.

That might precipitate a few emails to me, but at the end of the day, I believe it is because people truly appreciate and understand the value.

That is why I said before the interruptions that one has to take a holistic approach to health care. Let us look at what has happened since 2015, when a new Prime Minister was elected and the agenda of health care started to change in a very positive way. It was not that long ago, and I referred to this earlier, that we actually had the Prime Minister in Winnipeg at a press conference at the Grace Hospital. My colleague would be very familiar with the Grace Hospital. At the end of the day, we had the premier of the province, the provincial minister of health, the Prime Minister and the federal Minister of Health. We talked about the future of health care and how the $198 billion over 10 years would have a positive impact not only for today but for tomorrow, thinking of generations ahead. We talked about how it would impact the province of Manitoba.

Let us think about the number of agreements that have been achieved by the government with the different provinces and territories and indigenous community leaders, all dealing directly or indirectly with the well-being and health of people. Something that was missing previously was the type of financial commitment, along with the sense of co-operation. Then we look at the type of national programs that we would bring in, which would make a difference.

People talk about the dental program as an example. Having a dental program ultimately helped literally thousands of children over the last year, including children who would not have been able to see a dentist or get some of the dental work that they received as a direct result of a national program. There are actually children in the province of Manitoba who end up going to emergency departments because their dental work has been neglected. Moving forward with a dental program is a good thing.

We just came out with the national food program, where we are delivering more nutritious food for children throughout the country. Hundreds of thousands of children will actually benefit from the program.

That is why I said that health care is a lot more than just a hospital facility. People need to look at everything from independent living and community living to what takes place in our schools. They need to think in terms of the medications; the bill is about getting people talking about medications and the important role they play in health care. Along with that, I would suggest that there is a general attitude that says we are committed to the Canada Health Act and to making sure that we continue to provide the type of progressive programs that would complement the health and well-being of Canadians. That is the way I see Bill C-64. It complements the Canada Health Act, and people should not fear it. They should accept it and look at ways in which we can improve upon it.

We often hear about the issue of bulk buying, as an example, and the hundreds of millions of dollars that have been saved in that area. I would suggest that we could do even more. I look forward to seeing the ongoing debate on this very important issue. I would hope that my Conservative friends, in particular, would revisit their positioning with the idea of getting behind the legislation and voting in favour of it.