Health Committee on May 9th, 2007

[Linda Tennant]

I would just mention that as of five years ago—and I am a bit out of date, because that's when I retired from government—there was actually more industry in Ontario. If you look at the brand names and the generics, I think in Ontario we had maybe about 60%. I just want to point out that there's also a large industry presence in Ontario.

[The Chair, Conservative, Rob Merrifield]

Okay, that's fine.

Now, Elisabeth, go ahead.

[Elisabeth Fowler]

I just wanted to speculate perhaps a bit myself. Is it not possible that Quebec has realized that giving access to medications that will help maintain someone's health, that will help improve their quality of life, that will help to keep them working and being productive members of society will have far more benefits than maybe those for the few companies that are there?

If you look at the silos, if you see how much Quebec pays for drugs per capita, it is greater than what other parts of Canada pay, but what they pay for physicians and hospitalizations per capita is less.

[The Chair, Conservative, Rob Merrifield]

We have one more answer.

Dr. Janis Miyasaki, go ahead.

[Dr. Janis Miyasaki]

I'm not sure what the values are behind the judgments that lead to the Quebec formulary, but I think there's another possible explanation, and that is how they interpret the evidence. They are presented, really, with the same evidence. Those same binders go to every drug formulary, but it means they may be interpreting it in a very different way. They may put different values on different aspects of that submission.

It does speak, again, to the fact that every committee is going to have some hidden values that they bring to the table. They may not be able to articulate them all. So I don't think we have to invoke a nefarious plot or that they have consciously decided that more drugs mean more health. People look at the evidence differently and they value different things.

[The Chair, Conservative, Rob Merrifield]

Go ahead, Louise.

[Louise Binder]

It's not even that you don't know what they looked at. I quoted you, in the case of the drug that I provided, exactly what they looked at. They looked at all the quality of life things, such as side effects, toxicities, other medications, the fact that people are more likely to remain on a drug when it's a once-a-day medication. There's no secret about what the differences were.

The CDR discounted all of that, and Quebec took those things into account. There are no secrets, in my opinion, certainly about that medication and what the differences in the thinking were.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We will now move on to Mrs. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Mr. Chairman.

Thanks very much to our presenters.

We've been hearing a fair amount of testimony on this topic for quite a few meetings now, and there seems to be a common theme coming through, whether or not you agree that the CDR is doing a good job or not, and there's certainly two points of view on that. There is a common theme that a review is necessary.

I have a couple of very basic questions that I want to throw out here. I don't know who wants to answer them.

Do you think governments have a duty to look at the prices for drugs that we're considering paying for? If we do, how would we approach that? What would be the best way to approach it? If the CDR isn't working, what would be the way to do it? Does anybody have any suggestions on how and who should determine which drugs government should be reimbursing?

Does anybody want to try to answer those basic questions? Louise?

[The Chair, Conservative, Rob Merrifield]

Go ahead.

[Louise Binder]

Certainly I do think we should be looking at the costs of drugs. The idea is to do the best we can with the drug budgets we have, for sure. So the answer to that is yes.

How do we do that? I think we need to take a look. There are a number of different pharmaco-economic formulae that can be used. We need to determine the one that most appropriately fits with Canadian values, and I think you'll find it is not the one that's presently being undertaken by CDR. A one drug to one drug comparison, with cost being the only factor, as long as they both appear to be the same in efficacy.... If it costs more, that's the end of the analysis. I don't think that is part of Canadian values at all.

I think we need to be looking at the impact of factors that affect not only the drug budget but other health care budgets, such as Elisabeth mentioned: doctors' visits. We need to look at the whole impact on the health care budget when we look at pharmaco-economics.

The earlier question was put, how do we get some consistency across this country? And I think that actually should be the bottom line. It should be consistency based on the best practice in this country, not the lowest common denominator, which is what is actually happening under CDR, except in those provinces that don't listen to CDR. They don't follow the “no” rule all the time either, because the provinces didn't follow the “no” rule from CDR in the case I presented. So I don't think that's quite accurate that they always follow the “no” rule.

What I would like to see is that each province does the best it can with its present budget, with a common pharmaco-economic analysis that makes sense for Canada and is duly determined by Canadians. We've never been asked if that made any sense to us, and it doesn't. Where provinces can't bring themselves up to the best practice, if you like, in the country, then I completely agree with Joel. The federal government should then come in and help them to bridge the gap so that there is really good access to treatments for Canadians across the country.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Would this still be--

[The Chair, Conservative, Rob Merrifield]

I'm just going to try something out.

Dr. Janis Miyasaki, are you there?

[Dr. Janis Miyasaki]

Yes, I am. Isn't my picture there?

[The Chair, Conservative, Rob Merrifield]

Your picture is gone, but nonetheless you're looking fine. I just wanted to check.

We'll continue. Just speak up if you'd like to speak, because I won't be able to see you.

[Dr. Janis Miyasaki]

Okay, then I do want to speak.

[The Chair, Conservative, Rob Merrifield]

I was guessing that.

[Dr. Janis Miyasaki]

Part of the problem with the economic analysis of values is what the appropriate measure is. What's typically used is the quality adjusted life year. And we're not even sure that that's the most appropriate measure. It becomes difficult. How are you going to put a value on being able to dress yourself, on being able to feed yourself? These are very complex issues that can't be settled by a single equation or a single approach. It does speak to the need, again, to be transparent in how you make your decisions and how you value these things and to have input from the people who can give you the best information.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Go ahead, Pat.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

I'll put this back to Louise. Do you envision this, then, to be a provincial-territorial-federal group, similar to what CDR is? Or how do you envision it being done?

[Louise Binder]

I do see it as having to have the buy-in of the provinces, the territories, and the federal government, because all their budgets are impacted. So of course it has to work that way. I think, administratively, if we can keep it with the provinces administering it, it would be great. They already have the processes in place for doing that. Where I see the federal government coming in is in this sort of top-up area in those provinces where that's required.

I want to make another point, too. If we're talking about really doing the best we can with our budgets, how about looking at the generic drug prices in this country as well as at the brand-name drug prices in this country. You know, we pay the highest prices in the developed world for generic drugs in this country. If we want to talk about where they're located and why they get such good treatment in the provinces where they're located, we could do a lot of speculating. I won't. My organization has actually done a paper on this, and it's going to be presented shortly. It's something else we ought to be looking at.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

I think you'll see that there has been movement on the generic pricing. I think you'll see that in Ontario, specifically.

[Louise Binder]

Yes, we've been talking to the government there about this problem for a long time.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll go to Ms. Brown.