Bill C-213 (Historical)

Canada Pharmacare Act

An Act to enact the Canada Pharmacare Act

This enactment enacts the Canada Pharmacare Act, which establishes criteria and conditions in respect of drug insurance plans established under the law of a province that must be met before a cash contribution may be made.

Canada Pharmacare Act

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

moved that Bill C-213, an act to enact the Canada pharmacare act, be read the second time and referred to a committee.

Mr. Speaker, I am very pleased to kick off this historic debate in the House of Commons on a very important measure that would help millions of Canadians.

I want to start by thanking the seconder of the bill, our national leader, the member for Burnaby South, who is a strong advocate for national pharmacare. I also want to thank my seconder tonight, the member for Rosemont—La Petite-Patrie, our deputy leader, who is also a very strong advocate. I want to thank the member for Vancouver Kingsway, who is our health critic and knows more about pharmacare than any other member of Parliament, and our deputy health critic, the member for Vancouver East.

In other words, this is not an initiative of one member, though it is presented under Private Members' Business. This is an initiative of the entire NDP caucus. The entire NDP team is stepping forward to meet a need that, we know, is urgent across this country.

I want to preface this important debate by talking about another historic debate that took place in the House of Commons, in the old chamber in Centre Block, 100 metres from here, about half a century ago. Members will recall from the history books that at that time there was no medicare in our country. Anyone who has read the stories of life before medicare will know what hardship and desperate choices took place in Canada at that time.

People were having to choose between whether they could pay for the food on the table and keep making their payments for their home or for their farm, and having to cope with sudden and unexpected injury or severe disease or disability. What resulted was that often Canadians had to sell the farm or the home. They had to go bankrupt. They had to make desperate choices.

As members know, a man stepped forward, represented in this House as he was the national leader of the NDP, Tommy Douglas. At that time in Saskatchewan, he saw the necessity for universal health care, and what Tommy Douglas did as premier of Saskatchewan was put in place universal health care. He transformed Canada in a very real sense.

When he arrived here in the House of Commons, in the series of minority parliaments that we had in the 1960s, he, his House leader Stanley Knowles and the entire NDP caucus reached across the aisle to the prime minister at the time, Lester B. Pearson. They came together to put in place our universal health care.

As members are well aware, that has transformed Canada. When we ask Canadians what institution they are proudest of, often Canadians will say it is having universal health care in place. It is no longer having to pay for health care and making those desperate choices that happened in life before medicare. This remains an institution that Canadians are proudest of. Tommy Douglas went on to become judged by Canadians, from coast to coast to coast, as the greatest Canadian in our history for his endeavour and the work he did to put in place the universal health care system.

When we look at the Debates of the House from that time, we read that Tommy Douglas talked about how important it was to put in place medication as part of universal health care. It was very much a practical, realistic and necessary dream that he had, to extend universal health care to include pharmacare. Half a century later, Canadians are still waiting, but with Bill C-213, our Parliament and parliamentarians, members of Parliament from all parties, can come together. We can complete that vision by passing this important legislation.

The backbone of Bill C-213 is to put in place, in the same way we have with the Canada Health Act, the principles around pharmacare. Those principles are exactly the same as in the Canada Health Act for our universal health care. Those principles are for public administration and not for profit, for reasons that I will get into in a moment. As well, they are for sharing the comprehensiveness and universality of our pharmacare program, and making sure that the principles of portability and accessibility are also maintained.

What it does is set the legal framework that allows the government to negotiate the financial arrangements with the provinces that will bring into being pharmacare in our country. That is why it is so important to pass Bill C-213. We have waited half a century and now is the time to complete the vision Tommy Douglas had and ensure pharmacare becomes a reality.

Why? The reasons are very compelling. We know that eight million Canadians have no coverage for medications. UBC tells us, in consortium with other academic institutions from across the country, that a million Canadians have to make those desperate choices of putting food on the table, paying for their medications or heating their homes. Canada is one of the coldest countries in the world in December, January and February.

Those are compelling choices, but when we add to it the fact, as the CFNU tells us, that hundreds of Canadians die each year because they cannot afford to pay for their medications, we know we absolutely have to make the right choice and adopt this bill.

People in Quebec have also been saying that we need a pharmacare program. The major unions have all said that, because Quebec's current system is so flawed, we need a publicly managed universal pharmacare program. People all across the country agree that such a program is needed.

As the Parliamentary Budget Officer has told us, this a very cost-effective thing to do. The PBO tells us that Canadians as a whole will save about $4 billion by putting in place universal pharmacare. Why? With its universal discount, which the PBO estimates that at 25%, we reduce the costs of medication overall. The reality is that with this proliferation and patchwork of private and public plans right now, one in five Canadians have no coverage at all. At the same time, it increases the overall costs, not just administrative costs but also the costs of acquiring the medication, which is so important to the health and welfare of so many Canadians. The PBO put it at 25%, but we have seen other countries, like New Zealand, reduce the costs of certain medications by up to 90%. Therefore, that universal discount is a very real reality.

As well, the PBO tells us that Canadians as a whole pay about $5 billion out of pocket, but small and medium-sized businesses across the country pay about $6 billion in drug plans for their employees. This is another reason why the bill is so important. As members know, our universal health care is a major competitive advantage. In general, it is about $3,000 per employee for a Canadian company compared to its American competitor.

In Canada, with universal health care, we do not have those additional expenses that those companies have to pay in the United States. Pharmacare is about a $600 cost advantage, so it is competitive and an advantage for our business community. We spend about $13 billion through a variety of this patchwork of provincial plans, so putting into place universal pharmacare makes sense financially.

I have spoken in the House before about the $750 billion in liquidity supports that were provided to Canada's big banks within days of the pandemic hitting. If anything, this pandemic has taught us the importance of bringing in universal pharmacare. That $750 billion in liquidity supports equates to more than 35 years of universal pharmacare. It is the right decision to make.

We speak in this House, but we also need to listen, and I want to talk about three friends and how their lives would be advantaged by putting into place universal pharmacare. There is Jennifer, a friend of mine from New Westminster. She has Crohn's disease and is recovering from ovarian cancer. Her medication is a considerable cost. She is a campaigner for pharmacare because she understands, not just for herself but so many others, that universal pharmacare would make such a difference in her life.

There is Jim, who, up until a few months ago when the pandemic started, was begging in front of the Château Laurier because his medication costs about $500 a month and he lives on a fixed income. The only way he can afford to pay for the medication that keeps him healthy is to beg outside the Château Laurier.

No Canadian should be forced to do that. That is why we need universal pharmacare. Because of the pandemic, Jim has been unable to beg and is now facing huge debts. He has had to make that desperate choice between making sure he takes his medication to maintain his health and going into debt because there is no pharmacare.

Then there is Cole, a friend of mine from Burnaby, British Columbia. His family spends about $1,000 a month on his father's heart medication and is struggling to keep a roof over their heads. These are three voices saying to all of us in this House that it is time to put universal pharmacare into place.

This strikes back to the heart of the point I am making, and I hope other speakers will make it too. We have an initial hour tonight. We will have a second hour of debate in about 90 days, and then, subsequent to that, as we know, a vote in principle on the Canada pharmacare act. Over the next 90 days, every member of Parliament should be listening to the people in their ridings, their constituents, their bosses, our bosses, to make sure they have an understanding of how pharmacare would change their lives for the better.

There are a million Canadians tonight having to make desperate choices. They are deciding if they can afford their medications. They are scrimping on them and trying to get by with taking half as much, even though their doctors know that is dangerous for them, so they can put food on the table or keep their homes heated in the dead of winter. These are choices that Canadians should never have to make.

For members of Parliament to hear Canadians, Canadians' voices need to be heard. I am urging all of the people listening tonight who care about, as we do, putting into place universal pharmacare, to phone, email, do whatever it takes to contact their local member of Parliament and tell them to vote yes on Bill C-213. I urge them to share their stories. I have shared three tonight, but there are so many compelling stories of Canadians who are forced to make desperate choices because we have no universal pharmacare.

Canadians can speak up over the next 90 days. Canadians, I believe, will have an impact on each member of Parliament's vote and Canadians, in that way, can influence the result. If we vote yes on Bill C-213 in 90 days' time and move it through committee, we could have pharmacare within a short time frame. People having to beg and borrow could get the money to pay for their medications. All of the people cutting back on their food or heat right now, as a million Canadians do, to pay for their medications will see this Parliament acting in their interest.

I said earlier that this is a date with destiny for each member of Parliament. Each member of Parliament will have to make that crucial decision in the interests of their constituents and all Canadians. I ask all members of Parliament to please vote yes on Bill C-213, the Canada pharmacare act.

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Mr. Speaker, I thank my hon. colleague for his intervention today and his passionate plea. I think he did an extremely good job of pointing out a lot of the challenges that exist, unfortunately, for so many Canadians. He is absolutely right. No person should have to decide between taking their medication and putting food on the table. No senior should have to make the decision of reducing their prescription in order to make it last longer.

If he canvassed the House, I think he would find that a majority of its members support the concept of universal pharmacare. This government has been committed to that and put together an agency to review it in the last session of Parliament, which came back with suggestions, as my colleague knows.

The one thing I did not hear the hon. member talk about was the fact that creating a program like this relies so much on the relationship with the provincial government and developing it in partnership with the provincial government. How would he see that rolling out and how do we do that, practically, to make sure that we have buy-in from the provinces?

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

Mr. Speaker, the hon. member's question is important. I mentioned earlier the $13 billion that provinces are paying right now for a patchwork of public plans that leave so many Canadians behind. We saw all of the provincial governments come together for universal health care. The same thing can take place with universal pharmacare.

What the bill would do is provide the legal framework for the government to have negotiations and discussions with the provinces, so that pharmacare can become a reality. We can move very quickly on this, if we choose to.

We saw $750 billion going to banks in a heartbeat. Now is the time to provide the same level of support to regular Canadians. We can do that through universal pharmacare.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, I also share my colleague's objective of ensuring that vulnerable Canadians have access to pharmaceuticals. We can do that.

I am just concerned about examples of nationalization of pharmaceutical care having unintended consequences, as we saw with the OHIP+ program in Ontario, where 2.1 million Ontarians ended up, with the elimination of their privately funded system, having worse levels of care than they did before. They did not have access to drugs that they needed.

Has the member given any thought to that potentially unintended consequence of the bill and how he would mitigate that?

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

Mr. Speaker, I think the principles are very clear. They are the principles Canadians already accept in our universal health care system. There is not a single party in this country that would want us to go back to the days before our universal health care. The same principles would apply to universal pharmacare. It means making sure that we put this into place and that we follow those five principles that I mentioned earlier: public administration, comprehensiveness, universality, portability and accessibility.

Those are the guiding principles that will lead us to the same level of public buy-in around universal pharmacare that we already see with our universal health care.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Mr. Speaker, I thank my colleague for his speech. The Government of Quebec has decided that it does not want to be part of a Canada-wide pharmacare system.

Does my colleague acknowledge that Quebec society is more advanced than any other North American society when it comes to family policies, access to post-secondary education, taxation and pharmacare? Yes, Quebec already has a system, albeit one that is not perfect and could certainly be improved.

Can he tell me if he thinks Quebec should have the right to opt out unconditionally with full compensation, which would in no way preclude Quebec's collaborating to purchase drugs for less?

I would like him to comment on that.

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

Mr. Speaker, I thank my colleague for his question.

I think he should talk to major unions in Quebec, such as the Fédération des travailleurs et travailleuses du Québec, the FTQ, the Confédération des syndicats nationaux, the CSN, and the Centrale des syndicats démocratiques, the CSD.

The four major unions have said it is important to set up this universal pharmacare program. They know perfectly well that Quebec's existing system has a lot of problems and that many Quebeckers slip through the cracks.

We have to set up the system we are proposing. That is what Quebec's major unions are saying, and it is important to listen to them.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Mr. Speaker, I am very happy to join the debate tonight, even if it is virtually, to address Bill C-213.

I must say to my colleague that it is great that he took the initiative to bring the bill forward. I think that any time we have a chance to move the discussion on things that we know clearly Canadians would like us to discuss, we should take it. The work that is required to make that all happen, of course, is way ahead of us. Every time we have a debate, I think it is terrific.

I never thought that I, as a member of Parliament, would deliver a speech from the comfort of my home office, but this is a new normal that we are all experiencing in order to stay safe and flatten the curve of COVID-19. It is my hope that I will soon join my colleagues in the House to continue the great work that this government is providing for Canadians.

We know Canadians should not have to choose between buying groceries and paying for medication. That is just unacceptable, and I believe every one of us in the House believes that.

When constituents from my riding of Humber River—Black Creek visit the Yorkgate Mall or Jane Finch Mall, they should be able to reach into their pockets and purchase the food and medication they need. That is why the government is committed to implementing a national pharmacare program that would ensure all Canadians have access to the prescription drugs they need, and why I also welcome this discussion tonight.

It is a goal we have been working toward since we first formed the government in 2015, and it remains our goal. No matter how difficult COVID has been, it is still our goal to see national pharmacare, as we clearly stated in the most recent 2020 Speech from the Throne to remind everyone that we intend for this to happen.

The COVID-19 pandemic has reminded us how important it is that Canadians have access to the medicines that keep them healthy. We need to implement a national pharmacare plan that gets Canadians the drug coverage they need as soon as possible. People are struggling: we know that. I get calls at my constituency office every day from seniors and others looking for help, who want to visit loved ones, play cards at their local community centres and simply want to get their lives back to normal.

I tell them we are doing everything we can to fight the pandemic. National pharmacare would make a significant difference in the lives of many people in my riding. It would be a relief to many of these individuals if we could assure them that in their lifetimes they would have the dream of seeing national pharmacare happen.

People today need a break, and while we are now more committed than ever, it is important we get this plan right. To modernize the whole issue of drug regulations, we need to address the rising cost of drugs in this country. As the price of drugs continues to go up, trying to find sustainable drug costs has to be a solution.

Canada's approach to patented drug price regulations was outdated. Our previous pricing regime was established a very long time ago, and it needs to change to be brought up to date with current issues. We have more than 100 different public drug plans and thousands of private drug plans. All this means is we have many drug plans. It does not necessarily mean they are doing what they are supposed to be doing, other than being a patchwork.

It is well past time to bring these regulations into the 21st century. In order to make drugs more affordable, Canada needed a modernized approach to regulating patented drug prices that would protect Canadians from excessive prices. That is why last summer the government modernized the Patented Medicines Regulations, which provide the Patented Medicine Prices Review Board with the tools and the information it needs to protect Canadians from excessive prices.

Secondly, we want to consider the value a drug offers and its overall affordability. Most other countries with national pharmacare programs already do this, so we are behind the eight ball on this. When setting a price, one needs to have many discussions on things such as value for money, if the drug offers a therapeutic benefit that justifies its cost, the size of the market, how many people will benefit, Canada's GDP and GDP per capita, and if we can afford to pay for it. These things are not easy.

These changes would provide the Patented Medicines Price Review Board with the tools it needs to protect Canadians from excessive drug prices, and would bring us in line with the policies and practices of most other developed countries.

These regulatory changes were critical steps toward improving the affordability and accessibility of prescription drugs. Along with other consumer protection initiatives at the Patented Medicine Prices Review Board, we anticipate that these changes will save roughly $13 billion over the next 10 years. These are significant savings for Canadians. From the savings, public and private drug plans will have greater capacity to improve benefits for plan members or to consider new therapies not currently covered. All Canadians, including those with drug plans and those paying out of pocket, will benefit from lower prices for prescription drugs.

Modernizing pricing regulations complements the work already under way at Health Canada to streamline the regulatory review process for drugs by enabling priority drugs to reach the market more quickly. This supports the work already taking place under the pan-Canadian pharmaceutical alliance to negotiate lower prices for prescription drugs. As a member of this alliance, the Government of Canada is able to combine its buying power with that of the public plans in the provinces and territories. It is estimated that the alliance will save public drug plans more than $3 billion over the next five years. Successful negotiations will result in more affordable prescription drug prices for public drug plans and will lower generic drug prices for all payers.

These steps that we have taken to increase the affordability of drugs will improve the viability of a national pharmacare program. A national pharmacare program would be another step that could help us further control drug prices and make drugs more affordable for Canadians, especially drugs for patients of ALS and some of the other very serious rare disorders.

The government has also made some significant investments to ensure that we continue to take important steps in the right direction as we build this national pharmacare program we all want.

Budget 2019 earmarked $1 billion over two years beginning in 2022-23, with up to $500 million ongoing, to help Canadians with the rare diseases that I alluded to earlier access the drugs they need. Budget 2019 also proposed $35 million over four years to support the implementation of a Canadian drug agency, including the development of a national formulary, an important step toward a national pharmacare program.

A national formulary and increased capacity to coordinate across drug plans would bolster Canada's negotiating power to achieve better prescription drug prices on behalf of all Canadians. Negotiating better prices could help lower the cost of prescription drugs for Canadians. However, as we develop this formulary, we must work with the provinces and territories to determine which medicines represent the best value for money for Canadians from coast to coast to coast.

The people of Humber River—Black Creek and across Canada want a national pharmacare plan. I am confident that the government will be successful in implementing the initiatives that I have outlined today, and I congratulate my colleague for bringing this issue forward in a private member's bill so that we can continue to keep everybody's feet to the fire. That includes all of the provinces and territories, which have to be partners with us on this issue.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Speaker, all Canadians should have affordable access to prescription drugs. It is a key component of health care. Income and ability to pay should not stop people from having access to life-saving treatments.

I do want to thank my colleague from New Westminster—Burnaby for bringing forward a suggestion on how we can help people like his friends Jennifer and Jim. For us to evaluate whether his potential approach is the best one or would actually work, we must begin with a review of the current state. There are three points to consider.

First, how many Canadians have drug coverage at present and how many do not? At present, most recent estimates suggest that between 90% and 98% of Canadians have some form of prescription drug coverage, whether through private insurance or a public plan. While a smaller percentage of Canadians do not have coverage, many Canadians already do. We should be targeting our intervention to Canadians without adequate coverage and clearly defining what that means.

Second, the gaps in coverage are not just for those who cannot afford to pay for prescription drugs. There are also gaps in coverage when drugs are available elsewhere in the world, but not in Canada. One example is the life-saving drug for cystic fibrosis patients called Trikafta.

Third, health care delivery has a large jurisdictional responsibility within the provinces. While I believe federal and provincial governments should work together to address issues like this, we also need to ensure that any potential solution respects jurisdiction and the unique regional challenges of our Confederation.

In the context of these three points, I will evaluate whether the proposal of this bill is the best option to address this issue.

First, let us start with what this bill does. To re-emphasize, many Canadians already have some form of drug coverage, but the coverage these plans do provide is provided by employers and insurers, not taxpayers. This bill proposes that the best way to provide coverage to the smaller percentage of Canadians who do not have adequate coverage is to eliminate access to private plans for those who currently have them and replace them with plans provided by a government agency and the taxpayer with varying degrees of coverage that might be less than their current level of coverage and likely with a tax increase to cover the significant associated cost. This is what is commonly referred to as pharmacare in Canadian politics.

Many people do not understand that what proponents of pharmacare mean to do is eliminate the coverage many Canadians already have, replace everything with state-run coverage that might not be as good as their current coverage and likely significantly increase taxes to do so. I believe that instead of this approach, it would be better to focus on targeting support to those who do not have it, rather than entirely scrapping a system that works for a majority of others.

Second, this bill does not address the potentially unintended negative impact it might have on patient care. We do not know the level of coverage this proposal would provide and whether it would be a lower standard than what many Canadians already have in their current plans. This needs to be clarified.

A good example of this is what happened with the OHIP+ program under the Ontario Liberals. OHIP+ was supposed to fix access to drug coverage for people under 25 by providing public coverage. However, Ontarian Jackie Bain had to start paying out of pocket for her son's ADHD medication because her private insurance was no longer recognized. Many Ontarians face similar issues with access to other prescription drugs for epilepsy and rheumatoid arthritis.

OHIP+ transferred 2.1 million Ontarians who already had private plans to a public plan that provided worse coverage than what they had before and at a higher cost. In other words, the government's attempt to increase drug coverage by fully eliminating private plans removed more people from drug coverage than it added. The vagueness of this bill gives rise to this possibility, but on a national scale.

Third, this bill needs to clarify the potential impact of nationalizing access to pharmaceuticals on workers in pharmacies across this country. Would their jobs and businesses and ability to provide expert advice to Canadians be affected? This impact needs to be addressed.

Fourth, there is no consensus on whether this bill's approach would actually provide savings. For example, the Neighbourhood Pharmacy Association of Canada estimate a single-payer, pharmacare plan would cost between $10 billion and $14 billion, which is different from what this bill's sponsor has suggested. That cost estimate is on top of other issues it would produce in terms of dismantling existing private coverage and replacing it with government bureaucracy, for which detailed publicly available costing is not available.

On the issue of bulk purchasing, nationalization is not needed for provinces and territories to buy drugs in bulk.

Fifth, this bill does not address the issue of lack of access to life-saving drugs in Canada. There is no doubt that we need a strong drug and therapeutic safety review process, but as we have seen with the Liberals' slow and backward approach to reviewing COVID rapid tests, this system could use improvement.

Drug access for Canadians has arguably been threatened by the government's changes to what are called the PMPRB regulations. We have seen how this regulatory uncertainty has deterred some life-saving drugs from entering the Canadian market. These changes could dramatically alter pharmacists' abilities to run patient-support programs. While the new guidelines may lower some drug prices, they might also harm our ability to get access to certain new therapeutics, and this needs to be addressed.

Sixth, the bill does not adequately address other issues related to drug supply. Our drug supply has been in jeopardy since the start of the COVID pandemic because of disruptions to supply chains. Canadian pharmacists have been ringing alarm bells for months, but the government has not done anything. Given that government usually does not do anything particularly well, in this regard I worry about what would happen if the government took total control of access to prescription drugs, as the bill may propose.

Seventh, I am worried that the member has not addressed jurisdictional issues raised by members during debate today.

In short, I believe the bill will not provide access to pharmaceuticals to vulnerable Canadians who need them the most and could have significant negative unintended consequences that could actually make drug access worse for some Canadians and add another tax burden to already heavily taxed working Canadians. However, I do agree with the bill's sponsor that we need to help vulnerable Canadians who do not have access to prescription drug coverage, like his friends Jennifer and Jim.

This is what I suggest.

We should encourage the government to finally come up with a fully costed plan in coordination with the provinces to provide support for those without prescription drug coverage within the system that already provides significant coverage to millions of Canadians. That plan should be compassionate and first aimed to help those who are in critical need of access to life-saving drugs.

It should reduce bureaucracy rather than create it, as the bill proposes; sustain access to coverage for those who already have it; and protect jobs and businesses rather than looking to replace them with unnecessary government bureaucracy.

It should respect provincial jurisdiction while taking a leadership role to help those in need. It should also work with the provinces on creative ways to enable bulk purchases within existing regulatory structures.

It should look at innovative ways to reduce costs for these products within the existing system, such as looking at policy options like classifying common drugs that are classified as over the counter in allied countries like the U.S. and the U.K. as over the counter here. Some estimates suggest that if we did that for just three drugs, we could ensure Canadians save $1 billion a year on spending on drugs.

This plan should also bolster Canada's capacity to domestically manufacture critical drugs. It should ensure strong safety reviews for therapeutics and devices, while eliminating the pedantic, slow and innovation-killing systems that prevented Canadians from getting COVID rapid tests and Trikafta. It should correct policies that prevent Canadian medical innovations from being commercialized in Canada, as many of our innovations are currently licensed out of the country instead of being retained here.

I strongly believe that we have a duty to provide support to people who do not have access to pharmaceuticals in Canada. I think it is long overdue, and it is something federal Liberal governments have been talking about since the 1970s. However, I do not think the bill gets it right. I think we should be looking at a hybrid system that takes into consideration the points I have made and allows Canadians to have adequate coverage. We should then build on that rather than just seeking to nationalize it. I think we should also be questioning what the role of government is in this regard, and we should be targeting our plan to the people the member for New Westminster—Burnaby talked about in his speech, rather than trying to eliminate coverage for people who already have it.

I certainly want to emphasise that the Conservatives will continue to support government action that makes prescription drugs more accessible and affordable for Canadians. We will hold governments to account, especially the current Liberal government, which has not addressed issues like access to novel therapeutics like Trikafta. However, we do not think we need to nationalize the entire system to do this, and we are concerned about examples like OHIP+, which really failed a large portion of people who enrolled in it.

I look forward to working with my colleague in a non-partisan way on this approach, but I think his bill needs a lot of improvement.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Mr. Speaker, it has been nearly 25 years since Quebec adopted its pharmacare program.

The program was far from perfect and implemented with limited resources since, at the time, Ottawa was cutting transfers for health, education and social services and imposing austerity. The Quebec program helped reduce poverty. In 25 years, no other province has adopted such a program.

If Ottawa ever goes forward with a universal public pharmacare program, which seems unlikely to me, then Quebec must have the right to opt out with full compensation so it can, for example, increase the coverage provided by its own program.

Quebec's labour unions have been sounding the alarm for several years now. The downside to Quebec's program is that pharmaceutical companies are generating revenue at the expense of union health care plans. They said, and I quote:

Rising premiums are eating into salary increases and threatening other collective insurance coverage...Funding through premiums is not fair because it places a heavier burden on low-income earners and even leads some part-time workers to resign.

It is costing them a fortune and the situation is becoming untenable. We need to take appropriate action. Ottawa's role with respect to health is to provide as much funding as possible, which it has not been doing for the past 25 years.

The Fédération interprofessionnelle de la santé du Québec, the Fédération des travailleurs et travailleuses du Québec, the Alliance du personnel professionnel et technique de la santé et des services sociaux, the Union des consommateurs, the Centrale des syndicats du Québec, the Confédération des syndicats nationaux and the Table des regroupements provinciaux d'organismes communautaires et bénévoles all want a universal public system.

In their request, they stress that such a system must respect provincial jurisdiction and that the federal government must allow provinces to opt out with full compensation as long as they create an equivalent or better system of their own. All members of Quebec's National Assembly agree with that condition.

On June 14, the National Assembly unanimously stated that, “Quebec refuses to adhere to a pan-Canadian pharmacare plan”. In its motion, the National Assembly called for “full and unconditional financial compensation if a proposal for a pan-Canadian pharmacare plan is officially introduced.” Members of all four parties represented in Quebec's National Assembly agreed to that motion.

The NDP in 2005 adopted the Sherbrooke declaration, in which it said it recognized asymmetrical federalism and intended to give Quebec the systematic right to opt out, but it seems to have written off Quebec ever since. That is what the drafting of this bill suggests.

Why did it not take into account the specification requested by the major unions or the unanimous motion of the National Assembly in the drafting of this bill? Why did it not use the demands of the Fédération des travailleurs et travailleuses du Québec, the FTQ, as inspiration?

For the FTQ, the terms and conditions of a public, universal pharmacare program must first and foremost be discussed in Quebec and established according to the needs of its people. That is why Quebec must be able to opt out with full compensation from any pharmacare plan. Furthermore, the federal government cannot discuss pharmacare without addressing the problems in health care funding. To ensure the sustainability of Quebec's health care system, the federal share of funding must be increased.

Ottawa has to increase health funding. Just before the Speech from the Throne, the provinces came together to call on Ottawa to increase its share of health care spending from 22% to 35% with no strings attached, a request that 75% of the population supports. Despite all that, the government chose to dig in its heels against the provinces.

The NDP's and the Liberals' obsession with wanting to interfere and decide for Quebec where it should spend its own money is toxic. The NDP and the Liberals should instead agree to the provinces' requests and increase federal health transfers permanently.

When it comes to access to drugs, there are things the federal government can do starting with regulating prices. According to the federal government's own data, drug prices in Canada are among the highest in the world, costing 19% more than the average country in the Organisation for Economic Co-operation and Development.

This situation did not come out of nowhere. It is the result of a government decision. The patented medicine regulations, which regulate the price of drugs, harmonize prices in Canada with the pricing used in countries with the highest prices. The Bloc has been after the government for years to change the list of countries it bases its pricing on and to exclude the United States and Switzerland, where prices are prohibitive.

We thought that we had prevailed. Members will recall that in 2017, draft regulations that met our demands were released. However, under pressure from the pharmaceutical industry, the government withdrew the regulations before their scheduled entry into force, set for January 2019. The regulations were then supposed to come into force in July 2020, but that was pushed to January 1, 2021. We shall see if, four years on, the date will be pushed back once again. I had to laugh when I heard my Liberal colleague talking about big accomplishments, when this matter has been delayed for four years for no reason.

Under these new regulations, whenever they come into force, the Patented Medicine Prices Review Board will be in a better position to do its job of ensuring that pharmaceutical companies do not overcharge for their patented drugs in Canada.

Once these regulations come into force, taxpayers could save $220 million in the first year, and up to $13 billion over 10 years. That is a huge difference. All the government has to do is implement the regulations it has been delaying for nearly four years.

During the election campaign, the Liberals also said that they wanted to take action to bring down the cost of drugs used to treat rare diseases. We have heard nothing for more than a year. They reiterated this intention in the Speech from the Throne, but we are still waiting for their strategy. The federal government must provide more information about what it plans to do. Above all, it must decide if it will co-ordinate with the rare disease strategy that Quebec intends to establish.

I hope that Quebec will have a universal pharmacare program. I really hope it will. Given that Ottawa underfunds health care, Quebec cannot afford to implement it. Quebec innovated with its system almost 25 years ago. It made a difference, and in the context of the austerity imposed by Ottawa, it was a remarkable policy. Twenty-five years later, we see the problematic consequences, especially for unions' group insurance plans.

That is why I would be very surprised if a universal plan were adopted here. If it ever does happen, Quebec should have the right to opt out with full compensation so it can enhance its own plan, in accordance with the areas of jurisdiction, the will of the National Assembly and the demands of unions.

I am gobsmacked that this was not included in the bill. It would have led to change, for once.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, it is with great pride that I speak to Bill C-213, the Canada pharmacare act.

I would like to recognize my colleague for New Westminster—Burnaby for his tireless advocacy in support of universal public drug coverage and thank him for introducing this historic legislation.

We introduce this bill in a unique moment in time. One hundred years ago next year, Sir Frederick Banting, a Canadian orthopaedic surgeon, along with his colleagues, Charles Best and J.J. Macleod, discovered insulin at the University of Toronto. However, Dr. Banting did something exceptional with his life-saving medicine: He sold the patent rights to the university for one dollar, claiming that the discovery belonged to the world, not to him. This allowed insulin to be mass produced, making it widely available to all who needed it no matter their financial means. The bill before the House reflects this noble principle.

The Canada pharmacare act would establish a framework for the implementation of universal public pharmacare in Canada. This legislation is modelled on our cherished Canada Health Act. It mirrors the 2018 majority support of the House of Commons Standing Committee on Health, which studied the issue of pharmacare for two solid years. It also is based squarely on the recommendations of the Hoskins Advisory Council on the Implementation of National Pharmacare.

Like the Canada Health Act, the Canada pharmacare act specifies the conditions that provincial and territorial prescription drug insurance programs must meet to receive federal funding. This includes the core principles of public administration, comprehensiveness, universality, portability and accessibility. The Canada pharmacare act would establish a new Canadian pharmaceutical policy by declaring that it would be the duty of the Government of Canada to facilitate access to prescription drugs without financial or other barriers in order to protect and promote the physical and mental well-being of Canadians.

The overarching purpose of universal public pharmacare is simple. It will ensure that all Canadians get access to the medication they need regardless of their ability to pay. For too long, prescribing decisions in Canada have been influenced by industry profits, marketing and lobbying efforts. Instead, decisions about what drugs are covered ought to be based on empirical evidence and the best health outcomes for patients.

To accomplish this, formulary coverage must be managed by an agency that is arm's length from government and free of industry interference. As such, New Democrats believe that it is imperative to construct a comprehensive public drug list that meets this goal.

For this reason, the Canada pharmacare act would give the federal health minister the authority to work with the provinces and territories to establish an independent drug agency with the mandate to the following: assess the clinical and cost-effectiveness of prescription drugs compared to other treatment options; advise on which prescription drugs, supplies and devices should be covered; negotiate prices and supply arrangements with drug manufacturers; provide advice to health care practitioners and patients on how best to use prescription drugs; and monitor the safety and clinical effectiveness of prescription drugs.

New Democrats are also very mindful of the need to ensure that Canadians with rare diseases and disorders are well served and that promising drug therapies are accessible. We believe that special care must be taken to ensure that drug listing decisions are responsive to these requirements and future pharmaceutical innovation. Ultimately, the goal must be to construct a broad, comprehensive, national drug list that all provinces and territories agree to cover, without cost to their residents, in exchange for federal transfers. This is the premise of our successful medicare system. It works and it is deeply valued by Canadians.

Importantly, New Democrats believe that pharmacare is an important piece of a large, comprehensive pharmaceutical policy reform. In addition to public pharmacare, Canada needs the re-establishment of public drug manufacturing in Canada, an intellectual property innovation fund that ensures taxpayer-funded research is commercialized for our citizens' benefit, patented medicine pricing transparency and the use of compulsory licencing when drug companies refuse to make patented pharmaceuticals available to Canadians on reasonable terms.

To situate this legislation in its historical context, it is important to remember that universal public drug coverage was always intended to be part of the medicare. In 1961, the Royal Commission on Health Services was appointed by Progressive Conservative prime minister John Diefenbaker to study the concept of universal public health care. Mr. Diefenbaker appointed a fellow Conservative, Justice Emmett Hall, to chair that royal commission.

In 1964, the Hall commission released its report, which surprised many by recommending the adoption of the comprehensive health insurance program based on New Democrat Tommy Douglas's Saskatchewan model. In response, some provincial premiers charged that this approach was an intrusion into their jurisdiction, and there was reluctance to proceed within then prime minister Lester Pearson's Liberal caucus. Ironically, we hear much of the same claptrap today.

However, because Canadians had elected a minority Parliament in 1963, with New Democrats holding the balance of power, Tommy Douglas was able to leverage this influence and work with the Pearson government to advance the implementation of medicare, and indeed they did. In 1966, Parliament adopted the Medical Care Act by a vote of 177 to two.

At that time, it was understood that prescription drugs and other essential health services would incrementally be integrated into medicare. In particular, the urgent need to provide coverage for out-of-hospital prescription drugs was specifically highlighted by the Hall commission. However, over a half-century has now passed and, despite repeated studies, proposals, pledges and solemn political promises in campaign platforms, Canada remains the only major country that offers universal health care without some form of universal pharmaceutical coverage. This is not just unjust; it is perplexing from both a health and fiscal perspective.

Canada's failure to implement universal public drug coverage means that at least 20% of Canadians, some seven and a half million Canadians, cannot access the medicine they need when they need it. One in four Canadians is forced to avoid filling or renewing a prescription due to cost, or skips doses because they cannot afford it. To add injury, Canadians pay among the highest prescription drug prices in the industrialized world, due to our U.S.-style private patchwork approach to drug coverage. Even those with private coverage are seeing their employer-sponsored benefits shrink, a trend that has accelerated due to the economic impacts of COVID. In fact, Canadians now are twice as likely to have lost prescription drug coverage as to have gained it in the past year. Worst of all, Canadians die each year simply because they cannot afford the medicine they need.

It is time to finally address this serious deficiency. Evidence has been clear for decades that universal public pharmacare would expand coverage and improve outcomes, while reducing costs for Canadians. Most recently, the Liberals' own Hoskins advisory council found that universal public pharmacare would reduce annual system-wide spending on prescription drugs by $5 billion through the negotiation of lower drug prices, increased generic substitution and streamlined benefits administration. The Hoskins report also found that businesses and employees would see their prescription drug costs reduced by $16 billion annually under pharmacare, and families would see their out-of-pocket drug costs reduced by over $6 billion.

Under this NDP bill, the average Canadian family would save $500 per year and the average employer would save $600 per employee. Universal public drug coverage would also mean long-term savings for our public health care system when those who cannot afford to fill prescriptions achieve improved health outcomes. Yes, it is a fact. With universal, comprehensive and public pharmacare, we can cover every single Canadian's prescription medicine and devices and save billions of dollars every year.

In public life, it is rare to find such an effective policy innovation staring us in the face. Only the most obtuse right-wing ideologue or courage-challenged centrist could fail to see the clear health and economic benefits of this necessary and sensible public policy. It is time and Canadians know it. Polls repeatedly demonstrate astronomical support for public pharmacare because, as with medicare, Canadians know a good idea when they see it. Just as establishing universal hospital and physician care took courage and cross-partisan collaboration, so too will the implementation of pharmacare.

I urge all parliamentarians to join us at this historic hour by supporting the swift passage of the Canada pharmacare act. Let us follow in the brave footsteps of those who served before us, and march forward together toward a more just and healthy society for all.

[The Deputy Speaker, Conservative, Bruce Stanton]

We have only a couple of minutes left in the time for Private Members' Business this afternoon, but we will get started with the next speaker. He will only have about a minute and a half, but he will have the remaining time when the House gets back to debate on the question.

Resuming debate, the hon. member for Niagara Centre.

[Vance Badawey, Liberal, Niagara Centre, ON]

Mr. Speaker, it is a pleasure to be here this evening to speak about universal pharmacare.

I want to start by congratulating the member for New Westminster—Burnaby for beginning the conversation with all 338 members of the House of Commons on this very important issue. I say that because it is going to be up to all of us, not one party, not some parties or others throughout the different levels of government, but all of us working together in the House of Commons and at all levels of government, provincial and territorial, who are going to be part of the process of putting this in place. We want to ensure that we in fact get this right and strengthen the universal medicare program that Tommy Douglas championed many decades ago.

As was said earlier, no Canadian should have to choose between paying for prescriptions, putting food on the table, putting their children through school and living the life that every Canadian should live. That is why we, as a government, have done more than any government in a generation to lower drug prices, and have included new rules on patented drugs that will save Canadians over $13 billion annually.

I want to emphasize two points. First, this is an important program to move forward with. Second, all of us at all levels of government, in the House of Commons and provinces and territories, can and will work together to ensure that we bring universal pharmacare to this great nation.

[The Deputy Speaker, Conservative, Bruce Stanton]

The hon. member for Niagara Centre will have eight minutes remaining in his time when the House next gets back to debate on the question.

The time provided for the consideration of Private Members' Business has now expired and the order is dropped to the bottom of the order of precedence on the Order Paper.

The House resumed from November 18, 2020, consideration of the motion that Bill C-213, An Act to enact the Canada Pharmacare Act, be read the second time and referred to a committee.