Mr. Speaker, it is a pleasure to rise tonight to speak to the bill on pharmacare. I want to thank the member for New Westminster—Burnaby for bringing it forward. I am sure the reason he has brought it forward is to call for action. There has been a lot of talk about pharmacare but, to be fair, there has not been a lot of action.
By way of background, the Liberals have been talking about pharmacare since 1992. They have been studying and talking, but nothing really concrete has come forward. Therefore, I am glad to see we are talking about this tonight.
Members may want to pay heed to my commentary. As a former shadow health minister, I was on the health committee when we studied pharmacare. We have heard all kinds of testimony from every province and territory and from all sorts of Canadians about what they think about pharmacare as well as on related topics, like the drug approval process and rare disease medications, which are also important and need to be addressed.
All parties in the House are looking for a common outcome. We all want to see Canadians have access to prescription medications. The discussion is about the best route to get there. This bill proposes to put everybody on provincial coverage essentially. That may be an oversimplification, but that is what it is.
If we look at the situation today, between 95% and 98% of Canadians have prescription drug coverage, depending on which report we look at and depending on the types of coverage. Many people have private plans. Those private plans typically cover more than 14,000 medications compared to the public plans that cover 4,000 to 5,000 medications. The private plans cover, in addition to the medications, many services. People are getting physiotherapy, orthotics, various and sundry, with their plans. However, not a lot of people who have a private plan would want to give that plan up to go on a public plan that would have less coverage. That is certainly one issue.
Most provinces have a plan that covers people. There are some exceptions. For example, in Ontario, people under 24 get coverage. If they are over 65, they get coverage. If they are on social assistance, they get coverage. Otherwise, unless they have a private plan, there is no coverage. There are some gaps there.
The other gap happens in the Atlantic provinces. In some cases, there is a plan there, but because the list of approved drugs is small, many people cannot get coverage for the particular drug they are taking.
This brings up an important consideration when we talk about the bill. The member's bill talks about the Canada Health Act and its requirements for accessibility and universality. If we talk about universality, it is difficult to have that in different provinces when each province has a different list of drugs that are covered. This is called a formulary.
Some Canadians move between provinces to get coverage for the medication they need because is not covered by their province. Through consultation and discussion with the provinces and territories, we could come to a more common list of medications that would be covered. That would go a long way.
Many people who do not have coverage may not be aware that they have access to a provincial plan. There is an opportunity to increase awareness in that way, and that should be done.
On the cost of these systems, the cost of transferring and putting everybody on provincial plans has been estimated. The Liberal proposition was for a single-payer federal system of pharmacare, and the Parliamentary Budget Officer costed that at about $20 billion a year. However, some of the costs we were paying for prescription drugs were underestimated by about another $20 billion. Therefore, we are looking at about $40 billion a year for that. I think there was a lot of resistance in the public to that idea.
We have seen what happens when the federal government tries to implement things. For example, the Canada Revenue Agency has a 30% error rate with the advice it gives people and is not always friendly on the phone. I do not think people would necessarily want their prescription medications administered in that kind of system. However, people are fairly happy with the provincial systems, so filling the gaps that way is one option.
Other options could be considered, and it is certainly worthwhile thinking about them. C.D. Howe published a report that said if we put the people who did not have coverage on the existing provincial plans, the cost would be about $2.2 billion a year. That would be reasonable.
As an engineer, when I was a contractor, I had to buy my own benefits. For $1,200 a year, I could not only have prescription drug coverage but I could have dental and medical coverage. On a volume discount, if we take the 2% to 5% who do not have coverage and add it up, that is about $2 billion a year. There is an idea where people could go on government benefits.
There are a lot of ways to approach this and the discussion needs to be about which way makes the best use of taxpayer money and takes advantage of some of the systems already in place.
Let me talk for a minute about rare disease medications, because this proposal would do nothing to address some of the issues with respect to that.
Today, to get coverage for rare disease medications, private insurance companies pool their money so not any one company has to take the risk of these very expensive medications, some of which cost $250,000 a year or a million dollars a year. If the government infused money into that pool on the condition that everybody would get their rare disease medications covered, that would be another great way to ensure people would have coverage for some of the most difficult to cover drug costs.
Access to medications also depends on ensuring that drug companies want to market their drugs in Canada. Unfortunately, the Liberals have put changes in place to the drug approval process which will make the process longer and more costly. As a result, many companies do not want to market their medications in Canada because we are a small population and they would have to operate at a loss. This has also impacted the number of clinical trials happening in Canada. The government needs to definitely reconsider that poorly thought out policy.
If we look at some of the examples of innovation happening in the world, Chile has a great funding model that is infusing money into a rare disease fund, but also allowing people to buy government bonds that also kick into that fund. There are a number of innovative ideas around the world at which we should take a look.
I look forward to working with my colleagues on this bill toward the common goal of getting prescription medication access for all Canadians. A number of things could happen to our benefit out of this. We would have better volume leverage and could reduce the cost of drugs and take away some of the co-payer issues that provide barriers. I look forward to discussing all these things with my colleagues when this comes to committee.