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.

Motions in Amendment

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

Madam Speaker, I am thankful for the opportunity to speak to a very important piece of legislation, Bill C-64, which deals with pharmacare and develops a framework for it. This bill, along with other investments made by our government, would help millions of Canadians who are struggling to pay for their prescription drugs. We had a very healthy process at HESA, the Standing Committee on Health. I want to thank all witnesses who appeared before the committee and those who sent written testimony because it really helped us understand the positive impact of this legislation.

This bill is a priority for our government. It establishes the fundamental principles for implementing a national pharmacare program in Canada. It also sets out our plan to work with the provinces and territories who so desire to propose universal single-payer coverage for a certain number of contraceptives and diabetes medications.

Since this bill was introduced, we have heard many facts about access to and affordability of prescription drugs within Canada. Statistics Canada's data from 2021 indicates that one in five Canadians has reported not having enough insurance to cover the cost of prescription medication in the previous 12 months. We know that having no prescription insurance coverage is associated with higher non-adherence to prescriptions because of cost. We also know that this results in some Canadians having to choose between paying for these medications and paying for other basic necessities, like food and housing.

This is why our government has consistently made commitments toward national pharmacare. Bill C-64 recognizes the critical importance of working with provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal single-payer coverage for a number of contraception and diabetes medications.

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

We have heard stories of people, or know someone, in our constituencies struggling to access diabetes medication or supplies due to a lack of insurance coverage through their work, or of an individual who has limited insurance coverage so they cannot choose the form of contraception that is best suited for them. For example, for a part-time uninsured worker who has type 1 diabetes and is also of reproductive age to manage her diabetes, it would cost up to $18,000 per year, leaving her unable to afford the $500 upfront cost of her preferred method of contraception, a hormonal IUD. With the introduction of this legislation, this individual would save money on costs associated with managing her diabetes and would be able to access a hormonal IUD at no cost, with no out-of-pocket expenses, once the legislation is implemented in her province.

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

The same cost-cutting principle applies to diabetes medication.

Diabetes is one of the most widespread chronic diseases in Canada. Although there is no cure for diabetes, there are treatments to manage the disease.

One in four Canadians with diabetes has reported not following a treatment plan due to cost. Improving access to diabetes medications would help improve the health of some of the 3.7 million Canadians living with diabetes and would reduce the risk of serious life-changing health complications such as blindness and 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 on the health care system due to its complications, including heart attacks, strokes and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028, as estimated by Diabetes Canada.

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

Beyond our recent work on Bill C-64, I would like to highlight some of the ongoing initiatives that this government has put in place to support our efforts toward national pharmacare.

On a national level, our government launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years. As part of the overall $1.5-billion investment, our government will make available up to $1.4 billion over three years to willing provinces and territories through bilateral agreements.

The strategy marks the beginning of a national approach to meeting the need for drugs used to treat rare diseases.

This funding would help provinces and territories improve access to new and emerging drugs for Canadians with rare diseases and would support enhanced access to existing drugs, early diagnosis and screening for rare diseases.

I would also like to highlight another initiative under way, which involves the excellent work by Prince Edward Island through a $35-million federal investment. Under this initiative, P.E.I. is working to improve affordable access to prescription drugs, while at the same time informing the advancement of national universal pharmacare. The work accomplished by P.E.I. has been remarkable. Since December of last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to five dollars for almost 60% of medications regularly used by island residents. I am pleased to share that through this initiative, P.E.I. residents have saved over $2.8 million in out-of-pocket costs as of March of this year.

Finally, on December 18, 2023, the Government of Canada announced the creation of Canada's drug agency, the CDA, with an investment of over $89.5 million over five years, starting in 2024-25. The CDA will provide the dedicated leadership and coordination needed to make Canada's drug system more sustainable and better prepared for the future, helping Canadians achieve better health outcomes. I am pleased to share that as of May 1, Canada's drug agency has officially launched.

In closing, members can see the extraordinary amount of hard work that has been dedicated to national pharmacare.

Bill C‑64 is a major step forward in our commitment to guaranteeing affordable, quality drugs for all Canadians. Our universal coverage plan for contraceptives and diabetes drugs will change the lives of individuals, families, society and our health care system.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, it is hard to know where to begin with the speech the parliamentary secretary just gave. I have heard some of this before at rare diseases conferences. I just want people at home to know that not a single rare disease drug would be paid for through this legislation. That is for starters. It is only mentioned once in this entire piece of legislation. Second of all, the Canadian drug agency is not created. CADTH is being repurposed and renamed into the CDA.

My question, though, is specifically on rare diseases because the parliamentary secretary mentioned them. Of the $1.5 billion announced all the way back in 2019, $1.4 billion is still left unspent. Could the member tell me which rare disease drugs were covered between 2019 and today, which patients received the drugs and for what conditions?

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, I want to thank the hon. member opposite for his advocacy on rare diseases and drug coverage. I have heard him speak before quite convincingly, and I thank him for the hard work he is doing.

The member is absolutely right. We have allocated $1.5 billion over three years, but that delivery will come through provinces and territories. We are doing the hard work to engage in bilateral agreements with provinces and territories so that we can flow that money through provinces and cover the cost of medication through bilateral agreements for rare diseases. That work is ongoing.

The work that we are doing through Bill C-64 on pharmacare is an add-on to that work. It complements the work that we are doing on rare diseases, and I look forward to continuing to work with the member opposite on this very important issue.

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

Madam Speaker, the Conservatives were fighting tooth and nail to stop the dental care program. More than two million seniors across this country have signed up for dental care already. In the first three weeks of the dental care program, 120,000 have had access to dental care, often for the first time in their lives. Conservatives fought like hell to stop that program from coming into being and helping their constituents.

Now the Conservatives are wasting $400,000 in taxpayers' money in a debate that is about deleting all the clauses of the bill, a meaningless, ridiculous, disrespectful debate that will cost Canadians $400,000 by the time it ends this evening to try to block pharmacare, which will help, on average, 18,000 Conservative constituents with diabetes medication and 25,000 Conservative constituents in every riding in the country in terms of contraceptives.

Why are the Conservatives so afraid of the benefits that the NDP has forced the government to provide that will actually make a difference and help their constituents' lives?

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, the truth is that the Conservatives do not support a pharmacare program. They do not support a Canadian dental care plan. They are throwing up all kinds of obstacles and denying the existence even of a Canadian dental care plan because they do not support that kind of really important help.

In fact, ideologically, they are motivated by private health care. If they have their way, that is what they will be championing, but on this side of the House, in this government, we strongly believe in a universal, single-payer system of health care and making sure that the most vulnerable in our communities get the care they need. That is why the Canadian dental care plan is such a success just in three weeks. The numbers cited by the member opposite are absolutely correct, and we will see more seniors and young people getting that health care because oral health is health.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I am wondering if my colleague can provide his thoughts with regard to how the Government of Canada works with other jurisdictions, in particular, the provinces, to look at ways that we can support Canadians in terms of medications.

I see this as a good, solid first step for pharmacare. I would ask him to add some comments with respect to that.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, the member and I share an experience. We have both served in the provincial legislatures in our respective provinces, Manitoba for him and Ontario for me. We know that one of the biggest responsibilities provinces have is the delivery of health care. That is why it is imperative that the federal government work with provinces and territories in delivering these programs. That is what this pharmacare framework legislation is all about. I am very much looking forward to entering into those bilateral agreements with provinces and territories once this bill is passed into law.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Madam Speaker, I would like to commend the members who may have the courage to sit late with us this evening.

Today we are debating Bill C‑64 to supposedly institute a national pharmacare program. I say supposedly because that is not what the bill does. Let us speak the truth. It is a bill mainly designed to playing politics, to the benefit of who knows who because by all accounts, the NDP is dropping in the polls.

What we are seeing today is a partial implementation of this system. The Liberal government, together with the NDP, is focusing on diabetes medication and contraceptives. What we are seeing today is a bit what the Conservatives have also been trying to do for a while now in this Parliament, to introduce American-style politics here in Canada's Parliament. We know that in the United States, in some states, the right-wing parties, the right-wing Republicans are attacking a woman's right to bodily autonomy. The Liberals are very afraid of the Conservatives, often with reason, because we know that there are a lot of people in the Conservative caucus who think that women do not have the right to control their own bodies. Essentially, the pharmacare plan is being used to Americanize Canadian politics.

Now, what this bill does is say that a national pharmacare program is needed. I want to point out that we are talking here about a federal national program, because we know that Quebec is a nation. The government is imposing a format. It is called first dollar coverage, which means that an individual must be insured and must have access to medication without having to spend a single penny. I understand that it would be ideal if many insurance plans, depending on the nature of the risk, were to say that, when a person is sick, they are not responsible for their situation. They did not do anything in particular to get sick, they are just unlucky and they should be insured and not have to spend a single penny. Society will be responsible for providing full insurance coverage.

However, Quebec already has an insurance program, a mixed insurance system. It is true that people have to pay a little. For example, for the public plan, when a person does not have a workplace plan or a private plan, they pay from $0 to $700 and change per year per person, depending on income. The contribution is geared to income. Most people have a plan through their employer that is negotiated as part of their collective agreement, so it is true that, in some cases, people pay a deductible for medication. They pay a certain amount, which is often very low, but everyone in Quebec is insured and the system already exists.

The money that is going to be used to meddle in Quebec's affairs in an area where the federal government is notoriously incompetent, namely health care, should be paid out to Quebec so that we can improve the system that already exists and help it evolve. There is a list of 8,000 drugs that are covered in Quebec. That seems to have piqued people's interest. The federal government knows it is going to be very expensive, so it is buying time. The Liberals know very well that this completely universal plan, where everything is covered, will never come to fruition before the Conservatives come to power. This plan deals with two health conditions. Do people realize how huge a gap there is between reality and rhetoric and how we could have taken this money and sent it to Quebec so that these funds could be managed based on Quebec's priorities?

Some of the debates we had were disgusting in many ways. We, in the Bloc, were told that by opposing Bill C‑64, we were opposing the well-being of the people in our own ridings, and that the only possible way to show concern for people's health, supposedly, was to support a bill that will not properly establish a universal pharmacare system for Quebeckers. That is going to be addressed through questions, if the Liberals ask any. They will tell us that we are against this or that, that we are against people's health, but that is absolutely untrue. We are in favour of insurance, but Quebec is ahead of the game, and we cannot totally upend the Quebec system just because at some point, 25 years down the road, the federal government and the NDP decided to wake up one Tuesday morning. We cannot do that.

One of the reasons the NDP included this kind of program in its coalition agreement with the Liberals, and one of the reasons the only NDP member from Quebec, the member for Rosemont—La Petite-Patrie, is fighting tooth and nail for Bill C‑64, is supposedly because the major unions support it. It is a delicate situation.

It is true that the cost of drugs has increased, as has the cost of health care services in general, as well as all health technologies. As a result, the cost of private group insurance has gone up. In many workplaces, employer and employee contributions have increased over the past few years. This can put pressure on people's ability to pay. This can put pressure on collective bargaining to get higher wages to deal with the cost of living. We recognize that. We know that is important.

The reason the unions might be united in supporting this federal legislation is not because Ottawa is capable, it is not because Ottawa is good, it is not because Ottawa is competent, it is because the money is in Ottawa; it is because there is a fundamental fiscal imbalance; it is because there are more revenues in Ottawa than the weight of responsibility on the federal government; it is because the provinces need money. The federal government is so determined not to transfer money unconditionally to the provinces that many people have at some point lost confidence in one day having a federal government that will act responsibly and transfer money unconditionally. At some point, the unions decided that they will support the minimum. They will support what they think is feasible in a context where the federal government's lack of respect for provincial jurisdictions and its contempt for Quebec have been institutionalized for decades. That is what is happening.

The member for Rosemont—La Petite-Patrie is grandstanding and saying that he has the support of the unions. The message that he should be sending to the unions is this. He should tell the unions that, with Ottawa running this program, they will get less value for their money. There will be fewer drugs and less coverage. The system will not be as effective. The government will be creating a redundant system. In the end, the workers are the ones who will pay. This measure is extremely anti-union.

The member for Rosemont—La Petite-Patrie should have acted more responsibly. He should have explained to the unions that we need to stand together and look to Quebec to get the transfers with no strings attached because Quebec is prepared to improve its system. That is what should be done.

I served on the Standing Committee on Health for several months. The ability to spend, the ability to put a knife to the provinces' throats, to make them accept conditions in exchange for money is in the NDP's DNA. I spent enough time in committee to know that.

The Bloc Québécois proposed a completely reasonable amendment. It asked for the right for Quebec to opt out with full compensation because Quebec already has all the necessary infrastructure. Quebec already has a system. Quebec is prepared to improve its system. It needs that money to continue this social development, which, as with day cares, means that, today, Quebec has a social policy—

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, I apologize to our hon. colleague.

I rise on a point of order. In a debate such as this, there seems to be, according to our constitutional requirements, a lack of quorum.

[The Assistant Deputy Speaker, Carol Hughes]

I am sorry, but quorum cannot be called during this debate.

The hon. member for Mirabel.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Madam Speaker, indeed, the absence of Liberal colleagues in the House should not be mentioned.

We have tabled an amendment—

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I rise on a point of order. Just to be very clear, there are members inside and outside the chamber, from all political parties, who listen—

[The Assistant Deputy Speaker, Carol Hughes]

I am sorry. Someone was speaking while you were speaking initially and I did not quite get what the hon. member said.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, it was just in reference to quorum. It should be noted that members cannot call quorum, as you have pointed out, but there are members, both—

[The Assistant Deputy Speaker, Carol Hughes]

Yes. Thank you very much. I think all members know very well what the rules are because of the fact we have been doing this over and again for quite some time. There is no quorum call during these debates.

The hon. member for Mirabel.