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.

Pharmacare Act

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the House recognized Quebec as a nation. Through a unanimous vote in its National Assembly, Quebec is calling for a right to opt out with full compensation to improve its own program, which it has been administering for 30 years.

Does the leader of the NDP agree with the Quebec National Assembly?

[Jagmeet Singh, NDP, Burnaby South, BC]

Mr. Speaker, the offer today is for all Canadians and all Quebeckers. We want to give them free contraceptives. That will really help women in Quebec. I know that this is going to be costly, but there is a great need for it.

It is the same thing for diabetes medication. We want to provide free drugs and medical devices. That will help people in Quebec. What we want to do is work together with the provinces and Quebec. We want people in Quebec to get the same coverage as people in the rest of Canada. For me, it is unacceptable to have free diabetes medication in Ontario but not in Quebec. I will not accept a situation where Nova Scotians get free medication but Quebeckers do not.

Here is what we want to do. We want to create a situation where everyone across the country has access to free medication. That includes Quebec.

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

Mr. Speaker, I know that the member's riding of Burnaby South is always near and dear to his heart. I wanted to ask, through you, about the impact of this important historic legislation on people like Amber in Burnaby. Amber pays $1,000 a month for a diabetes medication.

How would this legislation help the member's constituents in Burnaby, like Amber?

[Jagmeet Singh, NDP, Burnaby South, BC]

Mr. Speaker, on that great question from my colleague, it is important to point out that although the Conservatives and the pharmaceutical industry will mention there is coverage that people have, many people have coverage that requires a co-pay or that has a cap on how much is covered, and they have to spend money out-of-pocket. Having access to free diabetes medication and devices means it would be entirely free; it would cover that medication.

When we think about the cost, if someone does not take the medication they need, they end up having worse outcomes and end up in an emergency room, and that costs all of us. It is not only a saving for that person, not only a saving for Amber, but also an improvement to the overall health care system if people can stay healthy and can prevent illnesses.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I want to acknowledge that today is the fifth anniversary of the National Inquiry of Missing and Murdered Indigenous Women and Girls, Two-Spirit and Gender-Diverse People. We need to acknowledge today that the government is failing to address the genocide against indigenous people, and that is failing both indigenous people and all Canadians. I certainly hope that the government prioritizes those calls for justice, knowing that to date we have only achieved two of the 231 calls for justice.

Today we are here to speak about Bill C-64. Today is, as my leader, the member for Burnaby South mentioned, historic. It is not just historic because of pharmacare. I do want give a shout-out to the Edmonton Oilers, who are now going to the Stanley Cup finals as of yesterday. It was a very big day.

I also want to start by saying how grateful I am to our leader. Our leader, the member for Burnaby South, has been a strong advocate for pharmacare for years. Instead of just being an advocate, he rolled up his sleeves, got to work, worked with the Liberals and he forced the Liberals, against all their historic votes, to put this framework in place.

I am so grateful to be a New Democrat today. I am so grateful to work with such a strong leader. I am also extraordinarily grateful to all the advocates who have done so much for decades to move this forward.

I want to start by talking a little about one of my constituents, Pat. He came into my office, and he had a challenge. We are really proud of health care in Canada. Canadians should be proud of our public health care system. However, when Pat came into my office and talked to my team and I, he told us that he had been able to see a doctor and he had been referred to a specialist. The specialist was able to give him treatment. The problem was that the medication for his treatment cost $400, and he did not have that $400. While our health care system is a point of pride, thanks to the health care system that Tommy Douglas developed, Pat was able to get part way there, but he was unable to get the treatment that would actually help him. It was never supposed to be this way.

When Tommy Douglas envisioned our health care system, pharmacare was always supposed to be part of that system. We know that Canada is the only country that has a medicare program that does not include pharmacare. It does not make any sense that we will treat Canadians to a certain point, but that we will not get them over the finish line without access to medication.

Today is an opportunity to make pharmacare a reality for millions of Canadians and to lay the groundwork to create a fully universal pharmacare system for all Canadians. It is truly historic.

Pat is not alone. A few months ago, I sat and listened to Albertans share their challenges and experiences at a pharmacare round table in Edmonton. One after another, Edmontonians stood up and they talked about how the lack of prescription coverage had affected their lives, how they had to juggle their bills and how they had to worry about groceries, utilities and rent, on top of their prescriptions. They had to make choices about which of those things they can afford.

As members of Parliament, sitting in this place, every one of us has a health care plan that covers our medication. However, for so many Canadians who do not have that access, this is game-changing. This is the difference between paying their rent and taking care of their health at the same time.

It was not just lower-income Canadians who were speaking out for pharmacare. Business leaders and health care professionals were all speaking about how important pharmacare was for them and why they wanted the government to move fast on this.

I spoke to a paramedic who shared his experience providing emergency care and transportation to hospital for people who could not afford their prescriptions, people who would be doing well if they had taken their medications appropriately, if they had not thought about cutting their pills in half, if they had not thought about taking a pill every second day. Those decisions that people are making are impacting their health, which in the long run have large costs on our health care system as well.

Doctors are so frustrated that their patients are not getting better because they cannot afford the treatment. Small business owners, despite paying more than minimum wage, can not possibly pay their employees enough in order to afford their medications.

A couple months ago, I sent out a mailer on pharmacare, as we all do in this place. I wanted to know what people in Edmonton thought about pharmacare. The response from constituents in Edmonton Strathcona was overwhelming. Ninety three per cent of people indicated that they were in favour of a universal pharmacare program and only 5% indicated that they were unsure or opposed. This mirrors national polls that put support for implementing a national pharmacare program to provide equal access to prescription drugs for everyone in Canada at 87%.

Last year, an Alberta-wide poll found that 74% of Albertans supported universal pharmacare. As the president of the polling company noted, the overwhelming support in Alberta for a federal program like this was surprising. He said, “Getting three-quarters of a population to agree with any piece of public policy these days, it is a bit astounding. It's very popular in Alberta.” He added that approval of the idea largely crossed all demographics and all regions of the province. Canadians understand and they know that we must care for one another. We must take care of each other, and universal pharmacare is a promise to take care of each other.

This legislation is not the end point; it is just the beginning but a very important beginning. We need the bill to create the mechanism for a full-fledged universal pharmacare system that covers all Canadians. No matter how young or how old, no matter where they live and no matter how they make their living, all Canadians have the right to prescription drug coverage, and this legislation is critical in getting it for them. The legislation is always going to be critical, but, right now, with coverage for contraceptives and diabetes medication, these two classes of drugs would impact millions of Canadians.

For example, nearly four million Canadians are affected with diabetes, a disease that impacts every aspect of their lives. In my province of Alberta, individuals with diabetes have had to fight the provincial government repeatedly to ensure they get the care they need and deserve. The bill would means that people living with diabetes may finally be able to put those battles aside and finally have hope for their future. By treating diabetes with devices and supplies on the same terms as the prescription medication, this legislation would save diabetics hundreds, if not thousands, of dollars each year.

With regard to contraceptives, we know the impact of contraception on women across the country and how vitally important this is. Manpreet Gill, the president of the Edmonton Zone Medical Staff Association and associate professor in the division of General Clinical Medicine at the University of Alberta, has written about the importance of contraceptive coverage to health and especially health care in Alberta. Dr. Gill states:

The cost of hormonal therapy (including for birth control) and intrauterine devices (IUDs) is a barrier for Albertan women to receive medically necessary care....

It also perpetuates unfairness in the system, resulting in unplanned and unwanted pregnancies. Universally available contraception would reduce the number of abortions, reduce economic stress on young and poor women and improve child and maternal health. It is estimated that 40 per cent of pregnancies in Canada are unplanned and it seems obvious that those who cannot afford contraception cannot afford to have a child.

The current patchwork system in Alberta is blatantly unfair. First, it is obvious that birth-control costs are primarily borne by women while men bear no such equivalent costs....

Secondly, while it is true that private plans cover birth control, it is worth considering two facts that this reveals. One, birth control reduces the costs to a private health plan, that’s why it is offered, and two, those that most [have that] need [are unable to] access...it.

As a woman, as a mother and as a mother of a daughter, I want my daughter, and every daughter in our country, every daughter in this world, to have access to the entire range of reproductive health care, including contraceptives. A system that provides access to some, those who can afford care, while denying access to others is not a system that I can support. Reproductive health care is health care, period.

Finally, I want to thank all the advocates across Canada who have worked so hard and so long to create this legislation. I want to thank Chris and the powerful advocates at Friends of Medicare in Alberta, who have worked not months, not years, but decades for this universal pharmacare. I want to thank the Canadian Labour Congress, the Alberta Federation of Labour and all the labour leaders, organizers and members across Canada who have put the needs of all Canadians, regardless of union membership, at the forefront of their campaigns for pharmacare.

We are here today because of the hard work of so many Canadians and so many leaders in our country. I continue to be delighted and honoured to work with all those leaders to ensure we get this over the finish line.

The House resumed consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the third time and passed.

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

Mr. Speaker, it is an honour to rise to speak to such an important piece of legislation, our national pharmacare bill, Bill C-64, which was introduced by the member for Ajax, the minister responsible for health care. In my opinion, this particular legislation is a long time coming. When health care, what Canadians have become accustomed to in Canada, was first introduced many decades ago, I think that there was always an expectation that Canada would follow suit with a pharmacare piece of legislation.

Indeed, it is my understanding that Canada is the only country in the world that has a health care plan that does not also have a pharmacare plan. I think that it is incredibly important that this piece of legislation is here. I have been listening to the debate over the last number of weeks regarding this particular bill, and I have found it quite interesting what I have heard in the House about it.

For starters, I want to say that it is a piece of legislation that I see as a starting point. It is a point at which we can start to implement a national pharmacare plan, in particular to help some of the most vulnerable Canadians get access to medications they need. I will address that point in more detail in a moment. More importantly, this is a starting point in the sense that we will start by having two major medications that Canadians use, medications for diabetes and contraceptives for individuals who require them.

I say that because I know that almost four million people in Canada are currently using medications for diabetes. This piece of legislation, even though it is only a starting point covering two specific medications, would certainly have an impact on so many people in our country. With the portion that is just for diabetes, that is nearly four million people on its own.

Bill C-64 would establish a framework, and that is the important thing. It is a framework toward a national universal pharmacare plan in Canada for certain prescription drugs and related products, including free coverage of contraception and diabetes medication, as I have already mentioned. The bill would also provide that the Canadian drug agency work toward the development of a national formula to develop a national bulk purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications.

I think that the part regarding the bulk purchasing strategy is so incredibly important because this is where Canadians would see the benefit of having a national pharmacare plan. The idea that we can, as a whole country, purchase medications in bulk would give us that purchasing power that I think is needed to be able to make the purchases at a fair price, a price point that we as Canadians will ultimately be paying for through our taxes.

Finally, the last part of the bill is that, within 30 days of receiving royal assent, the minister would need to establish a committee of experts to make recommendations regarding the operation and financing of national universal single-payer pharmacare. The committee would be required to provide its report of recommendations to the minister no later than one year after the bill receives royal assent.

As I indicated earlier, when one talks about a program that is this big and this complex, it is important to have that proper oversight and to have a committee of experts making recommendations to the government on how to proceed. When we talk about the number of people who would be impacted by this, I find the conversation in the House to be really interesting, and this is something I alluded to a few moments ago, because it would be a benefit that everybody would be covered under the program. The reason why I say that is that I think it is very easy to make comments, such as I have heard from Conservatives in particular, that so many people are already covered. There are already people who are covered under their private plans. I think about 80% of people are covered in one way or another.

However, not everybody is covered in the exact same way. For starters, at least 20% of people are not covered under any plan, and these would be the most vulnerable because these are people who would have to go to the drug store to pay for their medication out of pocket. On the other end of the spectrum, there are a lot of people who are fully covered, and there are some really good plans out there. There are some really good employers. There are some really good institutions that provide plans to their employees and family members that are going to cover a lot, up to, in many cases, 100% of the cost of medication. Then, there is everything in between concerning what the coverage is and how much coverage there is. This is why it is so important that we talk about universal coverage. Sure, 80% of people might have some degree of coverage, but not everybody is covered the exact same way. I think it is extremely important that everybody has the same basic universal coverage.

When we look at the way we are treated when we go into hospitals, everybody is treated the exact same way. At least, it is supposed to be this way, and it could be argued that provinces are setting up things differently. If we go into a hospital emergency room, we will see triage. The hospital will determine the critical nature of a person's visit, how quickly a person needs to be dealt with, and everybody is treated the exact same way. Most importantly, when we are done and when we leave the hospital, we just go home. There is no one asking for a credit card or a billing address. We have the luxury of having a health care system that covers everybody, which does not ask people to pay when they are in, quite frankly, what would be their most vulnerable state.

I think one of the problems with my generation, and generations after mine and a few before, would be that the idea of having to pay for medical care seems almost foreign. It certainly does to me. I never think to myself, “Wow, I should go get this checked out, but what's it going to cost me to do that?” That is never something that enters my mind.

Members can just imagine that, if I were living in the United States, for example, there would be a lot of people who actually have to make that choice. They say, “Well, I should get checked out, but what is it going to cost me to do that?” This is one of those luxuries that we have with a single universal health care system such that we have here in Canada. It is not something that enters our mind because I think we believe, as a society, that there is a certain onus to take care of each other when it comes to our health care, which is what our health care system provides, notwithstanding the fact that we could get particular about what different provinces are attempting to do now. However, that is the reality of the situation.

When we talk about pharmacare and the drugs that we also need to be healthy, we have to ask ourselves why they are not treated the exact same way. What I see with the bill before us is an attempt to move in that direction.

There are two very important, or at least very popular, medications that a lot of Canadians use to start with. This comes from the same premise that, when somebody needs to take care of diabetes, for example, or somebody wants access to contraceptive medication, they should not have to filter into the equation of the decision whether they would have to pay for it, for starters, as 20% of the population would, or how much of it they would have to pay for. They should not have to ask, “Do I have to pay for a portion of it? Does my coverage only cover 60%, and so I have to pay 40%? Does that make it worthwhile to do this?” Canadians should not have to think that perhaps they could go against their doctor's advice and not get the medication because they think they will be fine.

These questions should not be asked by Canadians. There are a lot of seniors out there who rely on a lot of medications who should not have to say, “I have to make a decision between getting the medication I need or buying food.” They should not be making those choices, and they should not be saying that maybe they will only take half the dosage they have been prescribed because at least then they are still taking something but are not spending as much.

When we talk about health care and pharmacare, it is my position that it should be treated in the same way that we talk about health care and accessing care in terms of going to see a physician or going to the hospital. That is why I think the pharmacare bill is so important, because, as I said, it certainly does not cover every drug. It actually covers only two very important and widely used drugs, but it sets the framework for how things can evolve from here.

One of the things I find really interesting, when we are having this discussion about universality and the fact that it is just two pieces of very important medication, is what I have been hearing from Conservatives to this point. They are getting upset over the fact that it would not cover a lot and a lot of people would not be covered. They are basically saying that more should be invested. I have heard the member from Battle River—Crowfoot talking about how we are not doing enough. Nonetheless, they will still vote against the bill.

I cannot help but wonder why they are saying we need to do more, but then are against the idea fundamentally. I do not know whether Conservatives are doing what we have seen them do a number of times before, which is to start by talking about a piece of legislation and trying to critique it all day long, only to then vote in favour of it when the time comes, or whether they have a plan for universal pharmacare that is even more ambitious than this one. I find myself somewhere in between, trying to figure out what they are really trying to get at with this.

At the end of the day, we know that this is something that would help Canadians. We know, and I strongly believe, that the concept of having a universal pharmacare system, in the long run to cover many more drugs, is certainly my goal. That would be to the great benefit of all Canadians.

The legislation is a huge step forward in delivering better health care to Canadians. As I said, it lays out the plan for universal single-payer coverage for contraception and for diabetes medication. This would mean nine million women and gender-diverse Canadians all across the country could get access to the contraception and reproductive autonomy that they deserve.

Notwithstanding the fact that lately we have heard some Conservatives start to talk and to reopen discussions about reproductive autonomy from decades ago, the reality is that we believe that when somebody makes choices about what to do with their body, in particular when it comes to reproductive aspects, they should be able to make those choices. A woman should be able to make those choices. In my opinion, the government should be there to support them in making whatever choice they think is the best for them as an individual.

Although the piece of legislation before us, as I previously said, would not cover every medication, or a lot more medication as I would ultimately like to see, it certainly would be a starting point, a place to begin. It would be a place to lay the groundwork. It would be a place to engage the experts to provide feedback as to how we could move forward. It would allow us to start somewhere significant, given the number of Canadians it would affect, and then from there, to grow.

I am really looking forward to the day when we can say that our pharmacare and the medications that Canadians depend on so much will be treated in the exact same manner that we see in the rest of our health care system, in particular when we go to visit a doctor or we have to go to an emergency room, as I described earlier.

I really hope Conservatives vote in favour of this at the end of the day, despite some of what I have been hearing. This is a great opportunity to show the country that the bill is not something we will make political and that it is something that truly would benefit many Canadians. It would help the 20% or so of people who might not have some degree of coverage. It would equalize the very well-off people with some of the most vulnerable in our communities by saying it does not matter what one's socio-economic status is and it does not matter what one's income level is. We respect the fact that all Canadians should have access to the medications they need so badly, and that their doctors, through our health care system, could provide it to them.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Madam Speaker, the place to start with pharmacare should have been with the people who have no money to cover medication, and that is in the catastrophic category of people who need medication but cannot afford it because it is not worth a drug company's while to mass-manufacture the drug. That being said, we have experienced shortages in medication, particularly for diabetics, in the not-so-distant past.

Given that there are so many people with diabetes and that it would be difficult to triage people on a one-on-one basis, how would the government decide who gets the medication and who does not, in the instance of a drug shortage? In other words, how would the government decide who lives and who dies?

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

Madam Speaker, with respect to the first part of her question, the member should know that there is already a program in place that specifically deals with rare diseases and the drugs associated with them. That angle of it is actually already covered.

With respect to her question about shortages, this is exactly why a national program like this, where we could purchase in bulk, makes sense. Companies that supply and that bid on bulk sales would know exactly what the demands would be based on what the government is asking for. They would also be helped to be able to produce the devices and drugs.

It does not take somebody who has been in business a long time to understand that when they have a customer, such as a government that asks for a certain product, or they get into a contract to manufacture a certain product, they will have to start delivering that product. I think we would steer away from the shortage problems.

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

Madam Speaker, at the beginning of his speech, the member said that it was important to have the expertise required and a committee of experts to analyze things. We do, in fact, have expertise in this area, and it is in Quebec.

My question is simple. What is the problem with the decentralization of funds to Quebec, which could work fully in its own jurisdiction, in an area where it already has a system in place?

It is important to remember that Quebec is ahead of Canada in these areas. That is the case in almost every social area. All of the parties recognize that. Why crush this system with something new when we already have a system that works and that could be improved upon? We have the same objectives and we agree on the basic premise. Why then does the federal government not want to transfer the amounts with no strings attached?

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

Madam Speaker, the member asked what the problem with it is. The problem is that I want to learn from that expertise. He is saying that Quebec already knows everything so Quebec should just be left alone. I am saying that the whole point in bringing the experts together is to learn. I want the experts in Ontario to learn from the experts in Quebec, because I think that, yes, Quebec is very successful at a lot of things. If the member is correct in everything he is saying, the rest of Canada has a lot to learn. I am looking forward to that learning opportunity with the incredible experts who obviously exist in Quebec already, as per what the member just said.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Madam Speaker, the member for Kingston and the Islands in his speech observed a unique Conservative critique that we have heard emerge. The Conservatives criticize policies as not being good enough, and then they vote against them entirely. If pharmacare is not perfect, the answer, in their minds, is no pharmacare whatsoever. If dental care excludes some Canadians, instead of amending or improving it, the answer is no dental care unless someone has private coverage. If Canada ranks 62nd out of 67 countries on climate change, then the answer is somehow to have no climate plan.

What does the member make of this unique logic?

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

Madam Speaker, I am glad that when I said that, the message got across. I was not exactly sure how to phrase it, but it is exactly what the member is saying. That is what we are seeing. The member for Battle River—Crowfoot said, in his 20-minute speech, that the system would not be a good one because it would not be for these people or those people, and that therefore we need no system.

Conservatives do the same thing on just about every issue. I do not know why they are doing this. I wanted to ask the member for Battle River—Crowfoot, if he does not like the proposed pharmacare plan, to tell us about his pharmacare plan, because we know they do not have one.

I just find it incredibly rich to continually hear Conservatives get up to talk down programs, almost implying that they would bring along an even better program. However, I think there is nobody in this room, and no Canadian who looks at this stuff objectively, who would think that Conservatives would be interested in a pharmacare plan, because we know they would not be.

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

Madam Speaker, my colleague talked about the fact that the program would be addressing two main elements, contraceptives and diabetes. I am thinking from the affordability angle and would like to hear his comments on that. We know when people are all of a sudden confronted with a huge expense or an unexpected, long-term expense what that can do to their budget. I would like to hear him comment on how the pharmacare program would help.

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

Madam Speaker, the affordability aspect of it, I think, is really important. I do not think it really matters what one's economic background or economic status is, but if any Canadian were to go into a hospital and receive a bill afterward, any of us would be taken aback by that just because of the concept. I have friends who live in the United States. One gave birth recently and received a bill for $26,000. It is absolutely insane.

The same logic has to apply to the medications we need. It is not even just about helping people with the costs; it is also about the investment. If we help people take care of themselves now, we are not going to have to pay as much when they end up in the hospital because they were not able to afford the medications they were prescribed.

What the bill is really about, and what I tried to emphasize in my speech, is that there are varying levels of affordability right now. Some people, 20% or so, have absolutely no coverage. Some people have the platinum level of coverage where they do not have to pay anything. Then there is everybody else in between. Some people pay 60%, and some people pay 40%, 20%,10% or whatever it is depending on who is covering them. At the end of the day, in my opinion, the coverage needs to be universal, just like the coverage is universal when it comes to receiving health care from a physician or in a hospital.