Bill C-64 (Historical)

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

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

Madam Speaker, I listened to the speech of my colleague with great interest, and I know he is a great advocate for health care for Canadians.

I would like to ask him about the situation in Quebec. Maybe he is not that familiar with it, but we did hear how many unions are in favour of our health care plan, even if their members have employer drug insurance.

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

Madam Speaker, that is an excellent question because we have different levels of coverage throughout our country. Those levels of coverage, directly or indirectly, are going to correlate to whether individuals are more wealthy or not. Therefore, somebody who works in a corporation, for example an executive high up in the corporation, probably has really good coverage. As well, within the unions, there are going to be different levels of coverage.

This is about accepting, realizing and coming to the conclusion that we all deserve the exact same level of coverage, regardless of who we are, where we work or what our income is.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, in responding to the member from Quebec's question, the member just proved that he knows absolutely nothing about Quebec's pharmacare program. Everyone gets the same coverage and has access to the same molecules. The example he gave makes it absolutely clear that this government does not know what it is talking about when it talks about pharmacare. They are sorcerers' apprentices.

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

Madam Speaker, the member is referring to the question that was previously asked and not to my answer. I would say that maybe the member did not hear what the question was.

The question the member asked me was specifically about union support for this bill and unions in Quebec that support it. I would encourage my Bloc colleague, who stands up quite often for the workers of Quebec, to consider what the union folks in Quebec are saying about this legislation. From what I hear, they are saying that they are supportive of it, so maybe the Bloc members should really give some consideration to that when it comes time to vote for this.

The House resumed consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the second time and referred to a committee, and of the amendment.

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

Mr. Speaker, I was not sure I would get the opportunity to speak this afternoon, so I am glad to be able to join in debate on a very important bill, Bill C-64, an act respecting pharmacare.

Bill C-64 represents the next phase of the government's commitment to establishing a national universal pharmacare program. It proposes the foundational principles of the first phase of national universal pharmacare and our intent to work with provinces and territories to provide universal, single-payer coverage for a number of contraception and diabetes medications. This is an important step forward in improving health equity, affordability and outcomes, and it has the potential to provide long-term savings in our very endangered health care system.

Public health care in Canada was built on the promise that, no matter where one lives or what one earns, one will always be able to get the medical care one needs. Despite this promise, Canada is the only country in the world with universal health care that does not provide universal coverage for prescription drugs. In the bill, we talk specifically about contraception and the things needed for diabetes. They are very important aspects of this program.

When medicare was first introduced, prescription drugs outside of hospitals cost less and played a smaller role in health care. Today, prescription drugs are an essential part of our health, helping to control chronic conditions, treat temporary ones, and aid in overall health and well-being. We need to work harder to get those costs reduced.

One area that has seen significant change is diabetes treatment, as mentioned earlier by the minister and by other colleagues. Over 100 years ago, thanks to a Canadian team of researchers, Frederick Banting, Charles Herbert Best, John J.R. Macleod and James Bertram Collip, insulin was discovered. Since this monumental scientific discovery, there have been several advancements in diabetes treatment, from the introduction of fully synthetic human insulin to glucose monitors and insulin pumps.

These breakthroughs have improved quality of life immensely for people living with diabetes, whether it is by enhancing their self-esteem, increasing social participation, or improving overall health and well-being. Through hard work, one colleague in the House brought forward a program for a national diabetes strategy. These breakthroughs have come with higher costs, creating new affordability challenges for Canadians.

Outside of hospital, prescription drug coverage comes from a mix of private insurance, out-of-pocket cash payments and various provincial programs. While the majority of Canadians have access to some form of public or private insurance, about 2.8%, or 1.1 million Canadians, do not. We constantly hear just how expensive everything is in and around the diabetes forum on a monthly basis for an individual.

Although most Canadians have some form of drug coverage, as I mentioned, this does not mean that those with insurance have equal access to the prescription drugs they need. The existing patchwork system of private and public drug plans leaves millions of Canadians under-insured. That is, their out-of-pocket prescription drug costs create a financial burden that leaves them struggling to afford an essential part of health care.

In 2021, Statistics Canada found that more than one in every five adults in Canada reported not having the insurance they needed to cover their prescription costs. They had to decide whether they were going to fill their prescription or buy dinner.

Under-insurance can take many forms. For example, Canadians may have high deductibles, resulting in significant out-of-pocket costs before their insurance coverage even kicks in; they may reach the maximum annual or lifetime coverage limits for their insurance and have to pay out-of-pocket; or they may have high co-payments, which are often more than 20% of the drug's cost on private plans and sometimes more on public plans.

All provinces have drug coverage to protect Canadians from catastrophic drug costs, but deductibles under these plans can range from 0% to 20% of net family income. In many cases, Canadians will never reach the deductible, leaving them without any support for their drug costs. This variability across the country creates a postal code lottery.

We can again consider the advancements in diabetes treatments. For a working-age Canadian with no private insurance, out-of-pocket costs vary widely. In some parts of the country, out-of-pocket costs for people living with type 1 diabetes can be higher than $18,000 per year out-of-pocket; for type 2 diabetes, they can be higher than $10,000 per year in out-of-pocket expenses. Even those with private insurance can face high co-pays or exceed annual plan maximums, resulting in high out-of-pocket costs.

Even for cases in which an individual is not accessing devices that cost thousands of dollars, they can face significant out-of-pocket costs. For example, we can consider a woman in her mid-twenties who is working a minimum wage job. An IUD, one of the most effective forms of birth control, can cost up to $500 with no insurance. Even with private insurance, a co-pay of 20% would be $100. While IUDs can last from three to 12 years and save money over the long term, the high upfront cost can make them inaccessible.

Under-insurance can be a particular concern for young adults, who age out of their parents' private insurance but do not have their own form of private coverage. Lower-income Canadians also make up a disproportionate share of the under-insured. While most provinces have put drug coverage in place for those accessing social assistance benefits, a gap clearly persists. Many lower-income households that do not qualify for social assistance continue to struggle with out-of-pocket prescription drug costs.

Employment factors contribute to differences in insurance coverage. People with low-paying jobs, such as entry-level, contract and part-time positions, often report less adequate drug insurance coverage. This may even discourage people who are accessing social assistance benefits from applying for jobs: Once hired, they may lose their public drug coverage, but many entry-level and part-time jobs do not offer drug benefits. One study found that only 27% of part-time employees reported receiving medical benefit coverage.

Under-insurance can have serious consequences. Many Canadians with high out-of-pocket costs report forgoing essential needs, such as food and heat, or not adhering to their prescriptions because of the costs they have to pay. Statistics Canada also found that, in 2021, close to one in five Canadians spent $500 or more out-of-pocket for their prescription medication; almost one in 10 reported not adhering to their prescription medication because of costs. This includes delaying filling prescriptions or skipping doses in order to save money.

When people do not take their prescription drugs the way they are supposed to, their health can suffer, and this results in serious consequences for the individual and their household. It also results in unnecessary costs to the health care system, as patients are more likely to visit an emergency room and be admitted to hospital. For example, the full cost of diabetes to the health care system in 2018 was estimated to be around $27 billion, and it could exceed $39 billion by 2028.

I think we can all agree that no Canadian should be put in a position where they must choose between the prescription drugs they need for their health and well-being and putting food on the table. This is unacceptable, and it is why we are continuing our work to improve accessibility, affordability and appropriate use of prescription drugs as we move forward with national universal pharmacare.

I am thankful for the opportunity to speak to a very important bill, as we start the debate and move towards to the legislation passing in this House.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Mr. Speaker, it was an interesting speech. Once again, it would appear that the Liberals are suffering from counting problems today.

That being said, we have often heard today about the number of insulins covered on this fantasy pharmacare program proposed by the NDP-Liberal costly coalition. We know, clearly, that in British Columbia, on their formulary, there are 17 insulins covered, and on this program there are only nine. Again, we come back to the magical number of eight, which is how many insulins are not covered by this program. I thought I would give the answer to the member before there is difficulty answering the question, as there has been all day.

I would also like to ask a question. For a cash-paying customer paying for birth control pills, how much would that be a month? Certainly the numbers are not adding up once again.

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

Mr. Speaker, this is a new program that is being introduced. I cannot tell the House how pleased I am that it is here.

I have heard from my constituents, whether they are interested in the issue of diabetes support or in talking about contraception opportunities. At the end of the day, this would save lives and a lot of money. It would also make our country far more understanding and appreciative of what people are suffering. When we talk about affordability, we need to start by helping people with their drug costs.

[Simon-Pierre Savard-Tremblay, Bloc, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, I would like to thank my colleague for her speech. She is the chair of the committee I sit on. We have often worked together in the past four and a half years, almost five. I have sat on the same committee since I first came to the House, so I have had the opportunity to work with the chair.

I will digress briefly, if I may. I urge her to table the motion we adopted last Tuesday as soon as possible. It has been a week now, and it would be nice to see it tabled in the House as soon as possible.

Now that I have said that, here is my question.

Quebec is certainly not against pharmacare, seeing as we have our own plan and are very good at public programs. Why would it be so difficult to include a right to opt out with full financial compensation that would allow us to receive our share of the money and improve our existing programs? That would make everyone happy.

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

Mr. Speaker, the member's first question was regarding a report. The member can rest assured that I will report the motion to the House at the first opportunity I have to do so.

On to the issue of Bill C-64, this is the beginning. It is a new program. We expect that there will be times for alterations as to how we do things. We will continue to work with the provinces on how we do the rollout of this plan. I think the best thing the member could do would be to work with all of us, and all of the parties in the House, to see that this legislation, Bill C-64, gets passed as soon as it can.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, certainly New Democrats support investments in pharmacare. We support the national dental care plan, which is bitterly opposed by the lobbyists in the Conservative ranks.

We have to look at larger issues of health care. I want to speak about indigenous health care, particularly children's health care. The government has spent millions of dollars fighting against the implementation of Jordan's principle at the Human Rights Tribunal, yet we still see, time after time, the government refusing to pay in a timely manner for children who need treatment in all manner of areas. We have therapists who simply cannot keep the lights on because the federal government refuses to pay.

Does the member not understand that these are obligations that were ordered by the Human Rights Tribunal, and that if we are going to provide health care, it has to be done in a timely manner for the vulnerable indigenous children covered under Jordan's principle?

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

Mr. Speaker, I want to thank the hon. member for his commitment to his community and the indigenous community, in particular.

Bill C-64 is one more way for us to talk about health care in Canada. We are certainly talking about the indigenous community, but we are also talking about all Canadians. The more opportunity we have to look at where we could improve the system, the better it is for all of us.

[The Deputy Speaker, Chris d'Entremont]

Before I call the next speaker, I would remind members that we will probably have to stop right around four o'clock. The member might get her whole speech in, but maybe not.

The hon. member for Fort McMurray—Cold Lake.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Mr. Speaker, it is an absolute honour to be able to rise in this place and bring forward a perspective on this bill and to speak in support of the amendment that has been brought forward by my colleague and friend, the member for Cumberland—Colchester.

It is very terrifying to me, because this is effectively another fairy tale promise that the government is pushing forward, along with a long line of fairy tale promises when it comes to the things it is claiming it is doing on behalf of Canadians.

This bill is not a pharmacare plan. Government members might state that it is a pharmacare plan and they can repeat it over and over again, but that does not necessarily make it true. Just because one says something over and over again does not make it so. This is something I will repeat over and over again, because if they think that it somehow works, then maybe we need to bring this forward as well.

This is a legislative framework to look at possibly one day, maybe, kind of, sort of, creating a pharmacare scheme of sorts, but it is not a true pharmacare scheme because it would only cover a couple of different drug types for a couple of different spaces, and it flies directly in the face of many provinces. In fact, in my home province of Alberta, the health minister, who is a former colleague of mine, Adriana LaGrange, very early on was exceptionally clear that Alberta would pull out of a federal pharmacare plan, citing subsidy program concerns and a lack of consultation from the federal government.

Whether the government and its NDP partners in its coalition want to admit it or not, provinces and territories in this country are the ones constitutionally responsible for the delivery of health care in this country. Therefore, not doing adequate consultation with provinces and territories before bringing forward a bill that would directly impact the delivery of health care is exceptionally concerning and should concern every single person in this chamber, whether they care about what the Constitution says or not.

Inevitably, we will see something similar to what we have seen with so many of the bills brought forward by the government. It will end up resulting in a whole bunch of lawyers getting rich from court cases when it gets found out five years, six years or seven years from now that, unfortunately, it did not fall within the government's jurisdiction and it overstepped.

The government has an opportunity right now. We are giving it an out. We are giving it a pass. It can accept the amendment from my colleague and vote against this and allow us to have a bit more consultation and to have some real conversations about this. However, government members are not concerned about that. They want to bully through. They think that Ottawa knows best, and frankly, in Fort McMurray—Cold Lake and right across Canada, the people in those communities know better for their communities. The provinces know better about how to deliver health care than Ottawa will ever know, but the Liberals will not pull the cotton out of their ears long enough to listen, and that is very unfortunate.

Like I said, this is just a promise. This is a promise along the lines of so many broken promises over the last eight years from the government. The government promised affordable health care. The reality is that it doubled housing costs. It promised that the carbon tax would not cost us anything, yet the reality is that we found 60% of families are paying more because of these carbon taxes. It promised taxes would go down, yet the reality is that taxes have gone up. It also promised safe streets, yet the reality is that we see crime, chaos, drugs and disorder.

I point out these broken promises because Canadians deserve to understand that, after eight years, the Liberal-NDP coalition government is just not worth the cost. It bears repeating that it is yet again trying to buy votes with a fairy tale scheme of sorts to possibly one day look at something that should be looked at, but it should actually consult with provinces and territories, which is something the government has decided to completely abdicate its role in.

I want to highlight the fact that I would be splitting my time with the member for Souris—Moose Mountain, who is one of my colleagues on the health committee and someone who is very passionate when it comes to provincial jurisdiction, as well as making sure that people are getting adequate care.

Going back to the broken promises we hear time and time again, it is indicative of a pattern. If we do not look at the patterns and take the government at its word because it claims this is new and shiny and that we should trust it, that would terrify the people I have talked to in Fort McMurray—Cold Lake. It is something people do not want to hear. They know full well that Ottawa breaks the things that it touches. I hear that day in and day out. People are saying something might be an okay idea and that we should talk about it, but they do not trust that the government is going to get it done.

Housing is a perfect example of this. We have seen, under the last eight years of the Liberal-NDP government, that housing prices have doubled. People in my generation do not think they will ever be able to afford a home. It now takes longer to afford a down payment on a home than it took most Canadians in the previous generation to pay off their mortgages. If that does not terrify everyone in this room, there are some serious problems at play.

We will continue to fight for Canadians because they deserve to have someone to fight for them right now.

We understand that the NDP did this in a quest to grab on to some form of power and to prop up a government that it complains about on every occasion yet votes with time and time again. New Democrats will get up in question period and have a big fight, but when push comes to shove, they co-sign everything the Liberal-NDP government puts forward.

Canadians have had enough. I hear from them every single day, as do all of my Conservative colleagues. We hear from people who are struggling to put groceries in their fridges and feed their kids a nutritious meal. We hear from families who are struggling with whether to turn the heat up in the dead of winter or put food on the table. These are real, true, honest concerns, but the government seems to be completely negligent when it comes to standing up for Canadians.

The news is positive. Conservatives have been very clear. We want to see a few things from this government, especially in this upcoming budget. We want to see it axe the tax. We want to see it build the homes. We want to see it stop the crime, and we want to see it bring forward a dollar-for-dollar law so that Canadians do not have to pay for its extravagant promises and costs.

Frankly, the Liberals would do well if they took my advice, voted for this amendment and allowed us to axe this bill.

[The Speaker, Greg Fergus]

It being 4 p.m., the House will now proceed to the consideration of Ways and Means Proceedings No. 20 concerning the budget presentation.