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.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks very much for everyone's testimony and for the range of expertise and expert opinion we have today. It's really welcome.

I've heard some, maybe, disparaging comments on the dental program. I just want to point out, on that note, that 100,000 Canadians have been served so far by the Canadian dental program, many for the first time. To me, this is a model of success, early success, of a great program. I think there are some things we can emulate with the proposed Bill C-64.

Mr. VanGorder, I want to go back to you. Thanks for appearing. I'm mesmerized by your backdrop, I must say. You wrote an editorial about pharmacare, and you talked about the successful collaboration between the federal government and P.E.I. in 2021. I wonder if you want to just comment briefly on that, on how that was a successful federal-provincial collaboration.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Bill C-64, except for diabetes medication and contraception, does not create a single-payer system. We don't know what the national pharmacare system is going to look like at the moment. It won't necessarily by the sounds of it be a single-payer system.

However, Ms. Eagan, in response to the idea of a single-payer system, you said this was wasteful because all Canadians would have to pay for it with taxes—which is true—but that, right now, many Canadians get it as a benefit from their employer.

It's not like that's free. That's part of your pay. You get paid a certain amount of money, but you get some benefits. It's a cost to the employer, and if the employer doesn't have to pay that cost presumably you would get more in your salary. If the government can have a system that is cheaper to run—and there is some indication that with a government-run system, a non-profit system, because of economies of scale, government could provide that system more cheaply than the employer could—that would be a net benefit to Canadians.

Would that not be the case?

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

Thank you, Mr. Chair.

Thanks to all the witnesses for being here.

Your remarks are interesting. You're giving us good information.

I'd like to go to you, Mr. Morin and Ms. Pelletier.

Pharmacists will definitely play a major role in the future of drug insurance.

Yesterday a large group of nearly two million Quebeckers, including members of the Centrale des syndicats démocratiques, the CSD, the Confédération des syndicats nationaux, the CSN, the Fédération des travailleurs et travailleuses du Québec, the FTQ, the Union des consommateurs, the Fédération interprofessionnelle de la santé du Québec and many other organizations, had this to say about the present situation in Quebec:

…the current Quebec drug insurance program can in no way guarantee all Quebeckers reasonable and fair access to drugs…“The various fees charged to drug purchasers are in fact copayments that have a deterrent effect: People skip doses or deprive themselves of certain drugs because they can't afford to buy them”…Furthermore, rising drug costs also put increasing pressure on private plans, leading workplaces to abandon their insurance and thus lose all their coverage.

These groups are calling for parliamentarians to pass Bill C-64.

You've obviously raised the matter of the formulary of drugs that will be covered. That aspect will be negotiated with the Quebec government. Other countries are fortunate to have universal, public drug coverage without any pharmacy closures.

Do you think it's important to ensure universal access to drugs that keep people alive and in good health, while being careful to negotiate repayment and to pay attention to how pharmacists are affected by this universal public system?

Is that the message you want to send today?

[Russell Williams]

At our meeting with the minister, those words were very reassuring because, when you take a look at the bill, there are a number of interpretations, which we heard about today, that cause a great deal of concern—excitement in some areas and concern in other areas—so the clarity from the minister is important. We did also talk about how the list that the government tabled is certainly not all-inclusive and doesn't reflect the clinical practice guidelines that Diabetes Canada creates with experts, and he assured us that this is a minimum list and one they'll start to work on. We supplied the committee members with a comparison between the clinical practice guidelines and the Bill C-64 list, as well as the NIHB list, which is a list of the government.

Ultimately, the care and management of diabetes is not one-size-fits-all. It's very individually focused, as you know. We have to make sure we build a program that will, on one hand, not just seem that there's a certain level of coverage but will actually be effective coverage for people with diabetes.

[Russell Williams, Senior Vice-President, Mission, Diabetes Canada]

Thank you very much, Mr. Chair and members of the committee.

Diabetes Canada has long advocated at the federal, provincial and territorial levels for improved access to medications, devices and services for the over four million people with diabetes. The goal of Diabetes Canada is to improve the quality of life for people living with diabetes.

Diabetes Canada applauds the government's intention to include diabetes medications and devices in the initial scope of the pharmacare plan. In fact, we see this as another step in building from the diabetes framework that was tabled last year.

Thank you, MP Sidhu, for your leadership in that.

However, there is an urgent and pressing need for those who are uninsured and under-insured. With broad consultation and careful implementation, this could represent a significant step toward reducing barriers. Providing comprehensive coverage and patient choice, continued improvement of care and a robust consultation system are our three key recommendations.

We recognize that there are significant gaps in coverage for some people living with diabetes. Our belief is that any public coverage should focus on addressing those gaps. As a first principle, we believe that government should focus on the uninsured and under-insured individuals, but the approach to diabetes management must also be comprehensive and align with Diabetes Canada's clinical practice guidelines. These guidelines are created by the country's experts and are one of the foundations on which physicians make informed decisions about patient care.

Unfortunately, the formulary that was tabled along with the law by the government is not aligned with the clinical practice guidelines or the NIHB program. It is limited in scope, excluding several key newer treatments while including older and outdated treatments.

We have produced a comparison of the proposed formulary of the CPGs and NIHB program. This document demonstrates that for many uninsured and under-insured individuals living with diabetes in Canada, most of the commonly prescribed medications would not be covered by the proposed plan. This is why filling the gap to focus on the uninsured and under-insured individuals to start with is so critical.

We met with the minister yesterday and he confirmed, though, that this list will grow and will move forward in terms of greater coverage.

We have to remember what we're talking about here, too. Let me underline the human reality. I know you all feel this. We're talking about the most vulnerable.

On our 1-800 line, which is open to all Canadians, we get a number of calls regularly from senior citizens who are choosing between rationing their drugs or going without. We get calls from people who are not taking the right amount of their medication because they can't afford it. Recently, we were getting calls about people concerned about their private insurance and whether they'd lose it during the transition to this law.

Again, we were assured by the minister, when we met with him yesterday, that people would not be shifted off their private insurance. These are two of the fundamental questions we had.

A further recommendation was the adoption of our principle of continued improvement and access.

Our CPGs have shown and new data continually indicates improvements to services, care and products. A pharmacare system must incorporate the principle of ensuring that new techniques and products that are more effective get incorporated into that plan when they become available. The system should actually welcome diverse approaches and creativity, including private insurance, while seeking universal coverage. Every province and territory has a distinct approach to its public formularies and pharmacare should be no different.

We already heard that Quebec's hybrid model is an interesting example and a good example to consider.

It's a universal plan, but it's mixed, both public and private.

We must ensure that all individuals do not lose access to drugs that they already have covered by private plans and are not included in the formulary. Unfortunately, we've seen examples of that issue in the past. Therefore, we are calling for a “do no harm” inclusion in the law to safeguard existing access to medications and ensure that persons living with diabetes can continue to access the latest treatments in care.

With these recommendations in mind, we believe that Bill C-64 needs a process of evaluation and practical analysis to ensure we set up the most effective system and ensure it's not just a debate about ideas, but a practical analysis for the effective system to improve access to medicines for people with diabetes.

We call for a more robust and transparent consultation process in the next steps of this law with people, patients, people with lived experience, health care providers, drug plan managers, researchers, provinces, territories and the indigenous communities.

We encourage parliamentarians to carefully ensure that this emerging national pharmacare delivers on its promise of improving access and ensures that no one gets left behind.

We appreciate the opportunity to share our ideas and are certainly open to questions.

Thank you very much.

[Jessica Diniz, President and Chief Executive Officer, JDRF Canada]

Thank you, Mr. Chair. I'm honoured to be here.

Good afternoon, members of the committee. My name is Jessica Diniz, and I'm the president and CEO of JDRF Canada.

JDRF is the world's largest charity focused on accelerating research to cure, prevent and treat type 1 diabetes and its complications, as well as helping to make life better every day for the people who live with it. We also advocate on behalf of the 300,000 Canadians living with type 1 diabetes, representing their voices on critical issues such as national pharmacare.

JDRF supports the goal of making access to medications and devices for treating and managing type 1 diabetes equitable and affordable for all Canadians. Patient choice needs to be a priority.

Type 1 diabetes is a lifelong autoimmune disease in which a person's immune system destroys insulin-producing cells in the pancreas, making them dependent on daily injections of insulin to survive. I just want to underscore that they require insulin to stay alive. I just want to make sure that is very clear.

Managing diabetes represents a significant financial burden for Canadians impacted by the disease, and many treatments and devices remain out of reach for some Canadians. We thank the government for bringing diabetes and the high cost to manage the disease into focus through coverage under Bill C-64.

While we align with the intention of Bill C-64 to provide fulsome, barrier-free access to treatments and devices for those living with diabetes, we'd like to raise a couple of recommendations to ensure that Bill C-64 meets the needs of all Canadians living with type 1 diabetes.

First, national pharmacare should not preclude anyone from using existing private and public insurance coverage to access insulin, whether they are listed on the national formulary or not. Bill C-64 should include a provision that clearly articulates this principle.

Second, based on consultations with health care providers and those living with type 1 diabetes, we'd like to see the list of insulins on the formulary be expanded to include more advanced insulins that help better treat the disease. It's a very limited list, including insulins that are rarely used and prescribed. It's important that physicians have therapeutic options to address the wide variation in individual patient responses to and tolerance of any particular drug, and that patients can access these, as one insulin may work well for one person and not for another. I think this is a very important point. By expanding the choice of medicines, you increase the number of treatment options available to help eliminate side effects, reduce complications and improve health outcomes.

We also have two areas of caution on how this program is implemented that we'd like to raise. Number one is changes in insurance coverage. The bill also creates a risk whereby the existence of the national formulary may motivate private insurers not to cover brand name insulins because some of the generic equivalents would now be available through the national pharmacare program. If this happens, the consequence could be the automatic substitution of a different insulin, which can impact health outcomes.

Another concern, number two, is stakeholder engagement and consultation. This will be critical to ensuring the implementation of a national pharmacare program that best meets the needs of Canadians living with type 1 diabetes.

JDRF is supportive of legislation that improves access to medications and devices for Canadians living with type 1 diabetes. We ask the government to provide clarity on this legislation to ensure it lives up to its intentions of equity and affordable access to medications and devices, and considers the input of various stakeholder groups that must have a voice now in how national pharmacare is rolled out.

It's critical to get the implementation of this legislation right to ensure it delivers on its promise, not only for those living with type 1 diabetes but for all Canadians who will benefit from this program in the future.

Thank you very much.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

We've heard from the Canadian Association for Pharmacy Distribution Management and the Canadian Organization for Rare Disorders. I think both of them sounded a note of caution about Bill C-64 being potentially a threat to access to drugs for rare diseases. Perhaps I'm not so surprised about that coming from Ms. Berg, but I am a little from Dr. Wong-Rieger.

Certainly, this bill does not create a single-payer system. We don't know as yet what national pharmacare would look like. Potentially, though, it would be a single-payer system.

I would have thought, particularly for Dr. Wong-Rieger, that there would be benefits with a single-payer system. I would have thought it would be more efficient. There are certainly cost savings to be had. There are certainly economies of scale in having one system. Right now, we have all these different providers. Each of these providers has its own management, and each of these managers and CEOs takes a bit of that money. This is money, in an employer-employee drug plan, that would probably otherwise be going to the employee. Instead it goes to the profits of the company providing the plans.

If you were to have one big plan administered by the government, you get economies of scale. There would be no money being siphoned off for profits, and there wouldn't be these many bureaucracies dealing with these different plans. There would be savings. In addition, if you buy 10 million pills at one time, you're going to get a better deal from a manufacturer than if you buy 100,000. If there was more money overall in Canada to buy drugs for everyone, wouldn't we then be able to afford drugs for rare diseases, which are often expensive?

Also, Ms. Berg, you were talking about shortages. Wouldn't we have money to provide for an emergency stockpile of medications, so we wouldn't have those shortages?

Perhaps I'll start with you, Dr. Wong-Rieger.

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

Thank you very much, Mr. Chair.

Thank you to our witnesses.

Ms. Silas, there is no doubt that Canada's nurses are the folk heroes of the pharmacare act. You'll recall three years and three months ago, we were working together on the Canada pharmacare act. It was a bill I sponsored on behalf of the NDP.

Canada's nurses did an extraordinary job. Some 120,000 Canadians wrote to Liberal and Conservative MPs to tell them to pass this legislation. We were all profoundly disappointed, as were most Canadians who supported pharmacare, that the bill went down to defeat with both Liberal and Conservative MPs voting against it.

Now, three years and three months later, you're testifying on behalf of the pharmacare act, which is extraordinary. You've sent a message to all parliamentarians. You wrote:

Passing this bill will help patients with diabetes and women who face the impossible choice between buying groceries and filling their prescriptions. This is not just a health care issue; it is a matter of fairness, equity and access. Investing in pharmacare will save lives, reduce overall health care costs and enable people in Canada to lead healthier, more productive lives.

We need you—

You are speaking to all parliamentarians:

—to act quickly and decisively. Your job is to protect and help build a public health care system that works for all people. Nurses across the country are doing their part, so put aside partisanship and let us make Pharmacare a reality.

That is an extraordinarily important message you're sending to all parliamentarians and to members of this committee.

I'd like you to tell us: What have Canada's nurses seen on the front lines with the lack of pharmacare, the lack of medication being available and people struggling to pay for their medications? What are some of the stories and the things that Canada's nurses have seen with the current system that lobbyists say are fine, but that Canadians want to see fundamentally changed?

[Linda Silas]

We all remember the 2019 report from Eric Hoskins. Dr. Hoskins and I were planning the pharmacare party, and then COVID hit.

I have to join you in congratulations to Dr. Wong-Rieger. I've been on many panels with Durhane. When I read the brief on Bill C-64, I was as excited to see rare diseases there, because 20 years ago, we weren't talking about it.

I believe that bureaucratic rules and obstacles shouldn't stop us from doing the right thing. We are improving health and we are improving the lives of Canadians with this bill. It's a door open, and we need to move on it.

[Dr. Durhane Wong-Rieger, President and Chief Executive Officer, Canadian Organization for Rare Disorders]

Thank you very much, honourable chair and members of the health committee.

Thank you for the opportunity to speak to you today. My name is Durhane Wong-Rieger, and I am the president and CEO of the Canadian Organization for Rare Disorders. I'm here to discuss Bill C-64 and, in part, its implications for the rare disease community in Canada.

I'd like to start, though, with a few facts that paint a bleak picture for Canadians with rare diseases. You may know that rare diseases affect over three million Canadians, the majority of whom are children. While most rare diseases affect children, we also know there are a significant number of adult-onset rare conditions that are being diagnosed.

Among the 7,000 known rare diseases, only 5% have an effective drug therapy. Unfortunately, one in three rare disease patients in Canada cannot access their treatments. In fact, only 60% of the treatments for rare disorders are made available in Canada, and most get approved up to six years later than they do in the U.S. or in Europe.

Even after the treatments are approved in Canada, many patients continue to face immense hurdles and delays in accessing new treatments due to the challenges related to the evaluation and funding of these medicines. When there are effective, available therapies, access can often be very challenging for patients. As you may know, they vary from one province to the other. As a result of these challenges, many patients experience an avoidable decline in functionality, and certainly many experience early death.

In an effort to respond to these challenges, on March 22, 2023, the federal government announced measures in support of Canada's first-ever rare disease drug strategy, including, at this time, a $1.4-billion investment for provinces and territories to improve access and affordability of rare disease medicines. This money had already been promised half a decade ago as part of budget 2019.

However, it's now been over a year since the funding announcement, and not a single penny has been spent to help fund rare disease drugs. While CORD supports efforts to improve access to medicine for all Canadians who need them, we're also concerned that the federal government has taken on another major commitment to fund a national pharmacare program when it hasn't even delivered on this promise to fund rare disease treatments—a promise that, as we said, was made over five years ago.

Notably, clause 5 of today's Bill C-64 would commit the government to long-term funding, beginning with products for rare diseases. We have to say it's unconscionable and unethical, and certainly really challenging for patients, to introduce a program designed to transform and save lives, and then fail to execute on it.

Moreover, given the lack of promised progress on rare diseases, what does that say in terms of the prospects for success of this pharmacare legislation? We need to see the prioritization for rare diseases in action. It was a promise made. When it comes to improving medicine access and affordability, CORD strongly believes that rare diseases represent the area with the greatest unmet need in Canada.

The federal government should focus first on rolling out the promised funding for rare disease treatments before undertaking another major pharmacare plan.

However, with respect to the bill itself, CORD has a number of comments. The predetermined categories, lists of medicines and proposed single-payer approach all risk limiting treatment options and potentially bringing everyone's level of coverage down to the lowest-common denominator. This is a concern.

Additionally, Bill C-64 outlines specific timelines for its key components, yet the rare disease drug strategy lacks a detailed implementation plan and time frame. The rare disease drug strategy must also be afforded clear timelines, publicly accountable milestones and opportunities for patient and clinical input. This is not in the current rollout.

Lastly, the formation of expert committees, as stated under Bill C-64, must ensure genuine advisory roles. CORD's experience with the current rare disease drug strategy implementation advisory group has highlighted significant issues with transparency, communication and accountability. Effective implementation of national pharmacare requires these committees to provide meaningful input, rather than service mere formalities.

I'd like to close by noting that Canada has an opportunity to become a leader in providing access to cutting-edge therapies that significantly impact patients' lives. We must aim high, ensuring that our national pharmacare program and the rare disease drug strategy deliver the best possible outcomes for patients with rare and common diseases alike.

Thank you very much for your attention. I'm open to any questions you may have.

[Linda Silas, President, Canadian Federation of Nurses Unions]

Thank you, Chair.

As mentioned, my name is Linda Silas and I'm the president of the Canadian Federation of Nurses Unions. As a nurse, I don't have to do what Angelique did and explain what we do. CFNU is the largest nursing organization in Canada. We represent over 250,000 unionized nurses and nursing students working everywhere, including in home care, long-term care, community care and acute care.

I'm so honoured to finally speak to you today on a bill that has been considered a leading priority for nurses for many years. It is a step towards a universal pharmacare program. CFNU has commissioned numerous studies and polls over the years to help build the case for the overwhelming merits of a public, single-payer pharmacare program in the country. You will be hearing from Dr. Marc-André Gagnon later on today, who was the author of one of our first reports.

There are many reasons why nurses support a public, single-payer pharmacare program: the positive health outcomes it would bring to our patients, the equitable access it would provide everyone in Canada, and the capacity it would free up in our health care system through avoidable hospital room visits and costs related to non-adherence to prescription drugs.

The latter point is the critical point I want to talk about today: the health human resources crisis. Each quarter, we witness the number of nursing vacancies rise to record heights across the country. Sadly, nurses are still working in our crippling system. We see patients unable to access their medications. They really should be at home, but they need to stay in our waiting rooms and hospital beds just to take their medications.

Members of Parliament, you have the power to change this today. We are thrilled to see Bill C-64 move ahead in the direction Canada's nurses have long advocated for. It is in sync with the recommendation of every major government study and commission on the matter, including the advisory council on the implementation of national pharmacare of 2019.

Ensuring universal access to contraceptives and diabetic medication and supply through a single-payer public system is a hugely significant improvement to our universal public health care system. It marks a fundamental step towards a truly comprehensive and universal national pharmacare program. Every day, nurses see first-hand the consequences of failing to provide equitable coverage for birth control and diabetic medication to our patients, from unwanted pregnancies to individuals who lack access to diabetic medications and supplies. They end up in our hospitals. This includes children and working Canadians. Patients divide their pills or go without them to buy food. This has to stop.

Canada's nurses have been lobbying parliamentarians like you for 30-plus years to move toward a universal national pharmacare program. Yes, it has to be single-payer and public, because that's what the evidence says is the best way to be fiscally responsible with our public dollars. That's what Canadians expect of us—to not have our health care services stop at a visit to the doctor or nurse practitioner.

Sadly, we are seeing many voices out there in support of the status quo. They say that Canadians are adequately covered by the patchwork system in place, and that a fill-in-the-gaps approach is the best way.

Nurses are motivated by the great care we can provide in this country. We say the best way to do that is through a universal public approach to prescription drugs. We urge you to follow 20 to 30 years of evidence, push ahead the passing of this bill and continue on the path of implementing a comprehensive, universal, national and public single-payer pharmacare program.

I stand proudly with all of you who will vote yes on Bill C-64.

Thank you.

[Angelique Berg, President and Chief Executive Officer, Canadian Association for Pharmacy Distribution Management]

Thank you, Mr. Chair and members of the committee. Thank you for your attention today.

I'm Angelique Berg, president and CEO at CAPDM, the Canadian Association for Pharmacy Distribution Management.

CAPDM is the nation's trade association for wholesale distributors that channel over 90% of the medicines our country consumes. With their trading partners, distributors form our efficient, accurate and reliable supply chain that ensures physical access to medicines, so naturally we support the aim of Bill C-64. We support both affordability and access in balance and not at the expense of one or the other.

Importantly, we recognize the enormous challenges that government and our citizenry face: slowed economic growth, regulatory overburden, health care system insufficiency and a growing percentage of the population over 65. I mention these to tell you that we're aware of the broader context, and we stand with you in navigating solutions where we can be of value.

To appreciate our comments relative to Bill C-64, I'll provide some basics about the supply chain because we rarely think about how our medicines get to us, just so long as they do.

The supply chain begins with manufacturers, who sell to distributors, who then sell to pharmacies and hospitals. Purchases flow the opposite way: from pharmacies, who buy from distributors, who buy from manufacturers. Rounding out that supply chain are service providers to this core supply chain, like third party logistics firms and transportation companies. The majority of Canada's pharmacy supply chain stakeholders are CAPDM members.

Distributors streamline orders and deliveries for 15,000 product SKUs between hundreds of manufacturers and over 12,000 points of dispensing over nine million square kilometres, creating efficiencies that save the country over $1 billion annually. Their safety stock also provides a short-term shortages buffer against drug shortages. The sector has over 30 distribution centres, all of which comply with at least three overarching acts, up to seven different Health Canada licences and very high technology to meet the conditions of all of those. The sector has roughly 20,000 employees—experts in inventory turnover and the secure and complex handling of all medications—and they are the backbone of our pharmacy supply chain.

Our market is challenging. It's a controlled market where funding is limited, yet operating and regulatory costs are not. Distribution is largely funded as a factor of the listed drug prices: The lower the price, the less funding is available to get medications to Canadians.

Costs have increased at least 2.5 times faster than volumes in the last five to 10 years, with market forces and increasing regulation. The gap is estimated at over $100 million annually, and distributors have so far absorbed that through eliminating expenses to stay in business and with only minimal impact to Canadians.

Assuming that it is striving for lower drug prices, we see that Bill C-64 has the potential to erode physical access and to exacerbate drug shortages. Because they run so efficiently, reduced funding means that distributors have few options left but to reduce services. Some examples are that they could stop carrying money-losing products, which would be those of the lowest cost; reduce safety stock, which eliminates the buffer against shortages; or reduce delivery frequency to high-cost regions or eliminate them altogether.

CAPDM members are understandably concerned about some of Bill C-64, generally about reduced drug pricing and specifically about a restrictive national formulary, which was addressed in last evening's panel, and bulk purchasing. Evidence suggests that these types of policies limit suppliers. When the government awards a contract to a single manufacturer, that firm effectively becomes a monopoly, so competitors have little incentive to stay in the market. Concentrated marked power increases the risk of limited supply, and therein lies our concern.

We recommend that this policy change be approached with caution, that further regulatory burden be avoided and that time be taken for consultation with all supply chain actors to uncover potentially unintended consequences so that Bill C-64's aims can be successful.

We don't have all the answers—we dearly wish that we did—but we're most willing to collaborate with government to find them in order to ensure safe, secure and timely physical access to medicines for all Canadians, and that's why we exist.

Thank you on behalf of the CAPDM board of directors, and I welcome your questions.

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 117 of the House of Commons Standing Committee on Health.

Before we begin, I would like to ask all members and other in-person participants to consult the cards on the table for guidelines to prevent audio feedback incidents.

Please take note of the following preventative measures in place to protect the health and safety of all participants, including the interpreters. Please use only the black, approved earpiece. The former gray earpieces may no longer be used. Keep the earpiece away from all microphones at all times, and when you are not using your earpiece, place it face down on the sticker placed on the table for this purpose. Thank you for your co-operation.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting. As a result of those connection tests, one connection was unsatisfactory to participate in the meeting, so we have a smaller witness panel than is contained in the notice of motion. Jessica Diniz from JDRF will not be with us on this panel. I have taken the executive decision of adding her to one of the later panels today, provided that we can come up with the right technology so that she can fully participate.

Pursuant to the order of reference adopted by the House of Commons on May 22, 2024, the committee is commencing its study of Bill C-64, an act respecting pharmacare.

As indicated in the memo that was sent out a couple of days ago, I would like to remind members that amendments to Bill C-64 must be submitted to the clerk of the committee by four o'clock today. It's important for members to note that, pursuant to the order adopted by the House on May 22, 2024, the 4 p.m. deadline to submit amendments is firm. This means that any amendments submitted to the clerk after the deadline and any amendments moved from the floor during clause-by-clause consideration of the bill will not be considered by the committee.

Without further ado, I would like to welcome our panel of witnesses and thank them for their patience as we attempted to overcome our technical difficulties.

We have with us today from the Canadian Association for Pharmacy Distribution Management, Angelique Berg, president and chief executive officer, appearing by video conference. In the room with us representing the Canadian Federation of Nurses Unions, we have Linda Silas, president. Also online for the Canadian Organization for Rare Disorders, we have Durhane Wong-Rieger, president and CEO.

Welcome to all of those who have joined us to help us out with Bill C-64. We are going to start with opening statements in the order that appears on the notice of meeting, so we are going to start with the Canadian Association for Pharmacy Distribution Management.

Ms. Berg, welcome to the committee. You have the floor.

Health

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

Mr. Speaker, that is a very thoughtful question. Of course, our number-one priority is to protect Canadians and to make sure they have all the necessary medications available to them. That is why we are actually bringing in pharmacare legislation, Bill C-64. I really hope the member opposite will support that bill because it would allow Canadians to have access to, initially, diabetes medications and contraceptives.

In relation to the particular medication the member is speaking of, I look forward to looking into it and working with him so that I can give him a more precise answer on the approval process for that particular medication.

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

Great. Thank you for that.

One thing that is not captured in Bill C-64 and that Canadians have relied on now for many years is the expanded scope of practice in the professional life of pharmacists. Is that something that you think should be captured in this bill?