Health Committee on April 23rd, 2007

[LCol Dave Cecillon]

We also have jurisdictional issues across the country in that we are multi-jurisdictional across the various provinces and because our care can be provided after hours. Then there are also changes that you have to accommodate, because certain provinces may have certain drugs on their benefit lists that may not be on ours. We aren't able to facilitate care to all our individuals within our system, and sometimes we rely on the private system to do so.

Those are some of the differences, as well.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

I think we'll draw this to a close, then. We want to thank the witnesses very much for coming forward.

Mr. Batters put a late name on. I'm a little reluctant. We're into round two, but I'll allow Mr. Batters to go ahead.

[Dave Batters, Conservative, Palliser, SK]

Did you not have anything, Bonnie?

[The Chair, Conservative, Rob Merrifield]

We have business afterwards.

Mr. Batters, I'll allow you to go ahead with a quick question, and we will promise a conclusion very quickly.

[Dave Batters, Conservative, Palliser, SK]

Do I have five minutes, Mr. Chair?

[The Chair, Conservative, Rob Merrifield]

At most.

[Dave Batters, Conservative, Palliser, SK]

I have two quick questions. Well, they're not that quick, but the second one is quick.

Mr. Potter, from NIHB, can you comment on your policy of forced switching to generic drugs? Isn't this a policy that's based purely on cost containment, without taking into account the health of aboriginal Canadians, which of course should be the priority? What happens if the drug the patient is switched to does not work for him or her? If it's, as I suspect, a policy based purely on cost containment, can you tell us how much money the department saves by switching these clients to generic drugs, when of course you have to factor in the extra costs incurred for transportation and doctor visits as a result of changing these prescriptions?

Finally, why does this policy of forced switching to generics only apply to NIHB and not to Veterans Affairs and the Canadian Forces?

Thank you.

[Ian Potter]

The issue you're asking about is whether or not there is therapeutic substitution available. We follow what provincial governments have enacted in their laws and regulations with respect to classes of medication that fit the same treatment profile. So they deal with the same diagnostic issue.

[Dave Batters, Conservative, Palliser, SK]

How much money do you save? That's the rationale—

[Ian Potter]

No, the rationale is to provide effective care. The example perhaps you're looking at is our policy with respect to proton pump inhibitors, and when we introduced that, we looked carefully at the literature. We saw that based on the studies within that class of proton pump inhibitors, there were a variety of different products that had by and large the same therapeutic effect.

[Dave Batters, Conservative, Palliser, SK]

Do you factor in, though, sir, the extra costs in terms of transportation and doctors visits as well? The only rationale for the forced switching would be cost containment. That would be it. I mean, sure, you're going to argue therapeutic substitution, that it's the same benefit from the drugs, but do you calculate in the extra cost of transportation and extra doctor visits as well?

[Ian Potter]

We try to pursue this on an efficiency basis. Our mandate is to use the resources that Parliament votes to us in the most efficient way we have, without compromising the therapeutic programs. We work with physicians and pharmacists to ensure that the program is therapeutically sound and that the services are, as well, delivered in an efficient way.

[Dave Batters, Conservative, Palliser, SK]

Why is this a decision that you've undertaken, yet Veterans Affairs and the military have not seen fit to undertake the same decision?

[Ian Potter]

You'd have to ask them.

[Dave Batters, Conservative, Palliser, SK]

I'm going to ask them now.

[Verna Bruce]

For Veterans Affairs, I know we do some generic substitution. I'm not sure how much, so I will get back to the committee with that.

[LCol Dave Cecillon]

At DND, we also do generic substitution. However, what we've also done, prior to the partners, is enter into agreements with manufacturers, and contracts with manufacturers would sometimes give us a preferred price. Sometimes it may be better than the generic price. So there are a number of ways that we do it.

[Dave Batters, Conservative, Palliser, SK]

You don't have a policy of forced switching, though. Is that correct?

[LCol Dave Cecillon]

If we switch to a generic product, no, not forced switching.

[Dave Batters, Conservative, Palliser, SK]

So if the patient wanted to stay on the brand name pharmaceutical, they'd certainly be allowed to do so.

[LCol Dave Cecillon]

Again, what we have is a therapeutic interchange. Where it's deemed to be interchangeable in two jurisdictions in Canada, then, yes, we would only pay for the generic.

[Dave Batters, Conservative, Palliser, SK]

My last question of the day, Mr. Chair, is to all of the witnesses. If the CDR was eliminated through funding cuts, and here at this level we can only talk about the 30% that's funded federally, what would be the consequence, or would there be a consequence, given the tremendous duplication that seems to exist?

[Verna Bruce]

I can take it for the partners, and others can jump in.

It would slow down our ability to make decisions about whether or not drugs should be covered as part of our plans. We'd be into doing six times each, individually, what we're currently doing through CDR. With the partners working together, we'd try to share information, but we'd each be doing our own thing.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

With that, I will thank the witnesses for their presentations and thank the committee for their good questions. We will continue this study next time.

At this time we will take a quick pause and then we will move in camera.

[Proceedings continue in camera]