Evidence of meeting #4 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Elinor Wilson  President and Chief Executive Officer, Assisted Human Reproduction Canada
Brien Benoit  Chairperson, Patented Medicine Prices Review Board
James Roberge  Chief Financial Officer, Canadian Institutes of Health Research
Sharon Watts  President and Chief Executive Officer, Hazardous Materials Information Review Commission
Pierre Chartrand  Vice-President, Research, Canadian Institutes of Health Research

4:10 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

I couldn't tell you an exact number, but I can tell you that we have about 90 investigations. That doesn't mean that 90 of them are going to result in a determination of excessive pricing, but it means that something in their reporting has triggered a red flag and our staff is looking into it in more detail.

4:10 p.m.

NDP

Judy Wasylycia-Leis NDP Winnipeg North, MB

I appreciate that.

I'm going to go on to the issue I've raised in the past when PMPRB has been before our committee, and that's the question of the averaging based on comparing the seven countries. I think it's the top range of seven top European countries, right?

4:10 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

Those countries were determined...and I've asked this question since I've been there. Those European countries were determined.... They're in the Patent Act, actually.

4:15 p.m.

NDP

Judy Wasylycia-Leis NDP Winnipeg North, MB

Right. Is there any reason--

4:15 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

Now, the Patent Act was written in 1987. You might ask, well, what about Japan? What about Australia? But they're not in our comparator countries.

4:15 p.m.

NDP

Judy Wasylycia-Leis NDP Winnipeg North, MB

Would you suggest that perhaps we--the committee or the government--should look at this fairly old legislation to see if it's still current and try to reassess the effectiveness of the formula?

4:15 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

There are a lot of economies and health care systems that are similar to Canada's that are not included in the seven comparators. I understand that the seven were chosen because their health care systems were similar to Canada's.

4:15 p.m.

NDP

Judy Wasylycia-Leis NDP Winnipeg North, MB

Okay, I appreciate that.

I'm going to stick to drugs for now, and then hopefully we can get to some of the other areas. There's more we need to know on this front. As you know, drugs are the second fastest growing part of our health care system, and if we don't figure out a way to get on top of it, it's going to kill medicare, so we have to find a way to do it.

One of the issues is about brand name drug companies agreeing to spend 10% of their expenditures on research and development in return for patent protection. We know that's not taking place. In fact, I think you reported back in June 2008 that 8.9% had gone into R and D. That even seems high, but it's still below the 10%. I'd like to know, first of all, how you evaluate research costs. Do you rely on independent auditing or industry self-reporting? What do you do to try to correct this shortfall, and is there any consequence for the manufacturers?

4:15 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

I'll answer the last part of the question first. We have no mandate to regulate how much percentage of gross revenues are invested in R and D in Canada; we simply report that. The figures come from the companies themselves. We have not audited the R and D expenditures of any company, and I'm not sure it's in our mandate to do that. We have no authority to do that.

In the 20-some years that the board has existed, I believe the industry has invested more than 10% on one or two occasions, but usually it's a bit less than that.

4:15 p.m.

NDP

Judy Wasylycia-Leis NDP Winnipeg North, MB

You report and you hope that some among us will take some action. Okay, we'll try to follow that up.

Let me ask about some of the high-cost new cancer therapies and biologic drugs that have been appearing on the market of late, not just here but internationally. Given that you rely on international comparisons, what are you doing at the international level to address these expensive treatments to keep them accessible for Canadians at the lowest cost?

4:15 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

First of all, we have various price tests. If you have a new cancer drug, let's say the cure for lung cancer, that would be deemed a breakthrough drug. The price that would be permitted under our concurrent guidelines would be the median international price. We would go to the publicly available price in those seven countries and determine the median of that, and this would be the price that would be permitted in Canada.

Let's not forget that provinces have different reimbursement priorities. Whereas Alberta may say we're going to pay for that drug, Prince Edward Island may say the cost-effectiveness is not enough to justify paying for it, and that's why there's a lot of discrepancy across Canada on these major drugs. So they get paid for in Alberta, not in Ontario, and we can't control that.

4:15 p.m.

NDP

Judy Wasylycia-Leis NDP Winnipeg North, MB

What if we had a national formulary? What would that do overall?

4:15 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

That'd be nice to have.

4:15 p.m.

NDP

Judy Wasylycia-Leis NDP Winnipeg North, MB

Nice to have?

4:15 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you very much, Ms. Wasylycia-Leis.

Can we now go on to Mr. Carrie? I understand you're sharing your time with Mr. Brown. Thank you.

4:15 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

I'll be splitting my time. Thank you very much, Madam Chair.

I did want to change the topic a little bit. I see that we have Assisted Human Reproduction Canada here. If you're paying attention to the news lately, we hear about these octuplets being born and a 60-year-old with twins. And I know friends of mine have used this technology successfully.

I do understand the statistics. Infertility is on the rise in Canada. I have two questions. First, how can your agency address this issue? Then the second one is, understanding that your agency has been in operation for about three years, how are you seeking to engage stakeholders?

4:15 p.m.

Conservative

The Chair Conservative Joy Smith

Dr. Wilson, do you want to take that one?

4:15 p.m.

President and Chief Executive Officer, Assisted Human Reproduction Canada

Dr. Elinor Wilson

Certainly.

Thank you very much for the question.

Yes, you are correct, infertility is on the rise in Canada and is of great concern. It's due to many factors, but one of the largest factors is the increasing age at which women are choosing to have their families. There are other issues as well, as you are aware: obesity, smoking, and sexually transmitted infections.

But whatever the cause of infertility, it is actually written into the act that the agency does have a mandate to educate the public about infertility. This has been part of our outreach in terms of starting to explore who else is engaged in educating the public about infertility. Also, where are the gaps in that education and how can we as an agency best fill those gaps?

A project that's under development is looking at what young people in the school system are taught about infertility. In the school system we spend a lot of time teaching young people about how to prevent fertility at an inappropriate age, as you know, but there's not a lot of emphasis on the issue of, yes, we do not recommend people perhaps getting pregnant at 16; however, this does not go on forever in terms of your window of opportunity. That's one project under development. As well, we already have phase one of our website in place, with questions and answers about that, and we're working on phase two.

The second part of your question, if I recall, sir, was about our outreach strategy.

One of the key issues of being a regulatory agency is understanding extremely well the field that you're regulating in. We've had an extensive outreach strategy to identify not only the patient groups but the professional side.

We've established relationships with the Infertility Awareness Association, IAAC, which is one of the major patient groups in Canada, as well as the Lesbian, Gay, Bisexual, Trans Parenting Network. These agencies have helped us learn more about patients' concerns in this area. They've also had the opportunity to educate our board about what the patients' concerns are.

On the professional side, our outreach has been to two major groups, the Canadian Fertility and Andrology Society, which is a subset of physicians who specialize in this area, and the Society of Obstetricians and Gynaecologists of Canada, and then other groups, such as, for example, the Canadian College of Medical Geneticists, and the Canadian family physicians, first of all to find out what their challenges and issues are in this area and also to start to already educate about the act, its provisions, and the kinds of things that we will need to be overseeing as the regulations are brought into force.

4:20 p.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Thank you.

4:20 p.m.

Conservative

The Chair Conservative Joy Smith

Mr. Brown.

4:20 p.m.

Conservative

Patrick Brown Conservative Barrie, ON

Madam Chair, I wanted to go back to the topic of the Patented Medicine Prices Review Board, which Ms. Bennett and Judy have already touched upon a little bit.

I am concerned. I would like to hear a little bit more of an explanation on this budget increase, the $4.7 million, which would be a 76% increase. Just looking at the annual report leading up to this, the note I saw in the 2007 annual report is that of the 1,114 drug products, 22 were currently having hearings. It looks like there's a high compliance rate. Are things changing? What would equate with the need for this growing budget?

Looking at this from a broader perspective, if you look back from 2004 to today, it looks like the budget has gone from $5 million to $11 million and the number of staff has gone from 44 to 62. Could you explain what the causes of this significant budget change have been?

4:20 p.m.

Conservative

The Chair Conservative Joy Smith

Mr. Benoit.

4:20 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

As I was trying to answer to this side of the table, the volume of work has increased. We have 22 drugs of the 1,100 that are deemed to be non-compliant. This is more than in the past. There has been a trend towards relative non-compliance. You may say that 90% are compliant and that's really great. That's a reflection on the success of the regime, I might say, but there are more that are not compliant. There are various reasons out there for that.

In Canada, there are fewer breakthrough drugs being introduced, so the pharmaceutical companies, in order to improve their margins and so on, are creating incremental improvements for which they ask a higher price than our scientists, our staff, and our regulations feel is warranted. That's basically the issue of it. That's why we have the hearings.

4:25 p.m.

Conservative

Patrick Brown Conservative Barrie, ON

Just on that note, how has that changed in terms of compliance today compared to four years ago when the budget was $5 million? Was the compliance different?

4:25 p.m.

Chairperson, Patented Medicine Prices Review Board

Dr. Brien Benoit

The act hasn't changed and our regulations haven't changed.