Thank you, Madam Chair.
Very briefly, the provinces are responsible for the delivery of health services. The federal role and the role that we play is in the approval of the drugs. Are they safe? Do they do what they say they do? Are they made with quality, so that every pill that a person takes is the same pill and has the same medication in it? That is our federal role.
The other thing that we do—not through my organization, but under the federal Patent Act, through the PMPRB, the Patented Medicine Prices Review Board—is monitor pricing. If there is a view that prices of some of the patent drugs are exorbitant, then they can come in and set a maximum. That is the federal role with respect to this area.
Provinces then deliver the health services. In addition, they create formularies for what drugs they will choose to pay for in their population for seniors, for people on social assistance, etc. They make decisions about what they do and don't want to list on their formularies. The only exception is if a drug is provided in a hospital setting, it is provided. If that same drug is provided outside a hospital, it would be a provincial decision as to whether it was part of their formulary or not. In a nutshell, those are the main roles and responsibilities.
The final piece is the colleges and the role that they play in training their health professionals to use these drugs. There is what we call “off-label use”. Health Canada will approve a drug based on what the company says is the indication that they're looking for, and we will put that information to prescribers on the label. However, the college then trains physicians who can say, “That's great; that's what the indication is for, but we would also like to use this drug for other indications.” That's called off-label use. It is completely legal and allowed, and it is within their jurisdiction as well.