Health Committee on May 16th, 2016

[The Vice-Chair, Conservative, Len Webber]

I'd like to call the meeting to order, please.

I would like to thank all of our presenters who are here today. We have a busy day of presentations, so I won't waste any time.

I would like, though, to go around the table and have you introduce yourselves and let the panel know what constituency you're from. That would be a nice thing to do.

[Kamal Khera, Liberal, Brampton West, ON]

I'm Kamal Khera. I am a member of Parliament from Brampton West.

I see a lot of familiar faces and it's good seeing you all. I'm also the parliamentary secretary to the Minister of Health.

[Nick Whalen, Liberal, St. John's East, NL]

I'm Nick Whalen. I'm the member of Parliament for St. John's East, and I'm subbing on the committee today for Bill Casey.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Good afternoon. My name is Doug Eyolfson. I am the member of Parliament for Charleswood—St. James—Assiniboia—Headingley in Winnipeg.

[Sonia Sidhu, Liberal, Brampton South, ON]

I am Sonia Sidhu from Brampton South.

[John Oliver, Liberal, Oakville, ON]

My name is John Oliver. Thanks very much for being here. I'm the member of Parliament for Oakville.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

I am Darshan Kang, member of Parliament for Calgary Skyview. Thanks for being here.

[Colin Carrie, Conservative, Oshawa, ON]

I am Colin Carrie, MP for Oshawa.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm Don Davies. I'm the MP for Vancouver Kingsway and the health critic for the New Democratic Party.

[The Vice-Chair, Conservative, Len Webber]

I'm Len Webber. I'm chairing the meeting today for Mr. Bill Casey, who is with his wife as she is going through some surgery right now. We wish them well.

Let's start with our presentations here today. We're going to start with Lisa Ashley. You have ten minutes, and then we'll ask questions after all the presentations are done.

Thanks.

[Lisa Ashley, Senior Nurse Advisor, Policy, Advocacy and Strategy, Canadian Nurses Association]

Thank you very much. I'd like to thank the committee for this opportunity.

I represent the Canadian Nurses Association and 139,000 registered nurses. I am a registered nurse and a senior nurse adviser at the Canadian Nurses Association.

Our prepared brief and my comments today align with the positions of other national nursing organizations, collectively representing more than 400,000 nurses in Canada.

As you know, Canada is the only developed country with a universal health insurance system that does not include universal coverage for prescription drugs.

At this stage of your consultations, you're well versed on the issues that catalyzed the call for a national prescription drug program. You've heard informed estimates of needs and costs. The Canadian Nurses Association relies on that same data, experts, and peer-reviewed literature to inform our recommendations.

Today we are pleased to contribute the professional perspective of nursing. From our vantage point in acute and long-term care and in community settings, the inequities in access to prescription medication are clear.

Every day we work with patients, their families, and their caregivers. Every day they make choices between filling a prescription and purchasing other necessities, such as food. We see vulnerable Canadians with chronic conditions caught in cycles in which they cannot access the medications they need to stay healthy and as a result end up in emergency rooms and clinics, needing urgent and complex care. The problems you have heard about are real.

What we know is that Canadians pay more than citizens in other comparable countries for prescription medications. As time advances, Canadians are paying more for prescription drugs and getting less. Significant savings could be redirected to other health care gaps, such as health promotion, home care, or palliative care, and the vast majority of Canadians would support a national prescription drug program. Canadians want this.

What we need now is political leadership.

The Canadian Nurses Association's mission includes promoting a publicly funded health care system. As part of this, we believe every Canadian should have timely access to safe, affordable, and effective prescription drugs, and that no citizen should be deprived due to inability to pay.

Today, I highlight five recommendations from our prepared brief that outline a role for the federal government, in partnership with the provinces and territories, and as both a funder and the fifth-largest provider of health services in Canada, to implement an equitable pan-Canadian strategy for prescription medications.

First, the Canadian Nurses Association recommends comprehensive, universal, public, affordable prescription medication coverage that ensures access based on need and not the ability to pay.

Fewer than 50% of Canadians are covered by public drug plans that pay for day-to-day prescription medications, while nearly 100% of citizens are covered in virtually all similar countries. As you have heard, as many as one in five Canadians reported not taking medications as prescribed because of concerns about cost. This increases their risk of poor health outcomes and complications, which is more costly overall to the health care system.

Second, Canada requires information and mechanisms to support appropriate prescribing practices. This includes government support for the implementation of Choosing Wisely Canada and for a portion of Canada Health Infoway funds to be targeted for e-prescribing.

In addition, the federal government could modernize the Food and Drugs Act and food and drug regulations to enable nurse practitioners to distribute drug samples in a way similar to that of physicians, pharmacists, dentists, and veterinary surgeons.

To expand on this, a medication that is inappropriate for a patient is not only wasteful and expensive, but it can also bring side effects that require other medications. Seniors in Canada who are given multiple prescriptions are often at the highest risk of medication misuse. Given our aging population, prescribing practices must be aligned with Canada's seniors strategies in order to limit such use of multiple medications and promote adherence to best practice guidelines.

Updated federal legislation that allows nurse practitioners to provide patients with samples is one simple, no-cost measure the government could enact that would help address access and safety. I would be pleased to discuss this in more depth.

Third, the Canadian Nurses Association recommends purchasing strategies such as bulk purchasing to reduce drug costs. Canada has achieved some progress in this area with all jurisdictions, including Quebec and the federal government participating in the pan-Canadian Pharmaceutical Alliance, the pCPA.

Provinces and territories are also working together to reduce the price point of commonly used generic drugs to 18% of the brand name price, but there are still efficiencies to be realized.

Fourth, CNA recommends the establishment of a single pan-Canadian formulary to eliminate inequities in the availability and cost of drugs between provinces and territories and to reduce the administrative costs of maintaining 13 separate lists of drugs. Our current system results in significant variation in the number and types of drugs covered and lag time between the regulatory approval of new drugs and their formulary listing.

In addition, there are many differences among private health insurance company formularies. A pan-Canadian formulary would eliminate regional inequities in prescribing patterns and drug prices and would provide clear guidance to drug companies during their listing process of what profit they can expect.

Fifth, the Canadian Nurses Association recommends that governments implement mandatory generic substitution, allowing for patient choice at their own expense and for prescriber reservation notes against substitution for medical reasons.

Several countries, including Norway and Sweden, employ mandatory generic substitution. Doctors and nurse practitioners are obliged to prescribe the least-expensive equivalent product unless a serious medical reason exists for more expensive alternatives. Pharmacies are also obliged to inform patients if a less-expensive generic alternative is available. If patients do not want the generic version, they must pay the difference out of pocket. When generic drugs should be avoided for medical reasons, doctors and nurse practitioners may provide reservation notes against such substitutions.

Our written submission also contains recommendations for attaining a stable supply of clinically safe and cost-effective drugs and for the federal government to address medications for rare diseases, which the committee has also heard about from other witnesses.

In closing, the Canadian Nurses Associations offers these recommendations today to assist the standing committee in comprehensively informing the development of a comprehensive, universal, public, affordable, pan-Canadian pharmaceutical strategy. By adopting these recommendations, the standing committee can contribute to better health, better care, and better value for all Canadians.

Thank you.

[The Vice-Chair, Conservative, Len Webber]

Thank you, Ms. Ashley. I appreciate that.

We're going to move right on to our next presentation, from the Canadian Pharmacists Association.

Mr. Eisenschmid and Dr. Emberley, please start your presentation.

[Perry Eisenschmid, Chief Executive Officer, Canadian Pharmacists Association]

Thank you very much, Mr. Chair, and to the committee, thanks for inviting us to join you today.

My name is Perry Eisenschmid. I'm CEO of the Canadian Pharmacists Association. I am joined by my colleague Phil Emberley, CPhA's director of professional affairs, who is also a practising pharmacist here in Ottawa.

We're here today on behalf of Canada's 40,000 pharmacists. Every day pharmacists see the impact on patients when they can't afford their medications. Not only do they counsel patients to help them get the most from their prescriptions, but pharmacists are the ones who must deliver the devastating news that a patient isn't covered.

Pharmacists are, quite simply, the health care professionals closest to this issue. It's pharmacists' proximity to some patients' daily struggle with inadequate prescription drug coverage and the negative impact on patients that drives our efforts to inform the conversation on national pharmacare.

Our primary concern is ensuring that patients have access to medically necessary medications that are right for them. Above all, we must prioritize health outcomes and patient needs. Investing in the right drugs and services early on is not only good for patients, it is also necessary for the sustainability of our health care system.

From CPhA's perspective, the status quo is not acceptable. Let me be clear: CPhA absolutely supports a plan for pan-Canadian pharmacare in which the federal government has a role in ensuring that all Canadians have access to medically necessary medications, regardless of income.

CPhA believes any future pan-Canadian pharmacare plan must address four key priorities: first, ensuring all Canadians have access to the medications they need; second, protecting Canadians from undue financial hardship; third, ensuring patient access to a stable supply of clinically effective and cost-effective drugs; and fourth, providing access to the full range of pharmacy services.

We have two main messages here today to convey to the committee. The first is that the committee should consider both incremental and long-term solutions. The second is the importance of the word “care” as an element of pharmacare.

This committee has heard testimony from witnesses with different ideas about how best to help those Canadians who don't have coverage or whose insurance doesn't go far enough for them to make ends meet. We all agree that Canada can provide better access to prescription drugs. The real question is on how we get there.

Broadly speaking, the discussion has been framed around an assumption that there are only two ways we can approach this issue: create a brand new national pharmacare system, or build on our existing system to make it more equitable and efficient. It's our position that this need not be the case. These choices aren't mutually exclusive.

What we do know is that Canadians don't want their friends, their family, or their neighbours to have to choose between paying the rent and paying for medications. We also agree that moving towards a new national pharmacare system that could replace all public and private plans would take time to develop and implement. In the meantime, many Canadians would still have to go without the medication they need.

That's why we're recommending both immediate steps to improve Canadians' access to medication as well as considerations for a longer-term approach. Our research provides the committee with various practical and affordable options to enhance the current system that could immediately help those Canadians who are falling through the cracks.

In the long term it's important to recognize that all potential models have strengths and potential drawbacks. Regardless of the approach Canada pursues, we should be fully aware of the potential risks. This is especially important as they relate to access and achieving optimal health outcomes, and we should identify ways to mitigate those risks. At the end of the day, we have to ensure that pharmacists have access to medications to provide their patients with the optimal drug therapy to achieve the best health outcome.

That brings me to our second recommendation, which speaks to the care element of pharmacare. While managing costs is essential, it's only a piece of the puzzle. An effective pharmacare system must not only address gaps in patient coverage but also address gaps in access to services that support safe and effective drug therapy for patients. As medication experts, pharmacists know there are important considerations for the functioning of any future system, public or private, to ensure that Canadians are receiving the maximum health benefit from their prescription drugs.

No matter what your perspective is on this issue, the fact is that drugs represent only 15.7% of total health spending in Canada. The right prescription, taken appropriately, is a low-cost, high-value intervention that improves health outcomes, especially when compared with costly alternatives such as surgery and visits to the emergency room.

Prescriptions drugs are a powerful, sophisticated tool. They can save lives when used correctly, but improper use can lead to ill health or even death. Containing and controlling drug costs is a key piece of any pharmacare plan, but now is the time for bigger and bolder thinking. Wouldn't it be better to make an investment to ensure first that the right medication is available to all Canadians, and second, that our citizens have easy access to effective medication management and oversight?

A long-term plan for pharmacare has to focus on the health of Canadians over their entire life cycle, not only when they're at the counter paying for drugs. A holistic focus that recognizes the value of appropriate drug therapy can help us realize savings for the broader health system while delivering sustainable patient-centred care. That means ensuring that Canadians have access to the drugs that make them healthier, and that means that Canadians have access to the advice and oversight of the undisputed experts in medications. The 40,000 pharmacists who work in communities and hospitals across this country have spent many years at school and on the job focusing exclusively on understanding how and when medications work, and when they don't.

In recent years, pharmacists' scope of practice has grown by leaps and bounds, delivering value for patients and payers alike. Expanded pharmacy services extend beyond dispensing of prescription drugs and capitalize on pharmacists' accessibility and expertise in providing much-needed oversight to our system of pharmaceutical care.

Take, for example, the medication reviews that pharmacists provide. These services help ensure appropriate use and enhance adherence, two major drivers of optimal health outcomes and drug plan costs. In some cases we're talking about reducing the use of medications, and in other cases it means expanding someone's drug regimen.

Here's a practical example. Most seniors over 65 take at least five drugs. With those aged 85 plus, it's ten or more at once. Let me tell you, this is a challenge that the profession is tackling head-on. We know of one 77-year-old woman in Ottawa who was taking no less than 32 different drugs, but a pharmacist was able to help her get that number down safely to 17. With medication reviews, pharmacists can collaborate with patients and prescribers to identify optimal drug therapies to ensure Canadians are on the right medications.

Unfortunately, these services aren't available to all Canadians. It's a real challenge that pharmacist services are covered differently across the country, some more comprehensively than others. A pharmacare program that recognizes the role of pharmacist services, such as medication reviews, would address many of the concerns this committee has heard about the need to go beyond simply paying for drugs and instead address the care aspect of pharmacare.

It's not only medication reviews; there are benefits to expanding pharmacy services in other areas as well. A study in Ontario found that pharmacist care can deliver a meaningful reduction in blood pressure, one that lowers the risk of stroke by about 30%. As well, consider how pharmacists are assisting people in their efforts to stop smoking. Recent numbers from the pharmacy smoking cessation program in Ontario show that 29% of participants in the program were still cigarette-free after one year. Consider the flue shot, especially for those who are considered at high risk for influenza complications: a recent survey found that 28% of Canadians in this group would not have been immunized if not for the convenience of pharmacy-based vaccinations.

The final thought we would like to leave with the committee is that the goal of any pan-Canadian pharmacare model, both in the short term and the longer term, shouldn't only be about reducing costs. It should be about providing optimal care. Getting value for each health care dollar is a principle that should be adopted across the entire health care system, not just for drug costs. We need to acknowledge that spending on drugs is an investment in the health of Canadians. We also need to acknowledge that the rush to achieve short-term savings can sometimes lead to longer-term costs, both in terms of health care expenditure and quality of life.

We know the committee has a complex task before them. There are no simple answers or solutions. Nevertheless, we encourage the committee to consider both short-term and longer-term approaches. Equally important, we encourage the committee to ensure the care in pharmacare. Including pharmacist services is an essential element of any pan-Canadian plan.

Thank you very much. We would be pleased to answer any questions.

[The Vice-Chair, Conservative, Len Webber]

Thank you, Mr. Eisenschmid.

We'll move on to Ms. Julie White with the Canadian Health Coalition. Julie, you may start now.

[Julie White, Board Member, Canadian Health Coalition]

Thank you for the opportunity to talk to you today.

I am primarily a researcher, and the author of four books and many, many articles focusing primarily on labour force issues. I worked for 10 years for the Communications, Energy and Paperworkers Union. This is the union that has now joined with the Canadian Auto Workers to form Unifor.

My work included research around the negotiation of benefits for workers, including drug plans. I've now been retired for four years and am a member of the Congress of Union Retirees of Canada, and I represent that retirees' organization on the Canadian Health Coalition.

The Canadian Health Coalition is an organization dedicated to the preservation and improvement of our national public health care. I wrote the CHC's recent policy document, called “A National Public Drug Plan for All”, which you either have or will be receiving.

Today I'm going to direct my comments to that part of the population referred to as being covered by work-based private plans, and I want to question the use of that term in some ways.

I think we all know that work-based plans cover the majority of the population. The figure I use in my report is 66% of the population. That comes from a document prepared by the pan-Canadian Pharmaceutical Alliance. I've seen other percentages, but all agree that the majority of the population are in private plans.

I want to make three points. The first is about who pays for these plans. The second is that work-based plans are very expensive. The third is that the quality of care provided is poor.

First, who pays? There is a tendency to talk about work-based drug plans as if they are paid for by employers, because it is employers, of course, that remit premium costs to insurance companies. However, this is not at all the case, because employees also pay for their drug plans, both directly and indirectly.

To give examples, nurses in Alberta, as several people at the table will know, pay 25% of the cost of their health insurance plan directly—that is, it is taken out of their wages. Nurses in Newfoundland pay 50% of the cost of their premiums directly. Retirees from your very own federal public service are currently seeing their contributions to their health plan, including for drugs, increase from 25% to 50% of the cost over a four-year period. Others pay in less direct ways, through lower wages or reductions in other benefits. Where unions are negotiating benefits and wages, there are often trade-offs.

Let's be clear: employees are paying for their drug plans.

The second point is that work-based plans are very expensive. First, there is the inability to negotiate drug prices. There are thousands and thousands of plans, so there is none of the negotiating power that is necessary to bargain for lower prices with pharmaceutical companies. Also, employers are not in the business of determining which drugs are more effective for the price than others, so these plans tend to cover all drugs, regardless of their effectiveness or their price. This is expensive.

Money is also wasted in the administration of these many thousands of different plans. Each plan has its own set of limits, its requirements, and its coverage rules. Every individual prescription must be checked against the plan covering that person. Insurance companies must also analyze costs, set premiums, discuss premium increases every year or two years with employers, and search for new business. Most insurance companies are also in business to make a profit—not unreasonably—but this is not the case in public drug plans. All this costs additional money.

The Quebec drug plan, the RAMQ, compared the cost of administration of its public drug plan with the cost of private health plans. Administrative costs were 2.9% in the Quebec public drug plan, but five times that amount in private plans, at 14.6%. Other studies have suggested much larger differences than this. If we are talking about cost, public drug plans are less costly than private plans.

I want to talk about the quality of care that these expensive plans provide.

When we say that the majority of the population is covered by work-based plans, this is a questionable statement. We need to ask what kind of coverage they get, especially at such high costs. Among other things, the problems are that coverage is unfair and haphazard, that most plans don't provide anything like full coverage, that plans are getting worse as costs increase, and that benefit coverage is not secure. I'll talk briefly about each of those.

Which workers have work-based coverage? Public service workers are more likely to have coverage than the private sector. Full-time workers are more likely to have coverage than part-time workers. Unionized workers are more likely to have coverage than non-union workers. Men are more likely to have coverage than women. Older workers are more likely to have coverage than younger workers. Please note that none of this bears any relationship to medical needs. It just depends on where you work and the nature of your drug plan. This is a haphazard and unfair way to provide health care to the population.

Most plans do not provide anything like full coverage. An Ontario study by Mercer for the Ontario Chamber of Commerce found that 38% of private employers with drug plans cover 100% of the costs of the drugs. The other 62% are providing just a percentage of the drug costs, which might be 80%, 70%, or 60% of the cost. This means that at the pharmacy counter, the employee must pay anywhere from 10% to 40% of the cost of the drug. It's important to note that this bears no relationship whatsoever to a person's capacity to pay these amounts. In fact, I would argue that workers who have been able to negotiate better drug plans and better coverage are often the workers who have better jobs and better incomes anyway.

There is increasing pressure on these plans as costs rise. This means both employees paying more and reductions in the coverage provided. When I worked at the Communications, Energy and Paperworkers Union of Canada, we saw the introduction of flexible benefit plans, something which, in my opinion, simply should not be permitted. This is a plan whereby individual workers decide what level of drug coverage they will take and pay differential premiums according to the level that they decide upon. You may decide to take a lower level of coverage and pay less, or a higher level of coverage and pay more. I think you can see the dilemma that this creates. Essentially, you guess what you think your drug needs might be for the following two to three years, because that kind of plan normally ties you in for that period of time. Guessing the future health of your family should not be the basis for drug coverage.

I advised CEP unions to avoid flexible benefit plans, but they came in anyway, under pressure from the rising cost of premiums transferred through employers and pressed on employees.

I want to talk about how secure our work-based plans are for those that they cover. The words “work-based” really say it all. If you change jobs or are laid off, you will lose your drug plan. Over the 10 years that I worked for the CEP, 30,000 paperworkers were laid off from their jobs. Due to a drop in demand for newsprint and the rising value of the Canadian dollar, many mills closed entirely, and others cut back substantially. Each one of those 30,000 workers lost their drug plan, and it was not only the workers but also their families, their spouses, and their children.

Let's not forget that at every negotiation, every two to three years, your drug plan may be up for changes. For workers without unions, your drug plan may be changed at any time.

I have a couple of final comments.

In my experience, employers want out from dealing with drug plans for employees. They wonder, as I do, why employers who are running businesses making paper or automobiles, or employers who are managing municipal and provincial public services, are making decisions about the provision of prescription drugs.

Why do we have this absurd situation in which employers, and in some cases unions, are determining health issues around prescription drugs? Would this not be better in the hands of medical professionals and medical researchers?

In the presentation that you heard by Marie-Claude Prémont, she explained with great clarity the mistake made by Quebec in institutionalizing work-based plans and requiring workers to participate in them. The spiralling cost of this decision should surely make us reflect on the successes of universal public systems in other countries at controlling costs versus the unsustainability of the Quebec system.

To summarize, work-based plans are a failure. They are expensive, inequitable, inadequate, and insecure. They are a major part of the problem; they are not part of the solution.

Thank you.

[The Vice-Chair, Conservative, Len Webber]

Thank you, Ms. White. I appreciate that presentation. You went a bit over, but seeing as you're retired, and the fact that you came here—

[Julie White]

I have all the time in the world. I'm sorry.

[The Vice-Chair, Conservative, Len Webber]

Exactly. We appreciate your coming anyway.

For our final presentation, we have Connie Côté and Debra Lynkowski here from the Health Charities Coalition of Canada.

Please start, Connie.

[Connie Côté, Executive Director, Health Charities Coalition of Canada]

Thank you.

Mr. Chair, committee members, thank you for the opportunity to appear before you today. My name is Connie Côté, and I am the executive director of the Health Charities Coalition of Canada. As Mr. Webber said, joining me is Debra Lynkowski, who is a member of our governing council and president and CEO of the Canadian Lung Association, which is one of the 30 members of our coalition.

First and foremost, I would like to express our gratitude to Parliament for initiating discussions on the issue of pharmacare and for taking important steps in working collaboratively with the provinces and territories to find solutions.

The Health Charities Coalition of Canada is a member-based organization comprising 30 national health charities and patient groups. Our members represent the majority of Canadians affected by health issues. We reach millions of people every year. We work together to improve health by identifying gaps, monitoring trends, promoting and improving best practices, and investing in health research. We believe in patient partnerships, and we create meaningful opportunities for patients to participate in the planning, decision-making, and review processes, such as the CADTH review process. Most importantly, we are a trusted source of information. Canadians rely on our members to provide evidence-informed, consumer-friendly information about disease.

The perspectives we share with you today come from the patients and the families we work with every day. We're here to tell you that access to medicine is extremely important to Canadians.

Imagine the following. A doctor continues to have repeat visits from a patient who has chronic obstructive pulmonary disease. The patient is experiencing severe exacerbations that are bringing him back into the clinic repeatedly, and occasionally into the emergency room. The doctor is concerned that the prescribed treatment is not working, until one day his patient confesses that he's only been using his inhaler once a day rather than twice a day, as prescribed. Why? Because he can't afford to renew his prescription. He thought he would reduce the number of times he took it per day and make it last a little bit longer.

A young woman living with arthritis has just completed her degree. She has secured an entry-level position and is eager to enter the workforce. What should be an exciting time of her life has turned into a nightmare. Now that she has graduated from university, she is no longer eligible for insurance under her parents' plan. In order to manage her symptoms, she takes a TNF-alpha inhibitor known as a biologic. The cost is over $1,800 per month. She is registered for the catastrophic drug coverage plan in her province, only to learn that the drug she needs is not listed on their formulary as a treatment option for her disease. She's distraught. Just imagine not being able to gain access to the medication you need. In her case, this results in her pain and symptoms becoming unmanageable, and ultimately she's not able to work. She feels defeated.

These are the stories we hear every single day. So what can we do?

The Health Charities Coalition of Canada believes all people living in Canada should have equitable and timely access to necessary prescription medications, based on the best possible health outcomes rather than the ability to pay.

We have three recommendations that we will elaborate on today: one, that the Government of Canada create an advisory panel to establish comprehensive, evidence-based, pan-Canadian standards for pharmacare; two, that the Government of Canada also take a leadership role and share the cost in implementing these standards; and three, that health charities and the Canadians they represent be active participants in any federal, provincial, and territorial consultations on pharmacare.

From the patient perspective, inequitable access to medication has a very real and profound effect. It means that people cannot afford or access the medications they need. By way of example, 57% of people living with diabetes report that they do not comply with their prescribed therapy because they cannot afford their medications, devices, and supplies, thus potentially compromising their ability to manage their disease.

While the majority of Canadians have some level of drug coverage, either through an employer-sponsored program, privately purchased insurance, or a provincial drug program, many Canadians still report challenges in accessing medication.

[Debra Lynkowski, Governing Council Member, Health Charities Coalition of Canada]

I was going to give you some compelling statistics to get your attention, but you've heard some of them today, and I suspect you have actually heard many statistics over the past few weeks. My guess is that you don't have to be convinced any longer that this isn't simply a small crack in the system. I know sometimes that's what we think, or we think these are isolated instances.

I will tell you, because we're all about the patient and all about the stories of the patient, that the two that really hit home for me were learning that sometimes you actually have to fail at a drug before you get the drug you really need, the one your doctor wanted you to have to begin with, which to me was completely mystifying. There's also the fact that sometimes it's actually in your best interest to stay in the hospital, because you actually might get better access there to the medications you need.

You know the stories, you know the statistics, and I'm not going to repeat them. I'm going to move into a solution and what we, as a coalition of 30 national health charities.... It's hard to get 30 national health charities to agree on anything, so believe me, the fact that we agree on this tells you that there is actually a profound problem.

Our solution starts with principles. We really think there are four principles that have to be at the foundation of this. They are patient partnerships, quality, equity, and sustainability.

Regarding patient partnerships, we believe any standards that need to be developed have to be done so in partnership with patients in a very meaningful and collaborative way, not in a way that feels in any way token, and we need to ensure that the right medicine gets to the right patient at the right time and, of course, in a cost-effective manner.

On quality, Canadians deserve high-quality therapies and services that are appropriate to their needs—you've heard that a lot today—and respectful of their choice and the best recommendations of science and their physician.

As for equity, all Canadians should have equitable access to a comprehensive range of evidence-based medications. This is key. It shouldn't matter who you are, what illness you're suffering from, where you live in Canada, or in what setting you're being treated in determining what kind of access you have.

Of course we need sustainability. We're not naive. We know the implementation of any standards must be adequately resourced, they must be cost effective, and it should be within a health care system that is continuously reviewed, evaluated, and improved.

With those four guiding principles, we offer these specific recommendations that my colleague referred to already, but I will elaborate on them briefly.

The Health Charities Coalition of Canada asks the Government of Canada to create a multi-stakeholder advisory panel. I put emphasis on the multi-stakeholder aspect, because we believe that's key. This panel would establish comprehensive, evidence-based, pan-Canadian standards for pharmacare. The panel would collaborate to provide recommendations on standards that would then inform a federal-provincial-territorial agreement that would be sustainable and equitable and provide greater access, all with the goal of improving health care outcomes.

Again, implementation of standards would ensure all Canadians have access to prescription drug coverage based on the best evidence and would respect an individual's and their physician's choice based on need, not on cost.

We further recommend and believe that the Government of Canada has a leadership role to take. We understand jurisdictional issues, but the Government of Canada is also responsible for the health and welfare of Canadians, and we believe the Government of Canada should share the cost in implementing these standards.

On a practical level, the government could take a role by ensuring accountability for increased investment in pharmacare and specifying requirements that must be met in order for the provinces and territories to receive increased transfer payments.

Finally, we ask that health charities and the Canadians they represent be active participants in any federal-provincial-territorial consultations to support the development of these standards.

As my colleague mentioned, we represent millions of Canadians and millions of patients. They want a meaningful voice and they want to be at the table. We can provide valuable perspectives on the development of policies and reform. We're well positioned to identify and describe these real-life examples, but more than that, we're well positioned to offer constructive and innovative solutions.

In closing, we know this is complex, we know you have lots of competing interests, and we know that meaningful collaboration can be challenging, but we trust in the collective wisdom not only in this room but of what a multi-sectoral panel could provide, and we strongly believe that if you use the patient as your compass, you won't go off course.

Thank you, and we're happy to respond to your questions.

[The Vice-Chair, Conservative, Len Webber]

Thank you very much.

You were right down to one second left. You must have practised.

Thank you all for your presentations. We're going to move right into our questions in round one.

I understand, Darshan Kang, you will start with your seven minutes of questioning now. Thank you.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you, Mr. Chair.

My first concern that comes to mind is conflict of interest, so it is very important to let the public know if any witnesses have any potential or perceived conflicts of interest.

My first question is this: are you, your organization, or a representative on your behalf currently registered with the Commissioner of Lobbying for the purpose of influencing federal government policies on the subject of a national pharmaceutical strategy?

Second, does your organization receive any money from pharmaceutical manufacturers, insurance companies, marketing firms, or other entities related to pharmacare who have a vested interest in influencing national pharmacare policy?

There are two questions.

[The Vice-Chair, Conservative, Len Webber]

Mr. Kang, who have you directed the questions to?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Everybody.

[Julie White]

I think that's a very good question. I think it's really important that we understand who we're talking to and whether there are conflicts of interest.

I have no conflict of interest to disclose, and I am not waiting for a telephone call, either.