Health Committee on May 16th, 2016

[Perry Eisenschmid]

I think there were two questions there.

I am a registered lobbyist, but not for a particular issue.

I think generally in terms of payments, what is commonly misinterpreted about the Canadian Pharmacists Association is that we actually represent the 40,000 hard-working pharmacists around the country. We're not representing big retail chains or drug manufacturers, so we represent the pharmacist workers in communities and hospitals across the country.

The other thing that is often not well known about our organization is that over 90% of our funding is secured by the selling of our products and services, which are the gold standard drug and therapeutic reference tools that we sell to health professionals around the country. That's 90% of our funding.

We do receive occasional funding from various private sector interests for specific issues. For example, on pharmacare we receive funding to do national consultations of the general public and the pharmacy profession around the country.

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

What about the Health Charities Coalition?

[Connie Côté]

I am not registered as a lobbyist. We certainly have not met the threshold that is set in order to register. Members of my coalition, however—a majority of them—are registered as their own health charity.

In terms of your second question with regard to a conflict of interest and funds, we are a member-based organization, so we receive funding from our own members. We do not receive any outside funding other than small grants, occasionally, to support specific projects, but nothing that's in conflict of interest with this particular dossier.

[Debra Lynkowski]

I am a registered lobbyist on behalf of the Canadian Lung Association, although I don't meet the threshold there.

I don't have any conflicts to declare. When and if we've ever received any funding from private sector partners, they're unrestricted educational grants and have no relation to this matter.

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

So not even in the future, you don't think?

[Debra Lynkowski]

We wouldn't do that. We guard our independence and autonomy very jealously so that we can be independent and honest brokers.

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

Thank you.

Lisa.

[Lisa Ashley]

Thank you.

I am registered as a lobbyist, as we speak on a number of health issues with the government.

I do not have any conflict of interest and neither does our organization. We are a member-based organization, which is where the majority of our funds come from. We may at times have some sponsorship at a conference where a pharmaceutical company may be there. I don't believe that is actually the case for this upcoming conference.

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

Thank you.

My second question is to the Canadian Pharmacists Association.

Do your members generally receive compensation from pharmaceutical manufacturers for prescribing brand name medicines when an equally effective generic drug is available?

Second, how would this practice be affected by a national pharmacare strategy?

[Dr. Philip Emberley, Director, Professional Affairs, Canadian Pharmacists Association]

Thank you for the question.

No, pharmacists are not compensated by a pharma company for dispensing brand name medication. They're required to dispense the lowest-cost drug for a specific molecule. That's part of their code of ethics.

As to the second part of your question, this will not change with a national pharmacare plan.

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

You said they are required. Who monitors that? For the pharmacists, there could be enticements for prescribing brand name drugs. There must be benefits to the pharmacist or the pharmacy for providing expensive drugs rather than generic drugs.

[Dr. Philip Emberley]

No, pharmacists are regulated at the provincial level, and they're required to dispense the lowest-cost molecule. If there's a generic available, they're required by their regulations to dispense it.

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

Even if the patient insists?

[Dr. Philip Emberley]

If the patient insists, in most provinces the patient is required to pay the difference between the generic cost and the brand name cost. That is a patient preference that is sometimes relayed by the patient to the pharmacist.

[The Vice-Chair, Conservative, Len Webber]

You have 40 seconds.

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

Okay, I think I'll stick with this. If the patient has coverage, is it still possible to get the brand-name drug?

[Dr. Philip Emberley]

If the patient has coverage for the brand name—and often they would know if they do—then they can request it from the pharmacist, who would then dispense it. For example, if someone works for a pharma company, they often have a policy of using only brand name products, in which case they will tell the pharmacist this, and the pharmacist will dispense the brand name.

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

The patient will not be encouraged to go with the generic drug because it's going to cost less for somebody.

[Dr. Philip Emberley]

The discussion would normally happen. As pharmacists, we believe there's equivalence, bioequivalence, as dictated by Health Canada, so they would be encouraged. However, in many cases they specifically request it.

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

Thank you.

[The Vice-Chair, Conservative, Len Webber]

Thank you, Mr. Kang.

We'll move on to Dr. Carrie, and after Dr. Carrie, Mr. Davies.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Mr. Chair. You're doing a fine job today.

One of the things I'm concerned about is that we are talking about increasing access to pharmaceuticals. I think we should be aware that without controls, it could be a dangerous and costly thing. In Canada we have challenges with over-prescription and with prescription drug abuse. I'd like your opinion on these questions.

We've heard from different witnesses that up to 40% of seniors are on inappropriate medication. Mr. Eisenschmid, I think you mentioned the role pharmacists could play in catching this. Mr. Emberley, I think you worked for the British Columbia government, and you are an expert on the optimal use of medication.

Have you guys ever run the numbers on how much money could be saved by the public system if medication were more properly prescribed to patients?

[Perry Eisenschmid]

I've never seen an analysis of that. It's patient by patient, but I think there are significant potential savings.

That goes back to the theme of my presentation. Making sure that all Canadians have appropriate coverage and that their drugs are covered by public or private plans is a great thing. The end goal, however, is not to dispense more medications; rather, it's to manage medication by professionals to make sure the patient is getting the appropriate care. We think pharmacists, being in 10,000 locations that are often open 24/7, are the perfect first point of contact and are the experts required to make sure medication is being prescribed appropriately and not excessively.

[Colin Carrie, Conservative, Oshawa, ON]

I think that's important when you're looking at the scope of your practice, because 40% of the time we're getting it wrong with elderly people. How dangerous is that to the system?

I'm also concerned about the stats on opioid abuse. I think Canadians, per capita, are the number one users of opioids. You wonder why Canadians need more opioids than anybody else in the world.

What role could you perform as pharmacists, and how would that affect your relationship with medical doctors?

I had a neighbour in Oshawa who was a pharmacist, and he told me about catching medical contradictions in different medications. I can see how your role could be expanded. It could be very cost-effective. How would your relationship with the medical profession have to change?

[Perry Eisenschmid]

I think our resident pharmacist is probably in the best position to answer that question.