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.