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.