Evidence of meeting #11 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pharmacists.
A recording is available from Parliament.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
My second question was on whether those kinds of rebates are given back to the customer. Do they get a a percentage of rebates, or do all the rebates go to the pharmacists? Do you have that kind of information?
Chief Executive Officer, Canadian Pharmacists Association
I think the undercurrent of your question is with regard to compensation models both for the business of pharmacy and for pharmacists themselves. I think you're bringing up a very good point, which is that right now the compensation for pharmacies and pharmacists is not aligned with the services and the value they are providing. There's no question that right now pharmacies rely a lot on either rebates or allowances in certain provinces to fund their overall operations, because, they would argue, they are not getting appropriately compensated for direct interventions like medication adherence.
We would all agree that we ultimately need a change in the compensation structure for pharmacies and pharmacists to ensure that there's appropriate payment for the appropriate service and that pharmacies don't have to rely on earning a margin on the drugs they dispense to cover other services. We would agree with that.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
Most of the time, pharmacists own or operate their own pharmacy. However, as you said, that's not always the case. Some pharmacists are paid an hourly wage. That's a different matter, if I understand correctly.
Conservative
The Vice-Chair Conservative Len Webber
We're in round two now. Members have five minutes each.
We'll go to Ms. Harder and then Mr. Oliver.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Thank you.
My question is directed to you, Mr. Eisenschmid.
Here at committee we've heard from a number of groups of witnesses—academics and industry, individuals and representatives—and many of them have pointed a finger at pharmacists for higher drug prices. The Pharmacare 2020 academics even went so far as to question the credibility of your organization to conduct research and picked on some of the statistics you brought forward, indicating that your conclusions were motivated by profit margins rather than other alternatives.
I can imagine these allegations are familiar to you. I'm actually just looking for you to comment on those allegations today.
Chief Executive Officer, Canadian Pharmacists Association
We were very disappointed by those allegations and that they struck at the credibility of the Canadian Pharmacists Association. We thought they were unfounded. In fact, we've had follow-up conversations with them to try to understand the rationale behind it.
The particular research study that I think they are critical of didn't have a particular perspective. It was an economic analysis conducted by an economic researcher who was trying to basically put some facts on the table and to update Professor Morgan's model with updated information, because he was using the exchange rates from 2013. We knew the world had changed a lot since he had first put his model together, and we commissioned a study to look not just at his model but at alternative models, including the Quebec model and the P.E.I. model, for example.
We just wanted to get some facts on the table. It wasn't a position piece. We didn't make a recommendation. We just wanted to make sure there was appropriate information to guide decision-makers.
Conservative
Rachael Thomas Conservative Lethbridge, AB
I have another question for you. I was interested to see that only 31% of Canadians wanted a truly national system, according to the brochure that you provided, and 85% of Canadians had concerns about the government's ability to manage a plan officially.
Could you comment on these findings and perhaps expand on them a little further?
Chief Executive Officer, Canadian Pharmacists Association
I can only speculate. This was purely opinion research on the Canadian population. The undercurrent.... It was quite a comprehensive survey.
The majority of Canadians are covered by private plans, and many are satisfied with their current plan. They hear stories about moving to a public plan that would cover everybody and that there might be a reduction in the benefits they receive. Roughly three-quarters of Canadians were concerned that moving to a national first-dollar public plan would actually result in lower coverage for themselves.
Conservative
Rachael Thomas Conservative Lethbridge, AB
I'll direct another question your way, if you don't mind.
Your organization has publicly stated:
...a single public payer national pharmacare program would likely incur significant public costs for limited net benefits to Canadians, based on our research to date.
Can you explain to me why this would be the impression that you've been left with and why your research results would differ from those of the Pharmacare 2020 report?
Chief Executive Officer, Canadian Pharmacists Association
The foundational fact to that point came out of that piece of research, which suggested that moving to a national public-payer first-dollar coverage plan would result essentially in a $6.6 billion annual cost transfer to the public purse from the private sector.
Again, the public sector has the ability to raise taxes to offset that, but that's a significant shift from private sector to public sector funding, and it has its inherent risks.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Earlier Ms. White said that perhaps it's time for the government to involve itself in terms of picking up some of the costs.
I find this statement interesting, because where would you suggest the government find that money? Perhaps you could comment on that, Mr. Eisenschmid.
Chief Executive Officer, Canadian Pharmacists Association
Where the government would find the $6.6 billion?
Conservative
Rachael Thomas Conservative Lethbridge, AB
Yes. If they were to involve themselves, where would they find this $6.6 billion?
Chief Executive Officer, Canadian Pharmacists Association
That's beyond my scope.
Conservative
Chief Executive Officer, Canadian Pharmacists Association
Where they would get the money?
Chief Executive Officer, Canadian Pharmacists Association
Well, clearly, from the taxpayer, whether it was corporate or—
Conservative
The Vice-Chair Conservative Len Webber
Time is up. Thank you.
We'll move on to five minutes with Mr. Oliver, and then we'll go to Dr. Carrie after that.
Liberal
John Oliver Liberal Oakville, ON
Thank you very much, and thank you all for your presentations.
My questions are going to be directed to Mr. Eisenschmid and Mr. Emberley for the most part.
In your pan-Canadian pharmacare document, you indicate that a national pharmacare program will result in inappropriate drug therapy. The rationale, as I read through this, is that a closed formulary will limit choice for patients and clinicians' autonomy, and that will negatively impact patient health outcomes.
Every single hospital across Canada uses a closed formulary. Are you basically saying then that hospitals are negatively affecting patient health outcomes by using a closed formulary?
Chief Executive Officer, Canadian Pharmacists Association
No, what we're saying in that is when we look around the world at countries that have implemented that kind of program, it becomes very much a cost containment strategy as opposed to a patient outcome strategy.
What we've seen, whether it's New Zealand or the U.K., are restrictions on the number of drugs being covered, for good reason. Part of the reason you move to this system is to try to get volume discounts on purchasing. Obviously you can't get volume discounts if you're not trying to consolidate the drug expenditure.
Liberal
John Oliver Liberal Oakville, ON
Are you stating for the record, then, that other countries that have a universal drug care program are negatively impacting patient health outcomes by using those formularies? That's the kind of argument that was being used in the 1980s and the early 1990s as hospitals moved to closed formularies.
I feel it's a bit anachronistic on the part of your association to be staying there.