Health Committee on May 16th, 2016

[Connie Côté]

We've looked at many different options, and what's really important to us is that no matter what option is implemented, we think it's crucial that patients have a voice and that we really look at some of the ways that patients will be able to have access. It's the inequitable access that we're really concerned about, so we really caution you to look at what those outcomes will be for patients.

[Don Davies, NDP, Vancouver Kingsway, BC]

Right.

How am I doing for time?

[The Vice-Chair, Conservative, Len Webber]

You have one minute remaining.

[Don Davies, NDP, Vancouver Kingsway, BC]

I have one minute.

I can't remember who asked or stated this—I think it was you, Ms. White, or maybe it was you, Ms. Côté—but it was that 50% of Canadians don't have workplace prescription plans. Did I hear that from someone?

[Julie White]

What I said was that the majority of Canadians, probably in the region of 60% to 65%, have workplace coverage. The rest do not.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay, so your testimony would be that about 30% or 35% do not have workplace coverage plans.

Ms. Côté, I want to ask you, if you could give this committee one single piece of advice as to how we could best move forward, what would it be?

[Connie Côté]

We're really calling for pharmacare standards. We really think it's important that we all understand what we're working toward and the standards we're trying to achieve. We really hope we will have a much broader discussion and that it is a very comprehensive multi-stakeholder approach.

We all see things through a very different lens, so it's not just one view that will get us to the place where we need to be.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Vice-Chair, Conservative, Len Webber]

Thank you.

We'll move on to Mr. Ayoub and then to Ms. Harder.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

I also want to thank the witnesses for their insightful presentations and the extremely important information they are contributing to this study.

I have not yet had time to introduce myself. I am the member of Parliament for Thérèse-De Blainville, located north of Montreal, in Quebec.

I will first mostly address the Canadian Pharmacists Association representatives.

Mr. Eisenschmid, you mentioned several times that we shouldn't focus too much on the cost of medications. Whether we like it or not, the cost of research is reflected in the cost of medications. According to a cost estimate for a Canada-wide pharmacare system, the costs would be high.

I would like to hear your thoughts on the fact that retail pharmacies sometimes raise the prices of prescription drugs. I have here figures going back to 2012-2013. That profit margin accounted for 4.2% of the total costs paid by public insurance plans for prescription drugs, or about $323 million. So public insurance plans put a cap on the profit margin refund for prescription medications.

Why are retail pharmacies raising the price of prescription drugs? Do private plans also set a cap on profit margin refunds?

How do you think we should address the issue of caps in terms of profit margins for prescription drugs if a Canada-wide pharmacare system was instituted?

[Perry Eisenschmid]

I'm not clear on the question. When you say pharmacists are increasing...drug prices are going up, or manufacturers are increasing prices....

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I'm talking about retail pharmacies.

The retailers.

[Perry Eisenschmid]

Do you mean dispensing fees?

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I would like to know more about pharmacies' profit margins.

It's not dispensing fees, but it's...

profit margins.

[Perry Eisenschmid]

The profits of the stores, do you mean?

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I want to talk about markups in the price of prescription drugs.

[Perry Eisenschmid]

You're saying that you have information that the profits on prescription drugs in Quebec went up.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

No, no, not in Quebec, in general. That's what the research has been trying get information about and that's the information we have right now. Are you not aware of that?

[Perry Eisenschmid]

We represent the pharmacists, who are typically on hourly wages or are salaried employees. That question is probably more for the owners of the retail chains and what they're doing with their business operations.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

All right. I'm a little bit surprised, but it's okay.

Since the first provincial pharmacare plans were implemented in the 1970s, generic drug companies have given pharmacies discounts. Generic drugs have also become an important part of pharmacies' revenues. However, over the past few years, the lower refund rates for generic drugs through public plans have reduced the discounts generic drug makers give to pharmacists.

Are generic drug companies still giving pharmacies those kinds of discounts? If so, what percentage of their revenues do those discounts generally account for? How much of those discounts are passed on to clients by pharmacies?

[Perry Eisenschmid]

Again, unless Phil has other information.... You're talking about the business of pharmacy? You're talking about the relationship between the drug manufacturers and the retail store owners?

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I am talking about generic medications.

[Perry Eisenschmid]

Yes.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Do pharmacies that get a discount on drugs definitely pass on a portion of that discount to their clients? It's a simple question.

[Dr. Philip Emberley]

A number of provinces in Canada do still allow rebates to pharmacies. A number have put in controls. For example, Ontario does not allow rebates for generic companies.

With a number of the changes that have been made to generic drug pricing across Canada, these rebates have gone down considerably. We feel it's very important for a lot of the services we've described that pharmacists do to be adequately funded. I know these rebates have decreased in recent times.