Health Committee on May 30th, 2016

[Colin Carrie, Conservative, Oshawa, ON]

Dr. Herder.

[Prof. Matthew Herder]

Just to quickly update you on Vanessa's Law, it's fantastic on paper, but implementation has been incredibly slow thus far.

The power to compel drug companies to keep studying post market is in force now, and hopefully it is being used. The power to make information more transparent is there. Some of them are in force now; others require regulations. A law was passed in November 2014, but there are still no regulations from Health Canada.

A key part of evidence-based decision-making for our clinicians in practice and for the national formulary, if we ever get one, is more access to the information behind drugs. Vanessa's Law is being implemented too slowly in that regard.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

I have one question. Some witnesses before the committee have proposed that we emulate the Quebec model, and others have critiqued the Quebec model. The two main criticisms are, number one, that the per capita costs for prescription meds are higher in Quebec than the rest of Canada. Second, there are equity issues between those who are covered by the so-called public system and those who have private coverage through their employers. I'm wondering if anybody has any comment on that.

[Dr. Robyn Tamblyn]

Quebec did face whether they should have a completely public plan or a public-private plan. It opted for the latter because of, obviously, a private insurance company lobby. That's one issue.

I think where they went wrong in Quebec—because I think their intent was absolutely fabulous, which is providing universal pharmacare—was that they took all the sick people, and everybody who wasn't sick got to go to the private insurance company. Then the private insurance companies got essentially everybody who was well and wasn't going to be using drugs to pay the premium. If private insurance had been regulated to take the mix and not just the well and active, thank you very much, but had the same mix as the public insurer, I think it would have been better.

The second is that Quebec does provide a very rich formulary. I'm not sure that they refuse very much, and then they put a copay on everything from insulin to your leisure drug of choice.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm from British Columbia. We have a different view, and it's not covered by any formulary currently, I don't think.

[Voices]

Oh, oh!

[Dr. Robyn Tamblyn]

I think you can be smarter about the formulary and be a whole lot smarter about those copays.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Does anybody else have a comment on Quebec?

[Dr. Durhane Wong-Rieger]

We get a lot of people who suggest that we should adopt something like Quebec did because they've got a very good patient d'exception program, so that if the drug comes in before it has gone through all the full review, you can have an individual patient that's adjudicated.

I mean that's kind of okay and it's kind of not okay, because sometimes we get stuck there as well. Patients are getting on one at a time. We don't develop the registry. We don't get good formularies. In some respects I think what we want to do is to bring the other programs up to being able to provide.

If you think about the adapted pathways and about what's happening in terms of collaborative HDA, at the time the drug is actually approved, we should be able to know, especially for rare disease drugs, which patient should be on it or not. We're not going to get better evidence after HDA looks at it. We will get better evidence after it has been on the market for a while, and then we'll have some other reviews.

We believe, and what we've seen happening in Europe under things like ADAPT SMART, is that there is a review ongoing while it's under review by Health Canada. At the time of approval, we can already begin to make some decisions about who should get access, who should not, and what conditions to continue to monitor.

The Quebec program works because patients can jump into it. We do not necessarily believe that that has the longest term benefit in terms of having a reasonable access for everybody.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

That concludes our official business. We're going to switch to committee business for a minute.

I want to say thanks very much to everybody, all the presenters, because you've provided us with a great deal of interesting information and in a way that we can actually understand. We do appreciate your time and appreciate your coming back.

Did you understand?

[Colin Carrie, Conservative, Oshawa, ON]

I just said, “That's hard.”

[The Chair, Liberal, Bill Casey]

Oh, it is.

Anyway, we really do appreciate your time and your contributions. Thank you very much.

[John Oliver, Liberal, Oakville, ON]

On March 21, the committee passed a motion that the chair present report 13 and report 9 from the 2nd session of the 41st Parliament to the House and request that the government table a comprehensive response.

I was wondering whether the chair could give us an update on how that reporting is going?

[The Chair, Liberal, Bill Casey]

The chair hasn't done it yet, but the chair will do it next week.

[John Oliver, Liberal, Oakville, ON]

That's perfect.

Thank you very much.

[The Chair, Liberal, Bill Casey]

The meeting is adjourned.