Health Committee on June 1st, 2016

[Gerry Harrington]

Even today I think there are examples—and I think smoking-cessation aids are a good example—of how economically it makes a lot of sense to make those accessible.

Our focus really is more on ensuring that we have a regulatory system to put these products on the market in a way that they're accessible to Canadians more quickly than they are now. They're waiting seven to nine years in comparison to how long U.S. and EU residents are waiting, and there are many Canadians who would prefer to take that control over their own health that way, and could do so successfully, who right now have no choice but to go to the doctor to get a prescription. These are for ailments that have already been clearly diagnosed, when the patient is very confident and able to self-treat.

So we look at it more as a matter of lowering barriers outside the pharmacare to make pharmacare more affordable.

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay.

That opens the door quite wide. I feel very uncomfortable with that.

What comes to my mind is the image of a long line of people waiting to get their free Tylenol and Advil, etc., because it's covered under a national pharmacare program.

Am I understanding what you're advocating for here?

[Gerry Harrington]

I'm sorry if I'm not communicating clearly.

No, we're not talking about including these products on the formulary or on the pharmacare plan, at all. People have to—

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay, thank you. I just wanted to clarify that. Thank you very much.

My next question here goes to the CMA.

Dr. Forbes, I read through the pre-budget submission that you submitted earlier, and in it your organization had two pharmacare recommendations. The first was that the private health insurance industry participate in the work of a pan-Canadian pharmaceutical alliance, because they cover the majority of working-age Canadians, of course. The second was to create a national catastrophic drug coverage plan for all Canadians.

You estimate that the cost of the catastrophic drug coverage plan would be about $1.7 billion. My question is, why did you not recommend an all-out pharmacare program right off the bat? Why are you going towards a more incremental approach rather than an immediate pharmacare program that would cover the whole nation?

[Dr. Cindy Forbes]

Thank you for that.

I think I addressed that somewhat in an earlier question but our intention really—especially with the pre-budget consultations—was to look at measures that were able to be easily implemented in a short time frame. We really see that recommendation as a step towards national pharmacare if that's where we're headed, so we felt that this was a reasonable approach. Again, it is scalable, as I mentioned before, and would be administratively easier than some other approaches. Really, getting from here to there when it comes to a national pharmacare program is probably going to take quite a long time, and this would get us closer.

[Rachael Thomas, Conservative, Lethbridge, AB]

Do you have any idea how long that's going to take us?

[Dr. Cindy Forbes]

Would you like to comment on that?

Owen is very familiar with what's happened historically and over time. There have been a lot of attempts in the past.

[Owen Adams]

Well, I guess it's a challenge. If you really want a full public pharmacare program, you're talking about what you are doing about the $17 billion in private expenditure as in 2014.

I do appreciate the modellings that show that there could be some savings from bulk purchasing and so on, but that's still quite a gulp, to say the least. That's why we don't see that happening overnight in the same way that medicare came in during the sixties. It was a much smaller enterprise at the time.

[Rachael Thomas, Conservative, Lethbridge, AB]

Mr. Adams, are you suggesting then that the pharmacare program is actually going to cost us rather than save us money?

[Owen Adams]

I assume you are referring to a public program. If you look at 2014, almost $29 billion total for Canada was spent. Of that, $12 billion came from governments—federal, provincial, and territorial—and then $17 billion came from private sources. It was $10 billion from private insurance and $6.4 billion out of pocket.

It was the National Forum on Health that raised this idea in 1997. It said that this money was being spent and it could be converted to public money. The question then is how you do that. The way it was done in medicare in the sixties was that the federal government stepped up to the plate and offered 50:50 cost-sharing to the provinces. It was phased in over several years and it did happen quickly, but I just think it's a much bigger gulp factor now than it was back then.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you very much.

[The Chair, Liberal, Bill Casey]

Thank you.

Mr. Kang.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you, Mr. Chair.

I want to thank the panel for appearing before the committee.

Natasha Mistry, Canadians face many challenges as we age. I joined the club on May 2. One of these challenges is the increased number of pharmaceutical medicines necessary to improve the quality of life for the elderly. Can you shed some light for the committee on how prescribing practices have changed for elderly Canadians, and outline how some of the vulnerabilities they face could be addressed with a national pharmacare strategy?

[Natasha Mistry]

Absolutely. I feel this may also address a lot of the questions surrounding whether or not prescriptions would get out of control if we did have a national pharmacare program. I think to answer that you need to look beyond pharmacare itself. I think the answer may lie in receiving multidisciplinary care. A lot of aging Canadians may live with one or more conditions. For example, if you live with rheumatoid arthritis, you may also suffer from depression, or you may also have to deal with inflammatory bowel disease. In the case of Canada, because we lack multidisciplinary care, treatments are offered by very different specialist groups. So you have a senior with three separate conditions, each of which may be treated individually.

National pharmacare may not address all those issues, but we hope that it may lead to more discussions around how Canadians, and seniors in particular, receive their care, and the means necessary to get access to all three doctors talking together, and receiving coordinated care to make sure that the medications they take are the ones that are most effective.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

CARP has been involved in challenging changes to pharmacare in Nova Scotia and in Ontario and other provinces. The concern was that higher-income elders would have to pay higher premiums. What were the exact proposed changes that CARP decided to challenge? Why has the approach of increased premiums on elderly Canadians failed to address the increasing cost of pharmaceuticals in Canada, and how could a national pharmacare strategy overcome this problem?

[Natasha Mistry]

Our community is very vocal about a lot of these changes. We usually support what our CARP members are calling for action on. Unfortunately, I cannot comment on particular issues in Nova Scotia and Ontario. This for me is day seven of working in CARP, but I do come from a long history of working in health care in general in Canada.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Can you provide us something in writing to the chair on that question?

[Natasha Mistry]

Absolutely.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you very much.

Why has the approach of increasing premiums on elderly Canadians failed to address the increasing cost of pharmaceuticals in Canada? How could a national pharmacare strategy overcome this problem?

[Natasha Mistry]

Is that addressed to me?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Yes, please.

[Natasha Mistry]

I would also like to provide that response in written format.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you.

To you again, many of your members are on fixed incomes, and some provinces such as British Columbia that introduced fair pharmacare have made a gradient for seniors. What are some of the provincial approaches to providing pharmacare that you believe have been beneficial, and what are some others that have caused more difficulty for those living on fixed incomes?

[Natasha Mistry]

Could you please repeat the question?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Many members are on fixed incomes, and some provinces, such as British Columbia, have an income-level approach. What are some of the provincial approaches to providing pharmacare that you believe have been beneficial? What other approaches have caused more difficulties for those living on fixed incomes?