Health Committee on June 1st, 2016

[Natasha Mistry]

As I stated in my presentation, B.C. is one province that we've pointed to as moving from a seniors-focused age-based coverage for pharmacare into one that is income-based. Often what happens with this is that our CARP members may not then benefit from specific senior-focused access to pharmacare. That is one example where it has not been successful.

I believe that seniors put in a lot of time, energy, commitment, and contribution to Canadian society, and we do know that there is an increase in seniors living in poverty. I believe strongly that a national pharmacare plan would support those seniors by allowing them to not have to worry about whether they could fill their prescription drugs.

We do know that 10% of our CARP members have stated that they are unable to afford their medications.

[The Chair, Liberal, Bill Casey]

Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair. Do I have three minutes or five minutes? Five minutes. I may pass some on to my colleagues if you don't mind.

First of all, I want to thank you all sincerely for the work that you do, particularly the work that Mr. Harrington and Ms. Willemsen do with Consumer Health Products, because I rely on you and your products 100% of the time. I am terrified of doctors and I will not go to a doctor, so I always go to the London Drugs store to get what I need. Thank you for that.

I was very interested in the stats in your research and what you did with how Canadians respond to their health care needs. I, of course, respond by going to the counter.

You said your research showed that 2% of people went to a doctor even though they were self-assessed as having very minor ailments. I have always had an issue with people going to the doctor for maybe a little cough or something and costing a lot of money, and you mentioned the amount it costs. You mentioned the amount, and I wasn't even sure of that. I wanted to get some clarification on that. What is the cost of that to our health care system?

[Gerry Harrington]

I'll give a bit of a preface, and I'll ask Kristin to jump in with the numbers.

The thing about the minor ailments burden on the health care system is that even though we are talking about 2% of minor ailment sufferers, that numerator sits on top of an enormous denominator. These ailments are extremely common and are experienced by the vast majority of Canadians. It's always a bit of a surprise when you do the math back to understand just how great a proportion of the doctor workload those represents.

I'll let Kristin get into that, because she actually did a lot of work in that area.

[Kristin Willemsen, Director, Scientific and Regulatory Affairs, Consumer Health Products Canada]

Thank you.

In 2011 we did a close look at the economics of that. We found that one-quarter of Canadians do go to a doctor when they're faced with some minor ailment. We looked at coughs and colds, and for those who go to the doctor, those things alone represent about $625 million in doctor visits annually. For the percentage of people who go despite having mild symptoms, if they practised self-care alone, that would save the health care system $89 million annually.

We translated that into what it would mean in savings on doctor visits, and it would mean enough savings for 500 000 Canadians to have access to doctors' visits. That's not prescription drug costs. That's not testing. That's not other costs as well.

[Len Webber, Conservative, Calgary Confederation, AB]

I guess the biggest concern I have is the mixing of my consumer products. lf I take a cold medication at night along with perhaps something else to help me sleep, I worry about that. We have that issue with seniors right now with overmedication. I'm concerned about the awareness and the education of Canadians regarding the effects of different over-the-counter medications.

[Gerry Harrington]

It's a really important issue. There are a number of initiatives under way right now in terms of improving product labels, and the need for education.

One of the things, I think, that are really interesting about the Canadian market vis-à-vis other markets, particularly the big one to the south, is that Canadians are three times more likely to interact with a pharmacist when it comes to their over-the-counter medicines than U.S. citizens are. It's really important to continue to emphasize things like this, and the industry, I think, needs to do things like that to ensure that these products are used appropriately, because while they're safe and effective when used appropriately, that's the key condition.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you for that.

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

We had some witnesses talk about the Canadian system. Overall there's fairly good coverage, but there seem to be some gaps when it comes to groups like the working poor and seniors.

I think it was Mr. Adams who said if we didn't have private insurance, then on Day 1, boom, the federal government would have to cover, I think the number was around $17 billion, or a portion of that. Whatever it would work out to would be significant.

One of my colleagues asked if you were opposed to having a publicly funded pharmacare program. Are you opposed to having a hybrid program or an improvement of the program we have now, a mix between private and public, to allow better access, as you said, to certain medications that may not be covered because of cost constraints?

[Dr. Cindy Forbes]

Absolutely not. As I mentioned, the model we put forward, for a shared...could easily still be incorporated with private plans as well, so absolutely not.

[Colin Carrie, Conservative, Oshawa, ON]

Do I have time for another quick question.

[The Chair, Liberal, Bill Casey]

No, sorry.

Mr. Ayoub.

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

Mr. Chair, I will give my minute to Mr. Oliver.

[The Chair, Liberal, Bill Casey]

Okay. You're very generous.

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

Well, I'm generous today.

[The Chair, Liberal, Bill Casey]

I'll make sure he deserves it.

[John Oliver, Liberal, Oakville, ON]

Thank you very much, Mr. Ayoub.

Thank you for your very interesting presentations.

The first question is to Mr. Harrington.

No disrespect meant to your presentation, but I found the relevancy of it for our study to be somewhat problematic. I think two or three times in your presentation, you said that you understood we were addressing national pharmacare, but your topic was more on OTC. You don't want the OTC incorporated into a formulary. The principal concern you have is that if we were to develop a closed formulary in a national pharmacare system, drugs would be expeditiously moved to the OTC side of things if there were reasons for that. Is that the main takeaway I would have, then, from your presentation?

[Gerry Harrington]

The main takeaway is that yes, there are things that are lagging right now in the regulatory system for OTCs that would enable the task of creating a pharmacare program.

[John Oliver, Liberal, Oakville, ON]

So it's the earlier identification of when a drug can become an OTC and get out of the national pharmacare—

[Gerry Harrington]

And it's the removal of the red tape that currently....

[John Oliver, Liberal, Oakville, ON]

Thank you for that then.

Dr. Forbes, this is going back to what my colleague Mr. Davies said. We've heard varying views and perspectives on national pharmacare. The Canadian Pharmacists Association had commissioned a paper, and one of the assertions by the author of that paper was that moving from the open formularies that we have right now to a closed formulary would reduce choice for patients and doctors, and that would have a negative health impact on patients. Do you support that perspective that the open formularies are better than a closed formulary model?

[Dr. Cindy Forbes]

First of all, I don't think it's quite that simple. Many patients who have private drug plans don't have open formularies. As a matter of fact, within some of the insurance companies, there are 10 different plans that your company could purchase. Some of them are much more restrictive than others.

It's possible to design a national pharmacare program that isn't as restrictive as what you're talking about. That's really up to the designers of the program looking at what the problems are with it being too restrictive, and how we can deal with that. One of the ways we deal with it now is by allowing for exceptions and special authorizations. As much as I complained about the paperwork, the fact that there is a process is very helpful, and I think we could mitigate that.

[John Oliver, Liberal, Oakville, ON]

Does the CMA have any recommendation on a body that would be charged with the responsible development of a formulary? We've had CADTH present here. They're doing a ton of work across Canada. Is that what you view as the most likely place to park responsibility for that evidence-based approach to developing a formulary?

[Owen Adams]

That would certainly be something to consider, absolutely. They've been around. They have a solid track record.

[John Oliver, Liberal, Oakville, ON]

Great. Thanks.

I'm trying to think through other advantages of a national pharmacare system for physicians. Right now, I think we heard one group say, there are more than a thousand different private insurance plans that pharmacists are working through for patients. The question seemed to me to be how we ever get to a comprehensive patient health record, and if a patient presented in a national pharmacare system, it would be quite obvious, and it would be easier to track what medictions they were on and how those medications were being procured.

Would it be easier for either an emergency doctor or a family doctor to have those prescriptions easily identified as they look at a patient's history?