Thank you very much, Mr. Chair and members of the committee. It's a great pleasure and an honour to be here.
Thank you very much for the opportunity.
Greg Marchildon is my colleague. He's the executive director of my commission and currently the professor and Ontario research chair in health policy and system design at the University of Toronto.
We are each going to speak for five minutes. I'll address the recommendations of the royal commission relevant to the present mandate of your parliamentary committee and the leadership question of whether we can move forward. Dr. Marchildon will put forward two options describing how we might move forward as a country, especially in light of the public opinion polls we just heard.
Unfortunately, the challenge we identified in 2002—which seems like yesterday—remains the same today. In fact, there's a long history of commissions and studies recommending national pharmacare, dating all the way back from Emmett Hall's report in 1963-64, to my own commission report in 2002. While the current and potential benefits of prescription drugs are undeniable, the benefits will only be realized if prescription drugs are integrated into the system in a way that ensures they are appropriately prescribed and utilized, and that costs can be managed. As we said in 2002, the issues are national in scope, and the problems are similar in every part of the country.
As a consequence, we argue that only a pan-Canadian approach will allow us to address the triple challenge of access, cost, and integration identified in the report. While I'm pleased to say that at least modest improvements have been made in terms of catastrophic drug coverage in a number of the provinces since 2002, but access still remains limited and uneven. Poor working and self-employed Canadians continue to have no coverage. Roughly 50% of Canadians have no public drug coverage at all, which is one of the lowest levels of coverage in the OECD. Private sector, non-unionized employees, and women have far less job-based coverage than public sector, unionized employees, and men. There are also significant differences in provincial coverage for retired individuals 65 and over, and those on social assistance.
When it comes to cost, we have made little or no progress. We are second only to the United States in terms of costly generic drug prices, and near the top of the OECD group of nations for patented drug costs. This is directly due to the fragmentation between private and public coverage, the loss of leverage with the pharmaceutical industry, and variations in the practice by having disparate federal, provincial, and territorial programs.
We have made modest progress on improving coordination since 2002 through the common drug review program and the pan-Canadian Pharmaceutical Alliance.
I would say, Mr. Chairman, and committee members, that we need to go much further to achieve the kind of integration required to improve access and quality of service to average Canadians in a fiscally sustainable way.
This brings me back to the steps I suggested in the report and the steps that we need to take to achieve real progress on access costs and integration. They are as follows: one, the establishment of a single national formulary; two, the creation of a powerful national drug agency that would regulate both patented and generic prescription drugs, provide analyses of both clinical and cost-effectiveness, and be the guardian of a national drug formulary; three, the linking of medical management, best practices, and guidelines with primary health care services; four, doing a comprehensive review of the Patent Act to address continuing problems, such as evergreening and the proliferation of so-called me-too drugs.
I want to emphasize how important federal leadership will be to achieving the goals of a national pharmacare plan and getting us out of our current situation. I say this as a former premier. I'm talking about federal leadership, national leadership. The public wants a strong federal role in advancing this much-needed step forward in reform. Will Ottawa act on this issue, just as Prime Minister Pearson in a minority federal government in the 1960s did, by overcoming opposition to implementing the goals of medicare? This does not mean compulsion, but it will mean setting out a national vision with clear objectives, supported by some non-negotiable, national criteria, which must be accepted before any provincial or territorial government can gain benefit of the federal investment in pharmacare.
At this point, I'll ask Dr. Marchildon to review the two main options in achieving the national pharmacare plan, and in either case the federal government will need to take a strong leadership role.
Greg.