Evidence of meeting #19 for Health in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was medication.
A recording is available from Parliament.
Chief Science Officer, Canadian Diabetes Association
In terms of accessing a new drug treatment, may I ask if you are meaning drugs that most recently come on the market?
Chief Science Officer, Canadian Diabetes Association
Many of those drugs are not covered, and they're certainly not covered consistently. They'd be listed in some provinces and not in others. When they're not covered by the patient's individual insurance plan or a public plan, they'd need to pay out of pocket. These drugs are frequently expensive and that cost barrier would preclude those patients getting the benefit of those medications.
Liberal
Sonia Sidhu Liberal Brampton South, ON
What costs associated with the management of type 1 and type 2 diabetes are covered by private health insurance plans?
Dr. Keon, can you enlighten us?
President, Canadian Generic Pharmaceutical Association
This is probably a better question for someone else.
Chief Science Officer, Canadian Diabetes Association
Again, I think a recurring refrain from us is patchwork, that private plans also have inconsistent coverage, inconsistent levels of copayment. For instance, people are very vulnerable in making a job change if their current plan covers their devices, supplies, and medications. They may be reluctant to shift to a company that provides a better opportunity for them but doesn't offer the coverage they need.
Liberal
The Chair Liberal Bill Casey
Thanks very much.
Now we're done the first round.
I want to ask a question of Mr. Keon. Mr. Keon, you said in your initial remarks that some of our testimony reflected unrealistic savings. Is that an observation, or do you have a study or anything that would help us?
President, Canadian Generic Pharmaceutical Association
I think what I was referring to, and the witness from the medical students association also referred to it.... Already, as I said, over the past four years, on the generic side of the business, we have negotiated what's called a tiered pricing framework. When a product is more difficult to make and there's only one maker, the price may be higher. Where it comes down and there are many competitors, such as a popular drug like Lipitor for high cholesterol, the prices are very low. They're at 18% of the equivalent brand. You can fill five or six prescriptions.
The other thing about the tiered pricing framework is the private sector is not at the table, but they are covered by prices. Our prices are transparent. They're the same price for everybody. They are already getting the low prices. There is no difference in price between the public and private sectors.
I guess I would question how a national pharmacare program is going to reduce costs dramatically in the generic sector, for example, beyond what the provinces have already negotiated. There may be some further savings, and we're at the table discussing that.
On the brand-name side, there are confidential private listing agreements, which I don't think the researchers would have access to, which already provide further savings to payers. All I'm saying is these estimates appear to us to be wildly over-optimistic. Our view is if you're going to move forward with a national pharmacare plan, you do it because of patient access, because it's the right thing to do, and not because you think you're going to save billions of dollars. I do not think that is a realistic assumption going into this.
Liberal
The Chair Liberal Bill Casey
Okay, but you just said it appears to you, so there's not a study or anything?
President, Canadian Generic Pharmaceutical Association
Well, I'm telling you that we already negotiate.
President, Canadian Generic Pharmaceutical Association
There is a study saying it was $7 billion. We criticized that study and do not accept the results of it.
Liberal
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you, presenters, for your patience today. I apologize for belabouring some things, but I feel passionate about it. In any event, my question is for Mr. Casey.
I found your presentation very interesting, especially your comment on the new innovations, the saliva in the shrew. I find it fascinating that the saliva would be used for perhaps ovarian cancer treatment. My question for you, and perhaps for Mr. Keon as well is, do you think that experimental drugs should be part of a national pharmacare plan? If so, do you think there should be a limit on how much would be spent? How should that limit be set? Is that in your realm?
President and Chief Executive Officer, BIOTECanada
Perhaps you could define “experimental drugs”.
Conservative
Len Webber Conservative Calgary Confederation, AB
On experimental drugs, I go back to perhaps your example with regard to the saliva. It's going to advance and it's going to perhaps become a medication one day, hopefully, if it's positive. At that time, I guess it would be referred to as an experimental drug, as long as it passed Canadian health care requirements. Do you think an experimental drug should be part of a national pharmacare program if it's effective?
President and Chief Executive Officer, BIOTECanada
Sure, but just to be clear, by that time, and we're talking about probably in 10 to 15 years, it will have gone through a very rigorous testing process in labs where you use probably rats, but also then you have to go through clinical trials. There are three different phases of clinical trials in human beings to make sure these drugs are absolutely safe and efficacious for patients. Only then do you get approval from Health Canada. At that point in time, you then have a product that can actually be used for patients.
I wouldn't consider that to be experimental at that point, because by then you've done all the work on it, and you've made sure it's actually going to work and be safe for patients. Then you're talking about a novel therapy, in which case, yes, because it's addressing an unmet need. Obviously, it's addressing an affliction of a patient who is suffering. It could save a life, so, yes, any sort of pharmacare program should cover that therapy.
Conservative
Len Webber Conservative Calgary Confederation, AB
Technically, there really are no experimental drugs that would be....
President and Chief Executive Officer, BIOTECanada
The closest you come to experimental drugs is if you're enrolled in a clinical trial, in which you would be part of the process of discovering...but by the time it's being put into you, it's pretty much sure that it's going to be safe. The question is, what's the dosage and how much can the patient withstand?
President, Canadian Generic Pharmaceutical Association
I endorse what Mr. Casey said, but there are circumstances in some cases where, for whatever reason, a company has not applied for approval of a drug in Canada, so it's not approved for sale in Canada, but it is approved elsewhere. Health Canada does have a program for exceptional circumstances where, if a physician is suggesting that this medication is needed, even if it's not approved in Canada, sometimes there can be opportunities to cover that medication.
President and Chief Executive Officer, BIOTECanada
If it has been approved. Usually the FDA or the European medical community has approved it as well. We're not talking eye of the newt type of stuff here.
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you.
I want to say to you, Ms. Hux, as well, that your presentation was interesting. I appreciate your coming up with recommendations for us. Your final comment was about how the federal government should take a leadership role with regard to a national electronic health records system.
Last spring we had a private member's bill regarding a national organ donor registry. It was defeated by the government. It didn't pass. The reason for it not passing was that they thought it would step into provincial jurisdiction. We've already heard here that a national pharmacare program would be a federal and provincial jurisdictional tug of war.
Do you anticipate any jurisdictional problems? Maybe I'll ask the entire panel here. The issue is jurisdiction between the federal government and the provinces, and such. Do you see a problem with a national pharmacare system being implemented and problems with the provinces?
Chief Science Officer, Canadian Diabetes Association
You began your question with respect to the electronic medical record. I may not have been complete in my remarks under the circumstances, but I suggested that an electronic medical record be implemented by the federal government for health care that is within its jurisdiction and that the provinces be urged to implement the same within their jurisdictions.
I think it is difficult to manage those jurisdictional issues. It's especially difficult when patients get caught in the crossfire of that and get suboptimal care because of jurisdictional issues. Nonetheless, we see tremendous promise in the electronic medical record for people with diabetes. The number of medications available for management of blood glucose alone in type 2 diabetes has quadrupled in the last 10 years, and it's difficult for physicians to always know which is the best treatment to offer for a specific patient in a specific circumstance.
Electronic medical record can queue that and can remind them that even though it looks like that might be the best medication, but because this patient has impaired kidney function, don't prescribe it. That improves the safety and effectiveness of drug treatment, and we feel that people with diabetes deserve to have that. Bolting it onto the pharmacare initiative would be an important way to support the implementation.