Health Committee on Sept. 29th, 2016

[Peter Weltman]

In the past, we have studiously avoided studying hypothetical situations. In the start-up phase, because of our limited resources, we've tended to look only at bills that were presented, private members' bills, because we wanted clarity. For example, we were asked early on to look at the cost of poverty. There were a lot of different assumptions that needed to be made, and we respectfully excused ourselves from doing that.

That's the simple answer. That is why we keep coming back and saying we need some precision around what the program looks like. With a private member's bill, there is usually a fair bit of precision in the bill. In this case, we are looking at a policy proposal, so we would not do any hypothetical study.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thanks.

[The Chair, Liberal, Bill Casey]

Mr. Davies, go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Mr. Chair.

If we asked you to determine the cost of adding pharmaceuticals to the Canada Health Act as an extension of insured services, could you do that?

[Mostafa Askari]

Well, that would be one model, one sort of structure, and that structure means that there has to be a formulary that would cover certain prescription drugs that all the provinces have to include in their program. Certainly, that's one structure.

If that's the case, sure, we can focus on that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Suppose we asked you to estimate the cost savings from a series of discrete, itemized factors. For instance, the federal government could engage in bulk buying of essential drugs in a formulary. I assume that we would give you a formulary of, say, the 150 most commonly prescribed drugs and we could ask you to estimate the potential savings from bulk buying. We could have exclusive licensing agreements with respect to certain drugs, as some countries are doing, and streamline the processing of claims. There is cost-related non-adherence, as Dr. Eyolfson has mentioned; that's the term for how much we would save from people getting access to their drugs as opposed to waiting and getting sicker without them. We could have an evidence-based formulary and increased use of generics.

If we itemized those as A, B, C, D, E, do you think you could give us rough estimates on what the cost savings from each of those elements might be?

[Mostafa Askari]

These are all good questions. To know whether it is possible or feasible for us to do that, we would have to go back, look at the question, look at the data availability, and see whether we can put a model around it and come up with a reasonable estimate.

Some of these things may require strong assumptions that may reduce the credibility of the results, because if you make too many assumptions, then the results are not very credible. These are the kinds of questions, unfortunately, we cannot answer right now until we go back and do our homework and get a better sense of the information that is available and the experience of other countries and other models. Then we can put together some terms of reference and come back to the committee and say what we can do within a reasonable timeframe.

[Don Davies, NDP, Vancouver Kingsway, BC]

The reason I ask is that witnesses at this committee have said that if we were to have a universal pharmacare system in this country that was an extension of the Canada Health Act, then they estimate that there would be an additional cost because you're covering more people, but that it would be offset by savings from these different areas.

I think the committee's interested in having some objective analysis of whether that may be the case, so that's why I'm asking.

[Mostafa Askari]

Those are big assumptions, and that may be true, depending on how you do it.

[The Chair, Liberal, Bill Casey]

That completes our testimony and our questions. I want to thank the PBO for your comments and your agreement to take this on, because we haven't given you a model to analyze.

We're lucky to have your agreement on that, but what exactly is the way forward now? What's going to happen next?

[Jean-Denis Fréchette]

The first issue is that we did not talk about any timeline.

Here is the way forward. We took note of all the comments from all sides. We will come back with the terms of reference or some kind of a work plan, according to what we heard, with some options.

We would like you to then decide which one you want. It will be your model. It will not be the PBO's model, so let's be clear on that. It's going to your choice. I'm sure people in the department are listening right now in meeting rooms, and maybe they do have a model. Maybe they have something in mind. We will ask them if they have a model. Then we can cost that. That's going to be the model they may have. They probably don't appreciate what I just said, but we will ask the department. There is a policy shop, a policy section in departments, so that's certainly a discussion we will have. That's the first thing.

The second thing is that we will present the terms of reference with some kind of timeline. In two weeks, roughly, we should be able to come back with the terms of reference based on the discussions that we had this morning, with some options for you to decide which one you want.

From there we'll discuss the timeline and what we will do. Then we can report on a regular basis to the committee, as we do with other committees, on the difficulties that we have with accessing data or developing our own analysis of it. I want to be clear that if you provide me with some kind of margin to manoeuvre within the motion that you have there.... As I said, I'm not sure where the motion stands right now. If I have to respect the motion, it's a little difficult, but if we can play a little with the motion, then that would be easier for us to develop the terms of reference. In two weeks we should come back with what I said.

[The Chair, Liberal, Bill Casey]

In two weeks you'll notify us. Can we schedule that now, or should we wait until you contact us?

[Jean-Denis Fréchette]

We will contact the chair's office. The process is always that we contact the chair's office.

[The Chair, Liberal, Bill Casey]

When we choose the model, do you have any idea how long it will take to get to get a final report? We're not in a hurry. I think I can say we're not in a panic.

[Jean-Denis Fréchette]

I would like to give you an answer. When Senator Kirby's report was done, I was at the Library of Parliament monitoring some of that research. I can tell you that maybe it will take...well, I won't say that long, but we will see after we have further discussions with this committee about the terms of reference.

I don't know if you have a steering committee. Do you want to deal with the terms of reference in the steering committee? I don't know; it's up to you.

[The Chair, Liberal, Bill Casey]

Mr. Davies, did you have a question?

[Don Davies, NDP, Vancouver Kingsway, BC]

Yes. I'm just wondering if it would be better to do the reverse. We, as a committee, could take the information we've received from the PBO and hone our motion, given the information you have—by the way, the motion is not passed yet—to provide you with the model and the parameters. It almost seems backwards to me to ask the PBO to provide us with the model and the parameters.

[The Chair, Liberal, Bill Casey]

Does the PBO have enough to work with now to analyze the models and come back with models? Do you have enough to do that?

[Mostafa Askari]

We can certainly look at the availability of data and put together preliminary terms of reference, which we can then share with the committee. Further discussion could clarify different parts of that, and then we'll go over the final terms of reference at that stage. That's a possibility.

As I said earlier, the idea of having a pharmacare program in general is by itself a costing project. Then we need further details in terms of what the committee thinks would be a reasonable kind of structure for that program—whether it is a federal program or a provincial-based program, those kinds of details. Then we can develop better terms of reference on that basis, finalize that with the committee, and start the work.

[The Chair, Liberal, Bill Casey]

So we have enough to go ahead.

[Mostafa Askari]

That's right. We can provide the terms of reference. As I said, it won't be the final terms of reference, but we can provide preliminary terms of reference for what kinds of things we can look at.

[The Chair, Liberal, Bill Casey]

Mr. Oliver, go ahead on procedure.

[John Oliver, Liberal, Oakville, ON]

I just want to follow up on Mr. Davies' suggestion. I think it's worthwhile for us to take a look.

I think we did pass the motion preliminarily but agreed that we would look at it again at the end of this session, following this discussion. Maybe we could go back, address some of the questions and concerns that have been raised here, be a bit more specific in certain areas, and pass it over, but I still think we should have an iterative process with the PBO. We'll pass a motion to give them a more concrete direction of where we as a committee would like to see the study go, but then be receptive to a report back in two weeks from the PBO on what works, what doesn't work, and what advice they would give us to fine-tune it. I think that would be a bit more of an iterative process than to simply punt and wait for that to come back.

[The Chair, Liberal, Bill Casey]

Ms. Harder is next. We are breaking all the rules here. I hope it's all right with everybody.

[Rachael Thomas, Conservative, Lethbridge, AB]

I agree with Mr. Oliver. I think it would be in our best interest to reconvene as a committee and talk about the motion that we are putting forward, in terms of the direction that is being delivered to the PBO, because it feels a little convoluted right now.

The other thing I would recommend to the committee is that once our motion or direction goes forward to the PBO, perhaps we could ask them for an outline of their report before they get going so that we would be able to see exactly where they are able to take it, because there are going to be some points that perhaps they can't expand upon and others that they can. Perhaps we could get a detailed outline from them and sign off on that before they put the time and energy into it.