Good morning.
I am happy to appear before the committee.
It's really a pleasure to be here this morning. Let me begin by thanking the standing committee for inviting me to appear today.
I'd like to start with a couple of facts. First, arthritis is a disease. I say that because many people don't see it that way, but that's exactly what it is: it's a disease, not an inevitable aspect of aging. It responds to treatment, to therapy, and as we're here to talk about today, it responds to medicine.
Second, arthritis is a chronic disease, and that's vitally important. A lot of the focus around medicine has been dedicated to those with acute conditions, and that's of course totally understandable, but we have to also address those who live with chronic disease and chronic pain and whose quality of life depends on affordable access to the right medicines.
How many Canadians are we talking about? It is 4.6 million, and that number is growing. Current trends suggest that by 2030 that number will double to nearly 10 million Canadians. Not only in health-care terms, but in economic terms, the toll is enormous. Arthritis is the second-leading cause of disability. It takes people off the job and out of the workforce, costing, according to our estimates, $33 billion a year, and two-thirds of that is lost productivity. By 2040, we'll be looking at an annual economic impact of double that. We call that the “arthritis tax”.
I'm not even touching on the intangible but very real human costs of arthritis, such as the young child with juvenile arthritis can't play outside with his friends, a young mother whose disease is so advanced that she can't pick up her children and hold them, grandparents who finds it so painful that they don't travel to visit their family.
Those are the intangible but very real human costs of arthritis. I raise that because I want to underscore the enormous good that can be achieved with fuller, more affordable, and more equitable access to medicines.
Let me offer the first of two core recommendations to you today by saying, yes, the Arthritis Society strongly favours universal pharmacare, a program that will plug the loopholes, the gaping holes in coverage that people with chronic disease face today, an approach that will expand access to medicines, boost productivity, and combat pain.
Let me assure you that based on those I talk to regularly, the need is great. As we all know, in hospitals the cost of those medicines is covered, but those living with arthritis typically aren't in hospitals, and coverage is inconsistent. In 2013 we surveyed more than 1,000 Canadians with arthritis and found that only 63% reported they had workplace insurance plans. That's nearly four in 10 who aren't covered, resulting in large numbers who end up having to leave the workforce, retire early, because their treatments don't allow them to remain productive. For those with private plans, we're seeing an increasing litany of challenges with some drugs covered, others not, copayments rising, and benefit caps becoming more common. Most concerning of all for us, choice can be limited, with newer therapies having restricted access.
That takes me to my second really important recommendation. Yes, we want to see a national pharmacare program, but it can't be built solely around the idea of lowering costs. It also has to have a substantial commitment to choice. Let me explain.
I know that for many, one of the benefits of a national pharmacare program is the idea of reducing the prices for more expensive drugs. By establishing a larger or even national formulary, our collective bargaining power can drive prices down, allowing us to buy in bulk and potentially save large amounts of money. We applaud that idea, but we can't risk establishing a formulary that is too restricted in terms of the range of medicines that are available, because the reality is that people living with arthritis each respond to different drugs differently.
A range of choice is therefore important, and that applies particularly to some of the more expensive new drugs called “biologics”. That new category of drugs includes living organisms. They're biologic, not chemical, compounds. Because of that, they interact differently with different individuals, according to that person's biological makeup. They can be a miraculous life-changer.
I'm going to tell you one story. A young man named Matthew was on his way to being a star athlete when he was diagnosed with rheumatoid arthritis and was completely incapacitated. He dropped out of school, had no ability to function, and was in constant pain. Now, thanks to biologics, he has been able to turn his life around. His pain has reduced dramatically. He's able to finish university and start looking at a career. That's not beyond his grasp, even though being an athlete is not going to happen for him.
However, the problem is the cost. His drugs cost between $20,000 and $25,000 a year, and since he's out of school, he's no longer on his father's plan. The family is looking at funding that and, effectively, looking at financial ruin because they want to make sure their son gets the life-changing treatments he needs.
We need universal pharmacare. That would make sure that people like Matthew were covered. However, it won't work if we're too narrow in our approach, because as I said, biologics affect different people differently, so if we restricted access to one biologic in the class for people with arthritis, many people like Matthew would not be well served. Similarly, if we force people to switch treatments to cheaper alternatives such as biosimilars, which are now emerging, it could also result in reduced therapeutic benefits.
From our perspective, it is the patient at the centre of the decision, in consultation with their health care provider, who should determine the treatment and medicine that is most appropriate for them. I know that's not a simple choice. Expanding that choice and leaving choice available would offset some of the savings that might otherwise be achieved through national pharmacare, but we think a balance is required to establish a system that truly serves the needs of Canadians, especially those with chronic diseases like arthritis.
Universal pharmacare is needed. With 4.6 million people living with arthritis and struggling to pay for their medicines, that is clear. I urge the committee to establish two guiding imperatives, not one. Lower cost and wider choice will be the recipe for real progress.
On that, I'll conclude my remarks. I look forward to answering your questions.