Health Committee on Dec. 1st, 2016

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

[The Vice-Chair, Conservative, Len Webber]

We'll move on from there to Dr. Eyolfson.

You're up for five minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you all for coming. I've met some of you before. I also serve on the veterans affairs committee, so some of this testimony is familiar. My first question is for Mr. Doiron.

When you talked about how medication is approved to be covered by Veterans Affairs, you said it has to be medication for a service-related injury or service-related illness. We went on to talk about mental health. If a veteran has a significant mental health issue that is requiring medication, does the veteran have to prove it is service-related in order for Veterans Affairs to cover it?

[Michel Doiron]

Thank you for the question.

When it comes to the mental health services that Veterans Affairs provide, we acknowledge the fact that veterans are put into very difficult situations and often that causes mental health issues. We are extremely supportive of that with our programs and medication. If it's a mental health issue and there's any link—even a resemblance of a link—to any type of service or they've been in any special duty area, as we call them, Veterans Affairs will take care of that mental health issue.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right, thank you.

If the veteran had any history of mental health problems before service, is there the risk that the veteran might be turned down due to this being considered a pre-existing condition? Do you know if this happens?

[Michel Doiron]

Veterans can be turned down if there's no proof that it's a service-related issue or they've never gone to an SDA or something like that. However, we do not turn them down because of a pre-existing situation or pre-existing condition. Because they joined the military, they are deemed to be healthy. We put them in harm's way and, if something happens, we make sure to take care of them, pre-existing situation or not.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right. Thank you.

[Michel Doiron]

I'd like to mention that, even if it's not service related—I will put a little plug in—we actually have programs where they can get 20 treatment sessions with a psychologist. We take care of it. It doesn't matter if it's service related or not. We're there for the veteran, even if it's not.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

That's good to know. Thank you.

To go further with what Mr. Oliver said about this being contracted out, the administration being contracted out to Blue Cross, can you briefly comment on, say, the strengths and the weaknesses of contracting this out to a third party rather than dealing with it internally?

[Michel Doiron]

Thank you for the question.

One of the strengths of Medavie Blue Cross is that it is professional in the provision of health care and the administration of that. It has an expertise that the department does not have or it's very hard to maintain. Therefore, we buy it and it does the administrative part, which is not always the highest value part—the money part is always high but I mean the contribution. We brought in a pharmacist and a doctor to do the right monitoring, as identified by the OAG, but for the widget counts and getting the payments out and paying the pharmacies, it was more cost-effective to go with a company like this. It's not the only company but it is our provider, Medavie Blue Cross.

The other thing is that Medavie Blue Cross has a relationship with the pharmacies across the country, with portals where the pharmacist can bill us through not a paper process but an electronic process, and then Medavie can do the right monitoring of any duplications. These are things we could not do. I think, on the whole, it was much more beneficial to us to have it administered by a third party.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right, thank you.

My last question is for Mr. Perron. If we were to create a national pharmacare program, would you think it beneficial to have first nations health care needs administered through that same umbrella, or would you think it more beneficial to still have their medication benefits under the non-insured health benefits program for first nations?

[Sony Perron]

You're asking a very bold question. I will try to put my brain to work answering this.

I will say that there is some specific need for some specific segments of the population. Whatever model you have—and I think our colleagues from Veterans Affairs mentioned this—there will have to be a place for adjusting the formulary and the approach to some segments of the population.

I think the ambition of having first nations and Inuit take more control over their own programs would have to be thought about and accommodated. For example, right now with the Assembly of First Nations we are doing a joint review of the NIHB program to get their perspective not only on the pharmacy benefits but on all benefit areas to try to adjust and deal with a systemic issue they may be facing in one region, or involving one benefit.

I think we should not lose the ability to engage the nations in the program. This is as far as I can go.

I will say that one systemic issue we are facing is that this is a national program. We operate in 13 jurisdictions. Often we will have clients complaining about having difficulty accessing some products or services in one province, because suddenly the provincial plan will have made a decision to start to cover them and the other clients will want to get them changed from non-insured.

We are not there yet. The non-alignment of the formulary between provinces and territories has caused some difficulty for clients trying to access our program. For us to always have to monitor that is a challenge, because in the end we want to facilitate access to the drugs that the clients may need.

I don't know whether I answered your question—

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Actually, you did.

[Sony Perron]

—but somehow I think there is a need for adaptation, whatever model we use.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Sure. Thank you.

Thank you, Mr. Chair, for your indulgence in that.

[The Vice-Chair, Conservative, Len Webber]

You bet.

We'll move on to Mr. Davies.

You have three minutes. Thank you.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'm interested in following up a little bit more on medicinal marijuana.

Mr. Doiron, you said you don't use prescriptions for it but do use scripts. What's the difference between a prescription and a script?

[Michel Doiron]

Actually, I should have said an “authorization”. I typically say “script”, but the real term is an authorization.

There are doctors on your committee, so they can correct me, but a prescription is for when the doctor can refer to certain criteria. For example, if you have pneumonia, you're going to take penicillin—a certain dosage per day times seven days. In the case of marijuana, that does not exist.

The “authorization” they often write on the same pad as you would a prescription, but the doctor says, “I authorize my client to have three grams a day”. It's not a prescription, because in the drug world this is not a classified drug. It doesn't fall under that category; therefore, it's not a prescription.

The piece of paper is usually just about the same. There's no issue there, but it's the terminology.

[Don Davies, NDP, Vancouver Kingsway, BC]

I understand that, so we'll leave the technicalities aside.

The bottom line is that the Supreme Court of Canada has ruled that Canadians have a right to access marijuana for medicinal purposes. Doctors are writing, for lack of a better word, prescriptions on prescription pads for marijuana for medicinal purposes.

Veterans Canada is covering and paying for marijuana to be used for the treatment of certain things. For PTSD in particular it has been quite successful, I understand through some of my discussions with veterans, which I think would explain the explosive growth in usage among veterans, particularly those with PTSD.

My question, then, is to Health Canada. Health Canada, another branch of government, is not approving the use of medicinal marijuana for any first nations or Inuit people. Why the discrepancy?

[Sony Perron]

It goes back to the mandate of the program, which is to cover prescription drugs. We have reviewed the requests—there are a number of requests that have come forward in the last few years about this—but it doesn't fall under prescription drugs. This doesn't prevent the client from accessing the products at his home, but we do not have the authority at this time to cover and spend money on this product.

[Don Davies, NDP, Vancouver Kingsway, BC]

Are you feeling a pressure from the first nations and Inuit communities to have it covered in the way that veterans are getting it?

[Michel Doiron]

We have received requests. Volume-wise, I cannot tell. Maybe Scott can give us....

[Scott Doidge]

It's not very many. We get small numbers of them. They're more inquiries than requests.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

I want to leave it to all of you—I have a very brief time left—to say what advice you would give us. If Canada were going to set up a universal pharmacare system to cover all Canadians for a broad formulary, with your experience in looking at some angle of this, what is the best advice you'd give this committee?

Maybe I'll start with you, Monsieur Doiron.

[The Vice-Chair, Conservative, Len Webber]

Excuse me, though, Mr. Davies. You are out of time, but I'm pleased to tell you, if I have unanimous consent around the table, we can add another five minutes to each of the parties and we can start with you.

Okay, you have five more minutes.