Health Committee on Dec. 6th, 2016

[Rachael Thomas, Conservative, Lethbridge, AB]

Okay, thank you.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses for being here today.

Mr. MacLeod, I want to quote from the preamble to your report. The report states:

There is an urgency behind our recommendations, and action needs to be taken immediately. People are suffering and dying, as our current system does not meet their needs. Our population is aging, and new needs are emerging. We have to look out for all Canadians, young and old, regardless of socioeconomic status.... We, as a panel, expect our federal, provincial, and territorial political representatives to listen to and review our advice.

Given that we have three years left in the current federal government's mandate, with the next election in 2019—it being 2016—would you recommend that this federal government, this Parliament, act on the recommendations?

[Peter MacLeod]

I certainly believe it was the intent of the members of the panel to signal to government that they expected action within this term of Parliament.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'm going to move to the first step that is recommended by the panel. The panel calls on the government to move immediately to implement public coverage for a short list of basic, frequently prescribed drugs. I think you called it a down payment on the national comprehensive formulary that you ultimately recommend.

Can you expand a little on that for this committee? How many drugs are you contemplating, and what kinds of drugs do you think this government can act on immediately to provide national coverage for Canadians now?

[Peter MacLeod]

The idea of a basic list is an evolving concept. Typically, we're talking about between 100 and 200 medications that, to the best of my understanding, make up about 40% to 50% of prescriptions. These drugs are often used to treat chronic illness, and often they prove to be quite costly to those people without insurance. Those who are in precarious employment, those without coverage, those who are low income, perhaps, stand to benefit the most from a basic list. Of course, it would also begin to normalize the idea of public insurance for all Canadians.

In a sense, it's your biggest bang for the buck in terms of health equity and health outcomes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Give us a couple of examples of what kinds of prescription medications you're talking about there.

[Peter MacLeod]

I have to be careful; obviously, I'm not a physician nor a pharmacist.

However, these would be to treat normal chronic conditions, which might include hypertension or gastrointestinal issues. These are commonplace medicines that physicians, and certainly patients, would be very familiar with.

[Don Davies, NDP, Vancouver Kingsway, BC]

To be clear, the only prescription I'm asking for here is the policy one.

[Peter MacLeod]

Thank you.

[Don Davies, NDP, Vancouver Kingsway, BC]

Your panel recommended ultimately broadening the system to a universal public coverage of medicines listed on a new national formulary. You recommended that this formulary be extensive enough to accommodate the full range of individual patient needs, including rare diseases.

I also note that the principles identified by the panel either are the same principles or a mirror or are compatible with the principles under the Canada Health Act.

I am curious about your views on whether the panel would like to see the creation of a national public insurance system as a standalone system, with a national formulary administered on its own, or whether it sees an expansion of insured services under the Canada Health Act, under the present system of delivery. Or is there any big difference between the two?

[Peter MacLeod]

I'm not sure if there's a significant difference between the two. I know it was the intention of the panel to see that any new regime would be operated at some arm's length from political pressure so that it could be an evidence-based system that was directly accountable to Canadians both as patients and as taxpayers.

I think it's important, however, that any new public insurance plan reflects the intent and spirit of the Canada Health Act, and I think members of the panel were surprised to see that our existing patchwork approach is not consistent with those principles. Perhaps, besides universality, the key concern was the degree of variability that exists across the country. That's why, in working with the provinces and the territories, they call for national federal action.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. MacLeod, I've already quoted language from your report, some pretty tough language that “People are suffering and dying” under the current system.

Ms. James, is it your organization's experience that under the current patchwork system where people are not necessarily covered, people are dying in Canada because of an inability to access prescription drugs?

[Lesley James]

I did mention examples of people unable to access necessary and basic prescriptions for cardiovascular disease who skipped doses or are not adherent and that results in increased rates of heart attack presentation in emergency rooms.

We've been able to reduce the risk of mortality associated with heart attacks, but many people don't make it unfortunately, and that could be prevented with better access for all Canadians to preventive prescription medications.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is morbidity a consequence of this gap?

[Lesley James]

Yes. Both morbidity and mortality are.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. MacLeod, researchers estimated before this committee and otherwise that overall savings in Canada could be achieved by a national universal pharmacare program in the nature of $4 billion to $11 billion annually, depending on the structure of the system and the parameters adopted.

According to your report, an expert panel I think urged a more conservative view of cost savings achieved through universal pharmacare. Was the reference panel still in favour of a national universal pharmacare program if it achieves universal coverage but results in no overall cost savings to government for pharmaceuticals? Should we proceed anyway?

[Peter MacLeod]

I want to be careful in not speaking beyond the text of their report. My understanding of their intentions was that improving health outcomes and addressing fiscal inequities for Canadians probably superseded other concerns.

[The Chair, Liberal, Bill Casey]

Your time's up.

Mr. Kang.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you, Mr. Chair.

I want to thank the panel members for appearing before the committee today.

Mr. MacLeod, your recommendation is that:

This national pharmacare system should be provided through public insurance. This will ensure all Canadians have the same access to pharmaceutical coverage. It will unify buying power.... A public insurance system should...be accountable to Canadians through an arm's-length agency free from any profit-motive.

In the next paragraph you say, “This system must also allow individuals and employers to continue to purchase optional private drug insurance.”

When we have national pharmacare that is going to cover all Canadians, why do we need any private drug insurance? If national pharmacare is going to leave the door open for companies, what role do you see for private insurance?

[Peter MacLeod]

Thank you. That's an excellent question.

It was not the intent of the reference panel to see that all available drugs would be covered through a national formulary. Those that were evidence based and judged to offer the best course of treatment at a reasonable price are those that would be listed, as they are in other countries with national formularies. Nevertheless, it was important to members of the reference panel to preserve an avenue through which patients could still exercise some choice in the medicines they access. They see the private insurance market as an opportunity for supplemental coverage to provide access to those additional drugs.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Here we're trying to bring in national pharmacare. You said one in five Canadians probably don't have insurance, or they don't have enough. That's going to be kind of like a two-tier system. How about the people who cannot afford to get private insurance? How would we cover them?

[Peter MacLeod]

I don't think the two concepts are in any way mutually exclusive. We can look to many other countries that have robust systems of publicly funded prescription medicines but that also have supplemental drug insurance, much as we have, still with a robust medicare system in this country, many individuals who, either individually or through their employers, hold private insurance, which, of course, gives them access to paramedical services.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

I'm not really satisfied with that answer because I know we have people who are probably on fixed incomes, and if they were to try to get private insurance, they probably couldn't afford it. They have a difficult time putting their bread and butter on the table as is. My concern is leaving the door open for those who are disadvantaged and not covered.

[Peter MacLeod]

It's important to be clear that we're not talking about preferential access, nor are we talking about any barrier to required or necessary medicines for those on public insurance. What we're talking about, as one example, is the difference between a generic and a national brand medicine. Some people may continue to prefer that recognized brand, but as most clinicians are aware, those medicines are effectively identical.