Thank you, Mr. Chair, and good morning.
I'm delighted for the opportunity to appear before the committee to share with you a very special report, which is, in fact, being released today.
As the committee is well aware, expanding comprehensive prescription drug coverage to all Canadians has long been considered the unfinished business of our medicare system. Our patchwork approach, with one in five Canadians having either inadequate coverage or no coverage at all, makes Canada an outlier among OECD countries with comparable comprehensive universal health systems. While policy experts, clinicians, and pharmacare advocates have, for some time, encouraged government action, the voices and preferences of Canadians themselves have been difficult to hear.
The report I am presenting to you today provides unprecedented guidance from Canadians, and is directed to health ministers and policy-makers across Canada. I would like, in my remarks, to first review our process and recommendations, and then invite a member of the Citizens' Reference Panel, Monsieur Jean-Pierre St-Onge, from Dieppe, New Brunswick, to describe his experience as a participant.
The Citizens' Reference Panel on Pharmacare in Canada, which I chaired, was a substantive effort to provide Canadians with the information and context they would need to reach their own conclusions on the appropriate drug coverage model for Canada. Working under the supervision of an 11-member advisory and oversight committee that included some of the most respected clinicians and health policy leaders in the country, and with a research grant from the Canadian Institutes of Health Research, the Mindset Social Innovation Foundation, the Michael Smith Foundation for Health Research, and the Universities of Toronto and of British Columbia, we set out to convene 36 Canadians, giving them a very special opportunity to help shape health policy in Canada.
As with the many reference panels that have helped to influence public policy in Canada, 10,000 letters were randomly distributed by Canada Post to households across the country, far more than for a focus group or a town hall meeting. Each letter invited the recipient to volunteer to spend five days here in Ottawa. I'm pleased to report that at a time when we routinely underestimate the public's appetite to play an engaged role in public affairs, almost 400 Canadians volunteered, coming from every conceivable corner of the country and walk of life.
From among the respondents, 36 individuals were randomly selected, with one member, regrettably, withdrawing due to illness immediately before the start of the process. The members of the reference panel themselves, as I've said, were randomly selected, but in such a way as to mirror the Canadian population and the prevalence of drug coverage and personal expenditure.
I would refer the committee to page 10 of the report to see a map indicating their place of residence as well as the short biographies we have included. In short, we brought together a cross-section of Canadians, and working out of the Canadian Museum of History, with a commanding view of Parliament and that other body of citizen representatives here at the House of Commons, we began our work.
From Wednesday until Sunday, the members met and held lengthy, bilingual sessions often running from nine in the morning until nine at night. My facilitation team had prepared a detailed curriculum, and during our first days together we heard from 20 different speakers. These included clinicians, policy-makers, pharmaceutical manufacturers, insurers, patient representatives, and economists. Each was intended to add a critical perspective to the discussion.
For the members, it was a remarkable immersion in a difficult and nuanced policy field. These 35 people put everything else on hold for five days, without remuneration, in order to serve their fellow Canadians and provide the government with their best advice.
The question of drug coverage affects each panellist differently, and although they did not always agree with one another, they found a way to tackle these differences with enthusiasm and grace. Working together, the panellists identified nine issues, or areas of concern, which they recorded in their report. Among these concerns, they cited the following areas.
First, there is a patchwork approach that leaves millions of Canadians without the coverage they need, leading to poor patient outcomes and increased overall health care costs.
Second, there is weak purchasing power, leading to higher than necessary drug costs.
Third, there are inadequate data systems for monitoring the use and cost of prescription medicines.
The fourth concern was predatory pricing and patent extensions that drive up costs, with little transparency on the true research and development costs of new medicines.
Fifth is limited public awareness of this issue, leaving many Canadians to cope with inadequate coverage alone.
In response to these concerns, the panel issued a series of principles that they believe should guide policy-makers, as well as a set of detailed recommendations. The panellists named five principles: that any action uphold the principle of universality, that it be patient centred, be accountable to the public, be evidence based, and be sustainable.
Following extensive deliberations, the panel reached consensus and calls on the government to work with the provinces and territories to implement universal public coverage of medicines listed on a new national formulary. They recommend that this formulary be extensive enough to accommodate the full range of individual patient needs, including rare diseases. They also recommend that all covered drugs undergo a rigorous evaluation process to ensure both the efficacy and value for money of funded treatments.
Importantly, and as a first step towards a comprehensive public drug plan, the panel also calls on the government to move immediately to implement public coverage for a short list of basic, frequently prescribed drugs. This short list would begin the shift towards a comprehensive universal pharmacare system and become the basis for this new national formulary.
The panel also endorses an ongoing and valuable role for private insurers in providing supplemental coverage. Under any new system, employers, unions, and individuals could continue to purchase private insurance for medications not on the public formulary as well as other paramedical services.
Finally, the panel is not averse to the government funding the program through modest income and corporate tax increases, which they believe is the most fair approach. They also urge further consideration of copayment models, provided they do not create unreasonable barriers for low-income individuals.
To conclude, much as the health system is rightly focused on patient-centred care, it's my belief that federal legislation can only benefit from a more citizen-centred approach to policy-making. I hope you will recognize the members of the Citizens' Reference Panel on Pharmacare in Canada for their singular contribution to this important debate and the service they have provided on behalf of Canadians.
Let me now turn to a member of the panel, Jean-Pierre St-Onge, so that he can comment on his experience.