Health Committee on Dec. 13th, 2016

[Mostafa Askari]

We normally prefer to cost programs that are already in place or have been proposed by the government. Only the elements of the policy are known at that point, so it would be much easier and more effective to cost a program like that. This is an idea, so the elements of it are not really clear to us. With the directions from the committee, we have come to these terms of reference. Whether the final product or final policy is going to look like this or not, we have no idea. If we have better direction in terms of the actual policy design, it would help us.

[Colin Carrie, Conservative, Oshawa, ON]

I think that would make sense to anybody. Would it make sense to you, maybe, if we suspended the study until we got your information and expense report, or something along those lines? I'm just nervous about going around in circles and what this is going to end up costing us.

[Mostafa Askari]

That's obviously up to the committee. It's whatever you decide.

[The Chair, Liberal, Bill Casey]

Your time's up.

Go ahead, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you for being here with us today.

I've reviewed the document you prepared for the committee, and there are a couple of things I want to clarify. You do not have to purchase data from the Patented Medicine Prices Review Board, Statistics Canada, or Health Canada. Is that correct?

[Carleigh Malanik]

No, we don't.

[Don Davies, NDP, Vancouver Kingsway, BC]

Then any data from those three sources will be free.

[Carleigh Malanik]

Typically, no. Sometimes Statistics Canada does have a standard fee, as well as the Canadian Institutes for Health Information. It's very low. I believe it's approximately $250 an hour, but this is usually standard for their cost-recovery fees.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. However, I specifically didn't mention the Canadian Institutes for Health Information because what I'm trying to find out is who you have to purchase data from.

Let me try it that way. Who do you have to purchase data from?

[Jean-Denis Fréchette]

The main expense, the $100,000 that we mentioned, is for data from IMS Brogan.

[Don Davies, NDP, Vancouver Kingsway, BC]

From whom, sorry?

[Jean-Denis Fréchette]

It's now called QuintilesIMS, which is one of the stakeholders that is mentioned in the motion. They are basically the only provider of that kind of data across Canada.

[Don Davies, NDP, Vancouver Kingsway, BC]

Sorry; to be clear—

[Jean-Denis Fréchette]

It's a private firm.

[Don Davies, NDP, Vancouver Kingsway, BC]

That's the only organization that you have to pay for data?

[Jean-Denis Fréchette]

That kind of amount, yes. With other organizations, as Carleigh said, such as StatsCan and CIHI and so on, we have some kind of relationship. Some of the data may have to be paid for, but you're not talking about a lot of money.

[Don Davies, NDP, Vancouver Kingsway, BC]

I was going to say that one federal department paying another federal department is a wash at the end of the day, isn't it?

[Jean-Denis Fréchette]

It is, but that's the way it works.

[Don Davies, NDP, Vancouver Kingsway, BC]

In general terms, can you describe what kind of data you need to purchase? What is the category, or what are you looking for?

[Carleigh Malanik]

Specifically, we're looking for the drug level pricing information so that we can match any particular formulary, in this case Quebec's formulary. Then as well, because the committee was requesting some statistics on patients and their information, we're also asking for information on those individuals, such as their age, gender, and things like that.

[Don Davies, NDP, Vancouver Kingsway, BC]

I wanted to shift a bit to your document. At the top of page 2, you recite the exemptions that this committee had instructed, and I just want to be clear on this too. You say, “The criteria for exemption of the co-payment include...”, and then you listed some criteria there. This may have been the committee's lack of clarity, but I think what we wanted to do was match the exemptions under the U.K. model, which I believe was the instruction, and then I think we gave you some examples.

What I'm concerned about is that these four bullets are not all of the U.K. exemptions, so I want to clarify with you that you are clear in your instructions that you are to apply the U.K. exemptions in their totality.

[Mostafa Askari]

I don't think we were clear on that point, but some of these exemptions also.... I think the committee has to know that once we start an analysis and go through the estimations, we may have to modify some of these things because some of them may not be possible to do in a credible way.

For example, the exemption for pregnant women is going to be very difficult. You have to make some assumptions about what percentage of the population is going to be pregnant, and then how are you going to apply that? One issue there, of course, is also whether pregnant women are exempted only for the drugs that are used for their pregnancy or are also exempted for all the drugs that they use for other reasons.

[Don Davies, NDP, Vancouver Kingsway, BC]

I will probably leave this to my colleagues, but my assumption was that we would simply, for ease of reference, apply the U.K. exemptions, because obviously the U.K. would have that figured out. The U.K. either exempts pregnant women from the copayment for drugs related to pregnancy or for drugs generally.

My main concern was that this list is not complete. It doesn't include children under 16, as you've recited it here. It should include children under 16. Students are, I'm told, not between 16 and 18 but between 16 and 19. Also, I think veterans are not listed here, or people with long-term illnesses.

Anyway, my point was that if you need clarity on what exactly the exemptions from the copayment are, the committee, I think, should give it to you, but because you said “include”, I wasn't sure whether you were just showing some of them but were aware that there was a broader category or whether you meant that those are your only exemptions. We'll have to clarify that.

[Mostafa Askari]

Okay.

[Don Davies, NDP, Vancouver Kingsway, BC]

I was going to give a little statement.

I don't have the actual numbers here, but we know we spend tens of billions of dollars a year on pharmaceuticals in this country. We've heard estimates that a national pharmacare program could save between $4 billion and $11 billion a year. To me, then, to spend $100,000 to collect data that would be useful to the government to have in any event is not only, I think, a bargain, but in fact it's our responsibility to do. You mentioned in your report that this data would be retained by the PBO and would be useful not only to the PBO but to the health department. To know how many Canadians don't have coverage has been a concern raised by my Conservative colleagues. They doubt that we have accurate data on how many Canadians do or do not have coverage. To gather the data on what a national formulary would cost is superb information for the government to have in any event, and it may inform public policy.

My question is this: do you regard gathering this data as being of some utility to the health department or other departments in any other respect?