Evidence of meeting #39 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was military.
A recording is available from Parliament.
Cdr Sylvain Grenier
No. It was communicated only within the Canadian Forces.
In terms of budget cuts, the information is a very useful tool for showing that by providing the service ourselves, we have more control and save much more money. However, so far, these figures have never been made public.
Liberal
Liberal
Conservative
Rachael Thomas Conservative Lethbridge, AB
Thank you.
I'll start with Blue Cross.
I'm wondering if you can talk a little bit about your administrative costs with regard to the costs associated with your private plans, and those associated with your government-sponsored plans. Do you see a difference in the administrative costs for each of those?
Vice-President, Government, Alberta Blue Cross
That's a pretty broad question. Certainly from the government perspective, the way we organize.... Maybe I'll preface that by saying that I've heard the question asked often about whether or not a decrease in revenue affects administrative costs. Our role with the government is to help them decrease revenue, and that has nothing to do with the way we're paid administratively by the government. Our overall administrative cost for the government programs is a public number. It is published through the commitment that we have with the government.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Just in comparison with you running the private side of things, which one is cheaper?
Vice-President, Government, Alberta Blue Cross
I can't say which one is cheaper, because it isn't just about a drug program. It depends on whether or not in the private plans they have more benefits associated with the programs. I would never do a comparison. I look at the bucket that we do. Also, the services we provide are quite different for the Government of Alberta from the services that we would provide....
Conservative
Rachael Thomas Conservative Lethbridge, AB
But you don't know which ones are more administratively costly?
Vice-President, Government, Alberta Blue Cross
They're both extremely efficient, and I—
Conservative
Rachael Thomas Conservative Lethbridge, AB
I'm not asking that. I'm just asking for cost. Is there a higher cost associated with one over the other, or do they both cost the same?
Vice-President, Government, Alberta Blue Cross
I would say that our private plans have more variability than the government plan does.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Okay.
Now you talked a little about the formularies and their being determined. We use generic drugs first, but if a generic drug doesn't work for a patient, then what happens in that case?
Senior Manager, Benefits and Product Development, Alberta Blue Cross
I can answer that.
Again, back to the plan sponsors, they can decide how they want to handle those exceptions. In the case of government, they have a generic price policy. If a person has tried the generic and has had adverse effects or it's not working, that individual is allowed to go through the special authorization process. The individual's doctor sends in a request and asks for coverage, and if there is a legitimate need for it, then that person will be granted authorization.
On the private plan side, again, those plan sponsors have adopted that policy. There are a number of different mechanisms that can be used. One is that some plan sponsors will actually allow the pharmacist to override the prescription, so if the prescription comes into the pharmacy and it says “no substitution”, then the pharmacist can actually enter a code at the time of claim and then the brand name is paid. They also have the special authorization process as an option, if they choose to go there.
Conservative
Rachael Thomas Conservative Lethbridge, AB
If they go through the special authorization process, is the drug fully covered or only the same as what a generic would cost?
Senior Manager, Benefits and Product Development, Alberta Blue Cross
Yes, what we do with that is pay up to the level of the generic. Then the plan member is only paying the difference in the costs between the brand and the generic.
Conservative
Rachael Thomas Conservative Lethbridge, AB
I understand, thank you.
Over to you, Commander. How does this work in your...?
Cdr Sylvain Grenier
If it's a generic that doesn't work and the brand name works better for the patient, because it's the same molecule, the pharmacist at the base has the authority just to switch it. The policy is that they will use the generic first, but if the generic doesn't work for a specific patient, then they can go with the brand name.
If it is a change of the molecule itself.... Let's say a patient doesn't respond well to one blood pressure medication and requires a second line one. If that second line one is not listed in our benefits, then that requires a drug exception centre intervention. What they'll do is look at the patient's case specifically—it's case by case—and if the patient has looked at all the other drugs, then they can approve it in that case.
Just quickly, as well, I wanted to say that the advantage of having a very strong exception process is that when it's time to access medication.... We review medication, and it takes time for a drug to be listed on our benefit list. However, on day one, if a drug is available on the market and if a patient gets a prescription and there's a clear need, that patient could get it on day one because of the exception process we have.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Thank you.
My final question goes to Blue Cross. Right now, private drug coverage programs cannot access the pCPA. In your estimation, if they were to have access there, could that be of benefit? Could that solve the problem? Could that bring our drug costs down?
Vice-President, Government, Alberta Blue Cross
Absolutely.
As I said in my opening remarks, if the pCPA was able to do all drugs on behalf of all Canadians, I think that would certainly make a difference. I know there are mechanisms that the private side has tried to put in place behind the scenes as well. Certainly, there is some work, I understand, with pCPA moving forward, and I also know that it sounds like it's very difficult. I think they've been able to lower prices for 129 drugs, or something like that, in six years.
For sure, that would be extraordinarily helpful, but it's the broader...the 8,000 in the basket of drugs that we're talking about that would be significant to get to a base cost for all Canadians.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you all for coming.
Commander Grenier, from what I understand—and if this was addressed, I apologize if I missed it—this January 19, federal drug programs like the military's and several others joined the pCPA. Can you give any estimate on cost savings that have been realized by the Department of National Defence's drug program since joining the pCPA?
