Thank you. I'll try to be on time as well.
First, thank you very much for giving me this opportunity to appear in front of your committee.
By way of introduction, I am Commander Sylvain Grenier, as mentioned before, senior staff officer for pharmacy services in the Canadian Armed Forces, which I'll refer to as the CAF from now on. I am also a full-time military pharmacist.
I am the current president of the Military and Emergency Pharmacy Section of the International Pharmaceutical Federation. I am also an adjunct professor with the University of Ottawa and work one evening per week as a community pharmacist in Gatineau. I am here today in relation to my duties with the CAF. I have no conflict of interest to declare.
In the next 10 minutes, I'll provide you with a quick overview of the CAF's drug benefit program.
Last year, the CAF spent $26.6 million on medication, with 90% of these prescriptions being dispensed by our 23 military pharmacies. This is quite small when compared with the $30 billion spent annually on prescription drugs in Canada.
With a total of 71,000 eligible patients, this equates to an average cost per CAF member of approximately $375. The total expenditure has remained constant for the last five years.
In the documents tabled, you will find a graph comparing the average cost of prescriptions processed at CAF pharmacies versus those processed at private sector community pharmacies.
On average, the CAF saves $25—or 38%—per prescription filled by a CAF pharmacy. This figure takes into account the infrastructure costs and the salary and benefits of the military, public servants, and contractors who work in military pharmacies. This works out to savings of almost $14 million annually.
The principles upon which the CAF drug benefit program is based come from the CAF spectrum of care, under the authority of the commander of military personnel command. The spectrum of care delineates which health benefits will be covered for CAF patients. Since CAF members are excluded from receiving care from the provinces under the Canada Health Act, the spectrum of care includes many medical conditions covered by the various provinces.
I'd like to touch briefly on the process whereby medications are included on or excluded from the CAF drug benefit list, which we call the DBL.
Our process is evidence-based and relies heavily on the review conducted by the common drug review, the CDR, of CADTH. After the drug has been reviewed by the CDR, the CAF pharmacy and therapeutics committee, which we call the P and T committee, will review the recommendations and determine the drug's applicability to the military context.
The P and T committee comprises clinicians: physicians—both general practitioners and specialists—as well as pharmacists, nurse practitioners, physician assistants, and other health care providers.
After being evaluated, a drug will be placed into one of the three classifications. The first is inclusion into our DBL as a regular benefit, meaning that there are no criteria or specific requirements governing its prescription. The second is as a special authorization drug, meaning that the patient needs to meet criteria established by the P and T committee in order to receive that medication, which is often the case for second-line therapy agents. Third is exclusion of the drug from the DBL, which we often refer to as a non-formulary drug, which means that it could be dispensed with the approval of our drug exception centre.
For drugs that are not reviewed by the CDR, which include many over-the-counter medications and older medications, the P and T committee will conduct its own analysis. Similar to civilian hospitals, the CAF benefit program also covers select non-prescription drugs that are not normally covered under other public plans. These include smoking-cessation agents, antihistamines, topical antibiotics, and over-the-counter pain medications, just to name a few. Although they are classified as over-the-counter medications, in our organization, they require a prescription by an authorized prescriber.
The CAF benefit list currently includes 1,065 different drugs out of the over 13,000 drugs available on the market in Canada, with 78% of these drugs covered under regular benefits.
As mentioned earlier, CAF patients can have their prescriptions filled by military of civilian pharmacies.
However, our policy states that the prescriptions must be filled by a military pharmacy, except for after-hours emergency prescriptions, or if the patient does not have access to a military pharmacy, since not all bases have military pharmacies.
Our program does not require deductibles, premiums, copayments, or user fees. There are no annual limits for medically necessary coverage. And this is true for both military and civilian pharmacies.
When a patient presents at the pharmacy, if the drug is a regular benefit or a special authorization drug, and the patient meets the criteria for that drug, it can then be dispensed.
If the patient does not meet the criteria, or if the drug is non-formulary, the Drug Exception Centre, located here in Ottawa, will review the request. The pharmacists working at the DEC will look at the request on a case-by-case basis and will provide a decision.
In the end, there will always be coverage, either because the request is supported, or because there is an acceptable alternative available. Our patients are never left to pay for their medication, unless the condition falls outside the spectrum of care.
As part of our drug benefit program, we have a drug use evaluation cell, which is responsible for reporting on drug usage. It produces reports related to costs and statistics, like the ones I mentioned earlier, as well as clinical reports focused on helping the health care team make optimal treatment decisions.
For example, the cell generates reports on specific classes of medications and subsequently verifies that patients prescribed these medications have the appropriate military employment limitations.
Currently, we are working on a series of reports on opioid use, in order to identify potential risk to our patients.
Finally, we employ several cost-saving strategies in addition to our rigorous formulary management.
In the CAF, we have a policy on the use of generic drugs, which directs the use of generic equivalents over the use of brand name drugs. Since 90% of our prescriptions are filled at our military pharmacies, we also procure medications. We therefore have several contracts with manufacturers that are negotiated by Public Works as part of the federal, provincial, and territorial contracts. We are also considering looking into joining the pCPA.
I'd like to thank you again for inviting me here today.
I look forward to answering your questions.