Health Committee on Feb. 14th, 2017

[Matthew Brougham]

In short, yes.

What I have focused on and tried to talk about in terms of the structural change that fosters price competition in the marketplace is what you would refer to as supply-side management. What you are referring to is what an economist would refer to as demand-side management. You want to manage the demand for pharmaceuticals—in other words, the writing out of the prescription.

Yes, there are national agencies. There is the Best Practice Advocacy Centre, run out of the University of Otago in New Zealand, which essentially does what is technically referred to as academic detailing of physicians. Fundamentally, they use their own practice and compare it with what they might consider to be comparable practices and ask them why they're out of line or what they think they might do differently, etc.

Yes, those demand-side management activities are well utilized.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right.

[Matthew Brougham]

That's just the tip of the iceberg.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Yes, for sure.

[Matthew Brougham]

There are other answers to that question.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Certainly.

We talk about a formulary. Of course there are different formularies available, and we are looking at which formulary we would use if we were to establish one. There is one from the World Health Organization, and there are others, different ones.

How would you say New Zealand's formulary compares to the World Health Organization formulary? Is it comparable, more inclusive, less inclusive?

[Matthew Brougham]

I would say it is significantly wider.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay. Thank you.

Would you recommend that scale of formulary for Canada, or do you think the World Health Organization one to be sufficient as a starting point?

[Matthew Brougham]

To be frank, I think anything would be sufficient as a starting point to gain universal access, if the provinces were all in alignment and in agreement to see it funded. Over time you would manage it, adjust it, and add more to it. You might leave opportunity for those very high-cost, supplementary kinds of medicines to be dealt with, with the deep insurance market that you have in North America. In fact, I think that Canada, in a sense, has greater opportunity here than New Zealand did to have universal access to a good range of products and at the same time keep access to some of these very specialized and high-cost treatments.

[The Vice-Chair, Conservative, Len Webber]

All right. Thank you, Doctor.

We'll move on to our second round of questioning. It's a five-minute question-and-answer session, and we'll start with Ms. Harder for the Conservatives.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you, Mr. Chair.

Thank you, Matthew, for coming in and spending some time with us today and helping us better understand the New Zealand system.

I am going to issue an apology, because I'm going to take us away into a different topic at this point in time. It's a topic that is of the essence in terms of time, and it's a motion that has been tabled since the beginning of December. Unfortunately, this is my opportunity to do so.

At this time, I would like to resume debate on the motion that was adjourned at the meeting of December 13. The motion calls on this committee to review the effectiveness of the 2015 thalidomide survivors contribution program.

The committee will recall that a lengthy history of thalidomide and a detailed overview of the problems facing thalidomide survivors in their efforts to obtain compensation were presented at the meeting on December 13, as stated. That presentation outlined that survivors' medical records from the 1960s have been lost or destroyed, witnesses have passed away, and there is no medical or physical screening undertaken and no in-person interview conducted to determine whether survivors qualify for compensation.

The motion calls for a review of the current qualification procedures and how the procedures to qualify for compensation should be changed to ensure that Crawford's victim services are inclusive rather than exclusive.

These survivors, who have all been denied compensation under the current rules, have now gone through another Christmas without the assistance that the government offered to other survivors. As such, I respectfully request that the members limit debate and that we proceed to a vote on this motion at this time so that the committee can undertake this very important review as we go forward in 2017.

[The Vice-Chair, Conservative, Len Webber]

Thank you, Ms. Harder, for that.

I apologize, Mr. Brougham, for having to put you through this debate or this motion here, but hopefully we can get back to you right away.

I do have someone on the list here who would like to say something.

Go ahead, Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

I would move that the debate be adjourned on this motion.

[The Vice-Chair, Conservative, Len Webber]

Mr. Oliver, Ms. Harder has tabled a motion that has precedence and we have to vote on her motion—oh, I apologize; we have to vote on Mr. Oliver's motion to adjourn debate.

[Colin Carrie, Conservative, Oshawa, ON]

I'd like a recorded vote, please.

[The Vice-Chair, Conservative, Len Webber]

We'll have a recorded vote, then, not on the motion that Ms. Harder has put forward but on Mr. Oliver's motion to adjourn the debate on this particular motion.

(Motion agreed to: yeas 5; nays 3)

Mr. Oliver, your motion to adjourn this debate has succeeded.

Ms. Harder, we will have to continue your questioning. You have close to three minutes left.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you very much.

My first question here, then, has to do with wait times.

According to New Zealand Medicines, the wait time in New Zealand is actually 2.4 years on average from the time that a drug comes to market until it can actually be approved for this schedule. That's a lot of time. I looked on online and compared other countries, and it's actually the greatest wait time of any nation. In Canada, in comparison, the average wait time is 464 days. That's about half the amount of time that it takes New Zealand to approve a drug and get it out to patients.

That is a very significant difference and appears to be very detrimental to the health of patients and their access to the medicines they need. When we're talking about increasing patients' access to medicines and making sure that patients have what they need to take care of their health, this seems to be very detrimental.

I'd like your comments on that. Do you feel that it is beneficial to patients to have such a long wait time?

[Matthew Brougham]

Well, as usual there's a trade-off, isn't there? The trade-off here is that some Canadians don't have access to anything.

[Rachael Thomas, Conservative, Lethbridge, AB]

Do you feel that this is beneficial, then?

[Matthew Brougham]

A two-and-a-half-year wait time for a new drug versus no access to some people is.... Is that a reasonable...?

[Rachael Thomas, Conservative, Lethbridge, AB]

Let's be reminded that up to 18% of people in New Zealand are still not accessing medicines because of cost, while here in Canada, the number is only 10%, so I don't know that your argument holds weight.

[Matthew Brougham]

I don't know where those figures come from. I'd dispute them to some extent, but—

[Rachael Thomas, Conservative, Lethbridge, AB]

Well, they came from New Zealand Medicines—

[Matthew Brougham]

It's Medicines New Zealand.

[Rachael Thomas, Conservative, Lethbridge, AB]

—which happens to be the company you work for, is it not?