Health Committee on May 2nd, 2017

[The Chair, Liberal, Bill Casey]

Thank you.

Now for our last question, we have Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'm interested in how each of your respective systems deals with the issue of high costs of specialty drugs for rare diseases. It's those kind of drugs that sometimes cost tens of thousands of dollars or a hundred thousand dollars a year. Has your system been able to provide those drugs to the patients who need them?

I'll start with you, Ms. Wallström.

[Sofia Wallström]

I would say that these drugs are a challenge. In the pharmaceutical benefits scheme, we haven't said no to a pharmaceutical for rare diseases except once in the last five to seven years. Many of these drugs are in-patient pharmaceuticals. That means that the TLV is not really responsible for the decisions. Of course, we give a lot of support, and we do have health technology assessments to support the county councils. We're all kind of together in the challenge when it comes to these specialty drugs.

We have a higher willingness to pay when it comes to effective drugs for rare diseases that are really severe and where there are no good alternatives. We have actually developed this further. Last year, the TLV said that we were willing to pay even more. We have managed to subsidize and reimburse the costs of the majority of these drugs. Still, there are a few that are really a problem for us, and we try to develop our own system for handling these. We see that more collaboration with other countries within the Nordic and European area is something that we need to move forward on.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mrs. Wallström. I'm just going to stop you there because I have limited time and I want to give Mr. Golja a chance to respond. Thank you.

Mr. Golja, go ahead.

[Aldo Golja]

I would agree. The savings on generics have allowed us, just like the Swedes, to buffer the additional growth in the prices of specialty drugs, so we've had a relatively flat budget for pharmaceuticals. This has also allowed us to take up the more expensive products, for instance, the orphan products.

However, for the orphan drugs, we're going to have managed entry agreements. As I said, this is based on the budgetary impact. If there is a large budgetary impact, we will engage in financial talks with the company before reimbursing those—that's also for out-patient drugs. Especially for orphan drugs with a high cost per patient, we will be asking the companies to engage in additional data collection, and also in finding the appropriate use, the right way of targeting the right population for these drugs. We are adding these things to our reimbursements.

We've been very lucky up to now to be able to do that, to incorporate most effective products in our reimbursement system, but it is increasingly a problem. That is also why, within the international realm, we've started collaborating with Belgium, Luxembourg, and Austria, just like the Nordic collaboration forum, where we are talking about pharmaceutical policies and where we engage in joint negotiations.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

That completes our testimony today. I want to thank our witnesses very much. You've taken a lot of time to help us. You've both submitted written presentations and taken a lot of time here today. You've been very helpful to give us a peek at two completely different programs. I am certain that, if Canada does eventually adopt a pharmacare program, you can both say that you've helped. On behalf of the committee, I want to say thank you very much.

I also want to thank the technicians, because everything today was flawless. The communications were flawless from three different countries, and that is no small feat.

I want to thank the committee for the great questions, and again, I want to thank you on behalf of the committee. Thank you very much for your time.

[Sofia Wallström]

Thank you.

[Aldo Golja]

Thank you.

[The Chair, Liberal, Bill Casey]

We're going to take a little break, and then do some committee business.

Mr. Oliver, go ahead.

[John Oliver, Liberal, Oakville, ON]

I think this is our last meeting on pharma until we get the budget officer's report back. I have a procedural motion:

That the analysts be directed to use the time period, as required, from today until Parliament resumes sitting in the fall, to complete a summary of evidence and testimony received so far in relation to the study of the development of a national pharmacare program, with a weighting to using peer-reviewed scientific evidence.

I put that forward as a motion so they can get started. We don't want to start cold in the fall when we get the parliamentary budget officer's report.

[The Chair, Liberal, Bill Casey]

We want them to be really busy all summer.

[John Oliver, Liberal, Oakville, ON]

Absolutely.

[Some hon. members]

Oh, oh!

[The Chair, Liberal, Bill Casey]

Is there any debate or discussion on that motion, or any thoughts?

[Karin Phillips, Committee Researcher]

I want a little more clarification on the weighting toward peer-reviewed information. Obviously, I understand what peer-reviewed information is, but with written submissions, what we usually do is summarize all of the evidence, and then at the end of the day, when you give drafting instructions you can decide what you want or don't want included.

[John Oliver, Liberal, Oakville, ON]

At the beginning, we had a number of presentations by witnesses with material they had put together that didn't seem to match or up or align with others. It wasn't peer-reviewed, and it didn't have the same rigour. It seemed to be more opinion than hard data. My motion is reflecting back on some of those earlier presentations.

[The Chair, Liberal, Bill Casey]

Some were almost anecdotal.

Karin, are you good?

[Karin Phillips]

What's challenging for us and the reason we summarize everything is that it's difficult for us to be put in a position of weighting a submission from one witness versus another. It's difficult to make those judgment calls, because it can become political, depending on whose witness it is.

[The Chair, Liberal, Bill Casey]

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Maybe I could make a friendly amendment that you just do a summary of evidence and not worry about the weighting, and perhaps later on we could debate the political merits of one witness versus another.

We could take a break from that over the summer.

[The Chair, Liberal, Bill Casey]

Is that accepted?

[John Oliver, Liberal, Oakville, ON]

Sure. I would take the advice from the analyst that it's hard for them to do that.

(Motion agreed to [See Minutes of Proceedings])

[The Chair, Liberal, Bill Casey]

We're going in camera to talk about witnesses for the thalidomide study, and we have to talk about Motion M-47, as well as Bill C-211 very briefly.

[Proceedings continue in camera]