Mr. Chair, and Mr. Ayoub, I'm happy to make a couple of initial comments.
I think it's clear, and all of us in one form or another in our remarks have indicated, that there are clearly gaps in drug coverage for Canadians. There are, as I mentioned in my remarks, individuals who have no coverage and individuals who have inadequate coverage. I think it's fair to say there is more to the concerns and challenges in the pharmaceutical sector than simply coverage, as important as that topic is.
There's been mention here of relatively high drug prices that Canadians pay. Yes, it's true that Canadians in general receive less public support for their drug costs than many comparable countries, but our prices are high. The access that Canadians have is highly variable among provinces and territories, and between public plans and private plans.
We have problems also associated with both the underuse and the overuse of medications, and there's often a tendency to focus on the gaps in coverage. By the same token—Mr. Diverty talked about this—we know there are a number of instances where the absence of any degree of control among certain segments of our population, particularly seniors, and particularly seniors in institutions, is quite likely to subject them to what we might call polypharmacy, which is over-consumption of multiple medications for many different purposes. That has cost impacts, but worse it has severe impacts on the health and well-being of those individual patients.
We certainly have huge differences in formularies. It's not just that private plans generally speaking will list and reimburse any drug, while public plans tend to be more restrictive in wanting to have an assessment of the value of a medication before they pay for it. The problem with that is that often the most efficient ways of providing coverage occur in the public sector drug plans, but do not operate at all in the private sector, where basically any individual, if they're prescribed a prescription medication, will be reimbursed by that private plan. We don't make good use of the dollars we already spend on prescription drugs.
Maybe I'll just stop there, but I want to make the point that while coverage tends to be the area of focus, there are many other issues.
The last one I'll cite is that there are multiple reviews of drugs. You've heard from Brian O'Rourke about the common drug review. The PMPRB does its own assessment of a drug to determine whether it's a breakthrough medication when it looks at the price. Health Canada has already done a review to determine whether or not the drug should be made available for sale in the marketplace. Many provinces and territories, even after the CDR, still do their own review.
I don't want to make the situation more complicated than it needs to be, but I will say that there are multiple issues that need to be addressed in this area as you carry on with your work looking principally at coverage issues.