Evidence of meeting #7 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was plans.
A recording is available from Parliament.
5:25 p.m.
NDP
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
Thank you, Mr. Chair.
My question is for Dr. Gagnon.
We know that some people do not fill their prescriptions because the drugs are too costly. This leads to other health problems for them. Do we know what the cost of this is to the system itself?
5:25 p.m.
Associate Professor, School of Public Policy and Administration, Carleton University, As an Individual
That is something that hasn't been studied much. There are estimates, but so far the results differ greatly.
For example, some studies in the United States show that if more drugs were covered by the plan, there would be fewer hospitalizations. In fact, this argument is being used to state that more and more new drugs should be covered. However, the reality is something very different. The number of hospitalizations is significantly lower when there is greater access to drugs, particularly for lower-income individuals.
It is clear that the costs will drop when patients better follow their treatment. We see it fairly systematically, even though it sometimes means fewer choices when it comes to drugs. A new study—and I can send you a copy—was recently published by CVS, an American chain of pharmacies. It shows that, in terms of health outcomes, using a more restrictive formulary to reduce costs can make access to some drugs more difficult for certain patients. That creates a problem. Moreover, health outcomes are improved through better adherence to treatment than for other patients.
So a more limited formulary does not have an impact on the overall population, but can make a difference in specific cases.
5:25 p.m.
NDP
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
Some people are against setting up a pharmacare plan—
5:25 p.m.
Professor, School of Population and Public Health, University of British Columbia, As an Individual
Could I just add, just so you know, in 2013 the British Columbia Pharmacy Association reviewed literature on the financial impact of access barriers because of cost in the Canadian health care system, and as Marc-André suggested, there's not a great deal of literature, but they found estimates that range between $1 billion per year and $9 billion per year. Even if you just take the low end, that's a significant burden on our health care system. At the high end, it may still be realistic, given the numbers of diabetic deaths that the Ontario research study suggests have happened as a function of access barriers. It could really be as much as $9 billion a year.
5:25 p.m.
Professor, École nationale d'administration publique, As an Individual
I would like to add that a study was done in Quebec when the plan was introduced in 1997. In its first version, the plan provided that people entitled to free access to drugs, including social assistance recipients, would now have to pay the required deductible and co-insurance.
Professor Robyn Tamblyn from McGill University and others have conducted studies to measure the impact on the number of hospitalizations caused by the fact that people could not pay for the drugs they needed. So specific studies have been done on this.
5:25 p.m.
NDP
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
Some people who are opposed to the pharmacare program believe that it will lead to drug shortages. Could that happen?
5:25 p.m.
Associate Professor, School of Public Policy and Administration, Carleton University, As an Individual
I would like to answer that question.
I provided my opinion to the Government of Quebec, which put in place a bidding system for manufacturers of generic drugs. I should point out that this is where there are the most shortages.
It's true that some people feel that if prices are lowered, there would be more shortages. You need to be careful with that kind of statement. When it comes to generic drugs, how the supply system is organized is important. For example, if you launch a call for tenders for generic drugs and provide specific provisions to ensure the safety of the supply, that will help reduce costs while improving the safety of the supply. That's the case in Sweden and New Zealand. The cost of generics is a third of what we pay in Canada. Despite that, there are far fewer drug shortages there.
As for drug access, people think that if you pay more for a drug, it will be easier to access. That isn't the case at all. Standards are used, such as that of quality-adjusted life years.
Let me give you an example.
A government agrees to pay $50,000 for a drug because of the quality-adjusted life years. The manufacturer of a new drug decides to make the rate $100,000 instead. If the government in question agrees to pay that amount, every company will then ask $100,000. Indeed, agreeing to pay more won't solve the access problem. It will only push back the problem, which will come up again later.
If you continue to accept the increases, you'll only encourage people like Martin Shkreli, who is selling a drug for 50 times more than he should because he says that people are crazy enough to pay it. So that creates more problems with drug access and shortages. The large pharmaceutical company Valeant pretty much follows the same business model. These are predatory dynamics in the system in Canada, and we have no protection against it.
5:30 p.m.
Liberal
The Chair Liberal Bill Casey
The time is up.
We are done.
I really want to thank the panel, because you have given us a lot of incredible information. As we go forward, we would welcome anything you have, because we are serious about this. The information that comes from this committee will help determine the future of this possibility. We really would appreciate anything you have, either now or as you finish it. We would like to have any information you could provide to us.
I want to thank the committee, too, for the great questions and the way this has gone.
Everybody went over-schedule, and everybody broke the rules, but it was well worth it.