Health Committee on Oct. 17th, 2017

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to Ms. Gladu for five minutes.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Chair.

If we decide to go ahead and do a national pharmacare program, I'm assuming that we'll need more government employees to administer the program. Are the costs of that included in this report? If so, how many employees do you think it will take?

[Mostafa Askari]

The structure that is going to run this administratively is not something that we have taken into account in terms of how this plan is going to be implemented. If the program is approved and the government wants to go ahead with it, there obviously have to be negotiations between the federal government and the provinces to see how they want to implement it.

The provinces already pay about $13 billion for such a program, but if there are going to be negotiations, they are obviously not going to be easy ones. As for how they decide to do that and whether it's going to be a federal program completely run by the federal government, or a program run by each province separately that the federal government would contribute to, those are the things that we have not taken into account at all.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

I'm also trying to figure out exactly how much extra money, besides what we're paying already, we would have to pay to implement this. Regarding the public column, is that money today all from the federal transfer payments, or is some of that provincial money that's being spent as well?

[Carleigh Malanik]

That $13.1 billion is what the provinces are spending on their public drug plans. They do receive the Canada health transfer. Those transfers are meant for many more health services than just pharmaceuticals. They enter the provinces like general revenues, and they can spend them as they want. Conceivably, a portion of that transfer is paying for some of this drug expenditure, but we can't say how much.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

You can't really say, then, that of the $19.3 billion it's going to cost we're already transferring to the provinces $13.1 billion for this, so it's the differential that's really the net line item that we would have to put in the budget.

[Carleigh Malanik]

That's correct. Again, the Canada health transfer is for much more than pharmaceuticals.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

All right.

Did you do any benchmarking with other jurisdictions? There are a lot of places in the world that have a national pharmacare program. Did you look at what the costs of their programs are? Is there any information we could benchmark to see whether this is reasonable?

[Carleigh Malanik]

When we looked at the literature, there was nothing so clean cut to compare it to in that way, but we did look to international literature for help in our assumptions. For example, this assumption that volume would increase by 12.5% was calculated based on the price elasticity. We used a Canadian price elasticity, but we looked at the international literature to see how this compares to other nations, and they were fairly consistent. Those were the kinds of ways we looked at international literature.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

I have one specific question: are most cancer drugs covered on the Quebec formulary?

[Carleigh Malanik]

I don't have an explicit answer on this, and I'll tell you why. We could find out. Whatever is dispensed and paid for in a pharmacy outside of hospitals that's listed on the Quebec plan is included.

My knowledge of how cancer drugs in particular are administered and whether there is a wealth of them administered in hospitals or not is that if they are, then they're not captured. If we had a way of identifying all of the cancer drugs, we could take a look and see what is in there.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

I have the same question for palliative care. I'm not sure how palliative care is covered in Quebec. Are the palliative care drugs covered under the Quebec formulary?

[Carleigh Malanik]

It's possible that some of the drugs listed on the plan are covered. Again, I don't have a definitive answer, but as long as those drugs were purchased at a pharmacy, then we're capturing them.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Probably not if they were in a hospice or in a hospital?

[Carleigh Malanik]

That's correct.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Okay.

Those are my questions, Mr. Chair. Thank you.

[The Chair, Liberal, Bill Casey]

Next is Mr. Davies for five minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Let's take a look into the future. As Mr. Jacques pointed out, we're making a lot of assumptions and there are a lot of moving parts as we roll this out into the future. A plan like this might take three, four, five, or ten years to be fully rolled out and to realize all of the potential cost savings and maybe even the cost drivers of the program.

I want to focus on some of your numbers. You took 2015-16 as a bit of a base year. If I understand correctly, had we had pharmacare in that year, based on the Quebec formulary, we would have spent as a nation $4.2 billion less that we in fact did.

[Carleigh Malanik]

Yes. Also, the comparator number you want to use is the $24.6 billion spent on the RAMQ drugs.

[Don Davies, NDP, Vancouver Kingsway, BC]

Right. I understand that there's the $20 billion, but you subtracted from that $4 billion of drugs that would not be covered under a formulary.

[Carleigh Malanik]

That's correct.

[Don Davies, NDP, Vancouver Kingsway, BC]

The real thing is that we spent $24 billion as a country in 2015-16 and we would have spent about $20 billion. Do I have that right?

[Carleigh Malanik]

Yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

You have extrapolated your numbers to 2021. You say that the net pharmacare cost would be $22.6 billion.

[Carleigh Malanik]

Yes.