Health Committee on Oct. 17th, 2017

[Mostafa Askari]

Pardon me?

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Where would MPs fall? Where would we all fall?

[Mostafa Askari]

You are part of the cost to the federal government for the insurance it provides to its employees, including Parliament, the RCMP, and the military.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

So where would they fall in these...?

[Mostafa Askari]

They're not in those numbers.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

None of them?

[Carleigh Malanik]

Perhaps some of you would be covered by your public plan if you were eligible, but otherwise, if you're talking just about what federal employees receive, this is that $645 million that we're talking about on page 2.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Okay. I'm just a little confused, because on this context, I understand that in total we spend in Canada.... Is $28.5 billion not the total cost spent on drugs in Canada?

[Carleigh Malanik]

That's correct.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Again, my question is, where in those three columns—out-of-pocket, private, and public—would a federal employee fall?

[Carleigh Malanik]

If they have private insurance, it would fall under the private insurance column.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Do we classify the government's as private insurance?

[Carleigh Malanik]

Yes.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

All right. The public is, as you mentioned, the groups that would qualify for assistance. Do I have that right?

[Carleigh Malanik]

They are eligible for their province's public drug plan. There could be various criteria to meet that.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Okay. Then the out-of-pocket are those who have no plan?

[Carleigh Malanik]

In this dataset, it can include those folks. It can also include those who pay the majority of the costs out-of-pocket, so it's possible that this out-of-pocket expenditure is capturing some people who paid the full deductible and then, for the remaining prescriptions, were covered under private insurance.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Okay. Take me to your final analysis, which is that if we, as the federal government, take over all of those groups of people, which encapsulates everyone, it would then cost us $20 billion as opposed to $28 billion. Do I have that right?

[Carleigh Malanik]

Yes. Then you can net off any of the copayment revenues that were generated under this pharmacare scenario, then as well subtract that $645 million that they're spending directly on some populations, and then we arrive at the $19.3 billion net cost estimate.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Forgive me for being skeptical, but—

[The Chair, Liberal, Bill Casey]

We're very short on time.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

I'm sorry. What's the difference between the cost per capita in the private sector insurance companies as opposed to what the federal government...? Or do the federal government and all the others use private insurance companies? I guess they would, wouldn't they? It's all private.

Do I have enough time for any more questions?

[The Chair, Liberal, Bill Casey]

No, your time is up, but thanks very much. It was riveting.

Mr. Ayoub, you have five minutes.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Chair.

We had been waiting for a costing study for a good while. Obviously, it's great to have data at hand when making decisions.

Given the results that you have presented, which include possible cost reductions, my first reaction is to say that clearly, we can make improvements here.

In your study, you used the list of drugs covered by the Régie de l'assurance-maladie du Québec, the RAMQ. Are you able to say if the results could apply elsewhere, using Quebec as an example? Would it be possible to reduce current costs in each and every province using the comparison model that you have in your study, without creating a pan-Canadian pharmacare plan per se?

Have I expressed myself clearly?

[Jean-Denis Fréchette]

Thank you for the question.

That would mean not aggregating all the provinces as we have done. You are asking if the RAMQ model could be used everywhere.

I would say that it all comes down essentially to one's capacity to negotiate. Someone gave the example of U.S. veterans. If all the provinces came together, then that group's strength and the volume of drugs are what gives it negotiating clout.

The RAMQ in Quebec is able to negotiate because it manages a universal program which is much more extensive than that of many of the other provinces. That is the first factor to take into account.

Here is the second. You know very well what is also going on in Quebec, i.e., in terms of pharmacists' dispensing fees. You will have followed the debate. Dispensing fees in Quebec range from 8% to 90% of a drug's price. The RAMQ, because it buys huge quantities and has total control over its formulary, is able to negotiate and impose certain rules.

If we did indeed have a national program, and this is what we're trying to prove in our study, as long as all the provinces have negotiating power, this national program would wield enough clout that we would be able to save $4 billion post-negotiation and enjoy price reductions, as well as provide much more extensive coverage. What's more, we could cover everyone, which is currently not the case.