Health Committee on Oct. 17th, 2017

[Carleigh Malanik]

We did try to calculate this in one of our tables in the report. Also, the PMPRB released a report looking at just that. In general, there isn't that much variation. Plans typically cover what other public plans are covering in terms of expenditure and the number of drugs. There's some proportion, of course, that would have some variation.

When we looked at how much of the Quebec formulary was covered by other plans, we found results consistent with the PMPRB's. It is very representative across the public plans.

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

Excellent.

There are very expensive drugs that are included in the formularies today. In some cases, there are programs in place to fund those. Did you change any assumptions about those or just assume that it would stay the same?

[Carleigh Malanik]

Thank you for that question. If it was covered in the Quebec plan, it would be included in here. There are some drugs identified as the more expensive ones. They're called “exceptional” medications. Typically, the patient has to meet a very strict set of eligibility criteria in order to be reimbursed. We included them in the cost. We assumed that the price discount would be applied to these drugs as well.

The only I guess exception that we made for these drugs was our assumption around increase in utilization. We assumed that drug volume will increase by 12.5% across the board, except for these drugs. With these drugs, we didn't make any increase-in-volume assumptions. The reason for this is that we assumed, because of the strict eligibility criteria in place, that just because the cost is down for the patients, they're not going to start consuming this drug more. We would assume that those strict criteria would remain intact.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Mr. McKinnon, you have five minutes.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair.

Mr. Davies touched on this and Dr. Eyolfson went at it in more depth, but I want to carry on with it. Last night, I was speaking with a constituent who was telling me of friends who end up in the hospital or the emergency ward on a fairly regularly basis because they couldn't afford their meds. Of course, this represents a considerable cost to the particular hospital and to the provincial plans. It's a cost of not having an effective pharmacare program in place for those people.

Mr. Askari, I believe you spoke of not being comfortable with speculating on what such costs might be. Is that correct?

[Mostafa Askari]

That's correct, because, as I said, measuring the health benefits of having the coverage versus not having the coverage is extremely difficult to estimate. It depends on the specific situation, the patients, and the kinds of problems the patients have.

Instead of getting into that area, which becomes somewhat speculative, we decided not to take that into account. Typically in all our costing that's how we do it: we do not take into account the secondary impacts and the knock-on impacts of any program.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

I was speaking with Mr. Jacques before the meeting. He suggested that because of doing this study you have quite a number of people who are experts in these areas. Is that a topic that you would be able to entertain and to give us a number, with suitable caveats and plus or minus error bars and those kinds of things?

[Mostafa Askari]

It would take us into an area where we have not been before. That's going to be a completely different area. We do have expertise in terms of the data on pharmacare. Carleigh is obviously an expert in our office now, but in terms of getting the health benefits of this, it is moving a couple of steps beyond what we normally do.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

You wouldn't feel comfortable about being able to give us a number that's plus or minus a billion dollars or something like that.

[Mostafa Askari]

It would be extremely difficult for us to do that, yes.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Are there any other areas you can see like that, areas that we should look at ourselves, in terms of evaluating the benefits of a pharmacare program or the costs of not having one?

That's for anybody.

[Jason Jacques]

No. Again, for the purposes of the mandate of the committee, I think our report is an excellent starting point in terms of trying to identify some of the major cost drivers and factors that parliamentarians need to consider if they decide they want to move forward on solving some of the policy problems they've identified with respect to drug coverage across the country, as well as the escalation costs around drugs.

As well, in looking at some of the questions that have been raised around the committee table this afternoon, I think there are evident areas we did not cover in the report, areas that were out of scope, such as looking at the potential impact on the private sector and looking at areas around potential cost savings, including the costs associated with non-adherence to prescription medications when people actually can't afford those medications.

Whether we are best placed to look at those areas that are out of scope or not I think is open to debate. For instance, with respect to the potential cost savings, for the cost savings associated with people not taking their prescription medications, one of the major impediments on that front, of course, is just the lack of data. We're very good at analyzing data. We're very good at manipulating data. Carleigh is well placed to build you a 700-equation model with respect to a new national pharmacare program, but if you don't have data and you don't have good data, then the model isn't really worth a lot.

Just to offer a recommendation, there are other partners we've been working with, such as Statistics Canada, Health Canada, the Patented Medicine Prices Review Board, and the Canadian Institutes of Health Information. They were instrumental in helping us prepare this report in the first place. Many of you have seen them appear as witnesses in the past. I think they would be the first places to turn to in order to collect some of this data. Again, intuitively, in terms of the cost savings associated with people taking the medications their doctors prescribe for them and ensuring that they can afford to do that, there's potential for savings there, and we're happy to analyze that once there's actually good data in place.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

Your time is up.

Mr. Van Kesteren.

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

Thank you, Chair.

It's good to see you again, sir, and likewise Mr. Askari.

I notice that you've picked up a great new employee. Mark was with us on the finance committee.

It's good to see you as well, Mark.

Help me out. You have to dumb this down for me. If I go to page 3, what you're saying is that the total out-of-pocket is $4.7 billion. I guess I should be directing this to Ms. Malanik.

[Carleigh Malanik]

Yes.

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

Did I get that $4.7 billion right? The private sector—the private insurance companies—spends $10.6 million.

[Carleigh Malanik]

Yes.

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

The public sector spends $13.142 million, and the total we're spending in Canada is $28.5 million.

The public sector would represent about what...? Is it 28% of the population, or 35%? What is it? Does anybody know? Do you have that figure?

[Carleigh Malanik]

I'm sorry. Did you say the public or the federal...?

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

I said “public”. It's that column there. What percentage of the population would that be?

[Mostafa Askari]

The public we mention is not what the government uses for its own employees. That is the coverage they provide for their population. The various provinces have public insurance for certain groups in their population, such as seniors or people with low incomes. That's the cost for those groups. For example, seniors in Ontario get their prescription drugs free and that costs the Ontario government a certain amount of money. That $13.1 million covers them.

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

Who would they cover? Can you give us a list?

[Mostafa Askari]

Each province is different. Each province has a different kind of program.

As I said, Ontario, for example, covers all the seniors and also some people on welfare. British Columbia has a different kind of public program. They have some income testing, some means testing measures, and they cover certain people below a certain level of income. Each province has a different kind of program, but they all do have some kind of public program for prescription drugs.

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

Where would MPs fall?