Evidence of meeting #8 for Health in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was australia.
A recording is available from Parliament.
Liberal
The Chair Liberal Bill Casey
The time is up.
Ms. Harder, you're going to split your time: three and a half minutes and three and a half minutes.
The time flies when you split, so I'm just going to hold this up when the three and a half minutes is up. I won't shut you down.
Conservative
Rachael Thomas Conservative Lethbridge, AB
That sounds very good, Mr. Chair. Thank you very much.
First, thank you so much for coming. We certainly apologize for all of the interruptions today. We know that this isn't ideal. We wish it wasn't the way it is.
My first question will be for you, Dr. Henry.
In our formulary, we obviously cover off certain conditions but not others. At the end of the day, I'm wondering what effect this is going to have on some of the smaller populations. Then as we add new medications to the formulary, the other thing I see would happen is that new medicines that have greater effects on public health would have urgency; meanwhile, the less prevalent conditions would not.
I'm looking for you to comment on how we could put together a formulary that is equitable. This is a key phrase that I'm hearing over and over again. At the end of the day, unless we're going to cover absolutely everything, we're actually only creating another tiered system. I need some understanding in terms of how it is actually possible to make this system equitable and affordable, because it has to be both.
Professor, Dalla Lana School of Public Health, University of Toronto, As an Individual
The critical issue is not only equitable access to some program, but it's the drugs that are in that program and whether they are equitably meeting the health needs.
The issue is, would it be better or worse with a national program than the current patchwork—I use patchwork in the descriptive sense, not as a value judgment—of that territorial and provincial system that exists in Canada?
I would have thought that an argument could be sustained that people with, say, fairly rare and expensive-to-treat diseases might be better served under a national program, because of the large buying power that would have. The power of a program representing the interests of 35 million people has considerable influence. While you're right that the public health impact is really important, my experience of working in a national program is that a lot of the agonizing has been to make sure that people with rare diseases—there might be 100 or less in the country—were looked after.
I didn't mention it in my talk, and again just for the record, there is an act of grace arrangement that exists around the national pharmaceutical benefits scheme in Australia, whereby individuals who believe they're seriously disadvantaged by non-coverage of a particularly expensive drug can apply directly to the minister, who can perform an act of grace payment to cover it. Therefore, I think there are other mechanisms that can sit under the umbrella of a national program.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Dr. Henry, perhaps you could comment. I think this is somewhat similar to the Australian model. Here in Canada the provinces obviously have jurisdiction over health care in the way that it's realized. When it comes to putting forward a national pharmacare program, I'm looking for some feedback in terms of how willing you feel provinces are going to be in terms of delegating their authority, or relinquishing their authority on this matter. How would you propose to go forward with that?
Professor, Dalla Lana School of Public Health, University of Toronto, As an Individual
The point is very valid and I've spoken to lots of people in the provinces. It's too strong to say they're perverse in centres, because they're trying to do good, but they're working and establishing their careers and their whole process is invested in a provincial program. Suddenly taking that away and replacing it with a single national payer who pays all the pharmacists in their province directly from a national payment commission or insurance commission for this purpose is really a very big challenge because they're invested in it.
There is no easy answer to that. There is little doubt that the public good is going to be served by it, that their provincial electorates are going to benefit from it, but the negotiation that takes place around it is going to be difficult.
As I've said, I think it's almost like a big infrastructure undertaking. We're going to build something really big, and one day it's going to be open and that will be the day that it starts and everybody has to be committed to that day, that it really is going to happen and we're really going to make it work. It's a very big idea to take on. There's no easy answer.
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you, Chair.
Dr. Boothe, in your presentation you mentioned the pan-Canadian Pharmaceutical Alliance. I want to talk a bit about that.
Currently, the Canadian provinces, and I assume the territories as well, through the pan-Canadian Pharmaceutical Alliance, are signing confidential deals with pharmaceutical manufacturers that give them the off-invoice rebates from the drug manufacturers.
Advocates of this approach say this is simply a matter of governments using their purchasing power to get a better deal for government, but there is a lot of secrecy around these deals. Some could argue it is unethical for governments and their drug plans to get that preferred pricing, when 60% of the pharmaceutical purchases in Canada are paid for by the private sector at list prices that are inflated as a result of the deals that the governments put together with the pharmaceutical manufacturers. Basically, the out-of-pocket and the corporate personal plans are left paying the inflated price.
Do you think we should have in Canada some principles, rules around how these price agreements are designed and used? I'd like to get your thoughts on that, or the panel's thoughts.
Assistant Professor, Department of Political Science, McMaster University, As an Individual
Sure, thank you for the question.
I think there are two points. First of all, I don’t think it is realistic to say that Canadians should not take advantage of confidential prices the way every other drug plan in the world does. It's become a fact of life in the pharmaceutical market. Without passing judgment on whether it's a good thing, I'm of the opinion that it's inevitable. The question is how we get the most people to benefit from this practice. The answer is to have universal coverage. It increases the purchasing power of government, as you heard from Dr. Henry.
If the drug plan is sitting across the table from manufacturers and saying, “It's our price, or you won't be subsidized for Canadians across the country”, that's a strong bargaining position. I think you can have rules around the way these negotiations are conducted that would make them acceptable, but if you're going to have them, you should make sure all Canadians are benefiting from them.
Physician/Clinical Pharmacologist, Professor and Director, Division of Clinical Pharmacology & Toxicology, McMaster University, As an Individual
I have two quick points.
A bad deal is a secret price deal for which nobody knows whether it's good. It's the poor 25%, the most vulnerable of our population that have no insurance at all, who are losing. That is a tragedy. A good deal, and a good example I can think of, is a reduced price on a drug that may have a benefit for dementia. If the patient does not benefit from the drug, the company is paying the whole shot and is rebating. I think this notion of advancing our thinking is to look at what value we want out of these price deals clinically, as well as with cost reduction.
NDP
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
My thanks to the witnesses for their presentations.
My question is for Dr. Dhalla.
You have reached a consensus at the Health Quality Ontario roundtable and through your work there, and I would like to know what the findings are. You have access to scientific data and research results. In your view, does all that information show that the Canadian health care system would benefit from a national pharmacare system with a national formulary?
Vice President, Evidence and Development Standards, Health Quality Ontario
In my view, the scientific evidence does point to the fact that we would save money collectively if we had a national formulary and some sort of a program whereby the provinces were asked to maintain consistent standards, or there was a national standard.
Going back to the points that Katherine made a few moments ago, one way of putting it is that if some Canadians get a good deal by being in the public system, don't we want every Canadian to get a good deal by being in the public system?
I would argue that we do and we know in Canada that people who are not insured at all get the worst deal. We also know that we can put in place a set of principles to make sure that we are making the best possible decisions about which drugs get onto publicly funded formularies and which drugs don't. Those principles should be transparent. They should be vetted with decision-makers and, most importantly, vetted with the public and with patients so that we're not disadvantaging people with rare diseases, or disadvantaging people who have certain conditions versus other conditions.
I share Katherine's view, and I think the view of the member who asked the question, that there are pros and cons to these confidential pricing arrangements, that in the current environment the pros likely outweigh the cons, but it is also possible for governments to put in place arrangements to make sure that those deals are being appropriately scrutinized to ensure that Canadians are getting value for money.
Liberal
The Chair Liberal Bill Casey
I'm showing seven minutes until we vote, so we have maybe two minutes and then we'll have to run.
NDP
Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC
So the question I have for Dr. Holbrook will be short.
Witnesses have told the committee that hospitals are using formularies with a set budget to manage their drug costs.
To your knowledge, are those hospitals paying less per unit?
Liberal
The Chair Liberal Bill Casey
I'm sorry, but I've just been corrected, and we have four minutes until we vote, so we have to wind up. We have to go.
We don't know what's going to happen next, so we should adjourn now, because we don't know if you'll be sitting here for two hours, or one hour, or what.
I just want to thank you on behalf of the entire committee. You obviously have a lot of information that's very helpful to us, and we're very grateful for your information and will probably be calling you back for more information. Thanks very much.
The meeting is adjourned.