Health Committee on Dec. 11th, 2020

[John Adams]

If I may I'm going to use the example of ALS. You watched one of your colleagues in Parliament live through the disease and the finality of that occursion, as I watched my wife go through it.

I want to put in a plug here for some wonderful folks at Health Canada. There was a drug out of Japan that slowed down the progression of the disease. It did not change the course of the disease. It was not available in Canada. We have a tradition of allowing individuals to bring in, by personal import, a 90-day supply of a drug that's not available in Canada. That's a real problem because there are lots of drugs that are not available in Canada, separate and apart from the discussion on PMPRB.

It was a big deal to go to Japan and bring a 90-day supply. Health Canada reinterpreted the rules in a very humanitarian way. They didn't have to go to Japan. They could ship it, and they could ship in a 180-day supply. That drug company from Japan came to Canada and went through the process. The good news is that the drug is now available in Canada, but they could not come to terms with PMPRB under the old rules—not the new rules, the old rules—so they did a really unusual thing. They allowed their patent to lapse. They fled the jurisdiction of PMPRB. The good news is that drug.... It's not the greatest drug in the world, but when you're dealing with ALS you'll take faint hope.

My concern is that, given the additional barriers to reimbursement and patient access, when there is a breakthrough for ALS, like we've had for COVID-19, Canada's going to be even further back on the list of when ALS patients.... ALS patients don't have very much time for process. They need help ASAP.

I use ALS, but there are lots of other diseases that have no useful therapies, or not adequate therapies, today. With respect, I'm not prepared to wait for governments to pay for all the R and D that will bring a breakthrough molecule for ALS or anything else. We need investors in the private sector to be partners in this. Please, we ought not to be in the business of kicking sand in their faces.

[Chris d'Entremont, Conservative, West Nova, NS]

Thank you.

Mr. Chair, how much time do I have left in this round?

[The Chair, Liberal, Ron McKinnon]

You have a minute and 12 seconds.

[Chris d'Entremont, Conservative, West Nova, NS]

I know Mr. Thériault wanted to ask a few more questions. I know he doesn't have a whole lot of time, so I'm going to pass my time to Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you. That's very kind.

[The Chair, Liberal, Ron McKinnon]

Go ahead.

[Luc Thériault, Bloc, Montcalm, QC]

Doug Clark, executive director of the Patented Medicine Prices Review Board, PMPRB, said on November 27: “I don't think it's the purview of PMPRB to ensure that its guidelines, regulations and regime in its totality encourage R and D.” Later, when I said, “My understanding is that, in five years, you have not analyzed the economic or overall impacts of the reform on life sciences. Is that right?” he replied, and I quote, “No, we have not analyzed the impact on life sciences. However, we have done an analysis on prices, and we believe there will be no impact…”.

Mr. Adams, you say that the proposed reform denies one of the fundamental principles of the life sciences industry, because the process must be predictable, and it is through such a process that patent holders can assess the market for a drug and invest in research and innovation. Does this kind of answer surprise you?

[Annie Beauchemin]

Basically, we don't agree.

[The Chair, Liberal, Ron McKinnon]

Give a quick answer, please.

[Annie Beauchemin]

We're convinced it would have a negative impact.

It's currently under negotiation with the provinces. That's the way the process is going. Significant discounts are being given. We firmly believe that these new regulations go beyond provincial jurisdiction. It's important to take that into account.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Adams, you have in your brief—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault. Chris's time is up. You'll have two and a half minutes shortly.

We go now to Ms. Sidhu.

Ms. Sidhu, please go ahead for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Maybe this is the last sitting of our committee in 2020. I want to thank my colleagues and committee staff for their incredible work. Happy holidays.

I have a brief observation on the insightful discussion from the comments of one of the witnesses today. I strongly believe that Canada's economy and Canada's health care market is one of the most stable and predictable markets in the world. Through you, Mr. Chair, to Mr. Frank, I talk to my residents every day. The issue of drug costs and reliable insurance comes up in many conversations. As we all know, the government is working to move forward in establishing the fundamental elements of Canada's pharmacare. I often hear from my residents about the high impact of insurance premiums on their household budget.

Do you believe lower drug prices will result in overall savings for Canadians on their insurance premiums if the new guidelines are introduced?

[Stephen Frank]

There's no question that they will.

Premiums are a function of the expected cost that we will be outlaying on behalf of an insured individual. If those costs decline, anything we can do to bring those down will have a positive impact on premiums in the extent of reducing them. For many employer plans, they bear the cost of the medication directly. We just administer those on their behalf. It's an immediate and direct flow-through.

This is why we're so supportive of these reforms. It's critical that we get the prices more aligned with what we see globally. It's going to free up capacity to even contemplate paying for some of these new medications. It's really important that we get this done. We've been at this for many years now, and I think January 1 is the date we should be holding to.

[Sonia Sidhu, Liberal, Brampton South, ON]

Ms. Fuller, you spoke about your work with diabetes and access to insulin. As you noted, some drug manufacturers have tried to withdraw the less expensive insulin in favour of more expensive alternatives. Fortunately, the Canadian drug agency proposed under the national pharmacare plan would negotiate the best prices possible and keep affordable options on the market. Do you feel that the new regulations proposed by the PMPRB would effectively limit manufacturers from making decisions that prevent patients living with diabetes from accessing the affordable drugs they need?

[Colleen Fuller]

I think that it can make contributions to that. One of the things that the prices review board does is it looks at the evidence that there is a therapeutic advantage in newer insulin products, just like it does for any other drug. If the guidelines are implemented and they are able to access better information and more information, which will allow it to assess whether the introductory price is a fair price, I think that will be good.

Will the manufacturers say, “Sorry, we're not going to therefore introduce this drug”?

Sanofi did that with insulin glargine, brand name Lantus. They were in a huge tug-of-war with the prices review board because the board looked at the evidence and said that the evidence showed that this is not—I can't remember the name of the category—a drug that offers an increased therapeutic benefit. Sanofi got into a wrestling match. They did that in Germany, and they did that in the United Kingdom. It wasn't only in Canada that they were having this fight with regulators about what the fair and reasonable price was for that insulin.

The prices review board basically caved in and relied on the assessment of the fairness based on what was going on in comparator countries. Of course, they're all higher-priced comparator countries. I think that with a change in the comparator countries that's a very positive move. I also think that what needs to also happen is that the prices review board needs to rely more on the evidence. The comparator countries are important, but I also think the evidence really should have greater weight in their decisions.

I hope I answered your question.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu.

We'll now go to Mr. Thériault.

Mr. Thériault, you have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

My question is for Mr. Adams.

Your association brings together several organizations that represent millions of patients with a range of illnesses. During the first meeting, Mr. Clark suggested before the committee that many patient organizations don't want to develop an independent perspective because they are indebted to the companies that support them:

… there's a lot of research out there to show that, when you take money from someone, it—even implicitly, without your knowledge, subconsciously—impacts your views. There's definitely a correlation, and a pretty strong one, between where patient groups stand on these reforms and the extent to which they accept funding from industry.

In your brief, you lamented the fact that the patients were pushed aside. You say it is unfortunate that the concerns and lack of patient participation in this process have not always been reflected.

Don't you find Mr. Clark's statement to be somewhat contemptuous and bordering on defamation?

[John Adams]

I appreciate some of the candour of Mr. Clark. I don't go around looking for fights with anybody. Let me do an analogy. Among other things, as well as being a patient and a patient advocate, I'm also a recovering politician. I'm not unfamiliar with the question of politicians looking for funding for campaigns. We all have to govern ourselves with integrity when we seek and accept money for political campaigns. I don't think that's unique to municipal politics or to provincial. It applies to all levels. One has to be careful about that. I think Mr. Clark might want to....

I would look forward to a face-to-face conversation with Mr. Clark so that we could exchange, in a full and frank way, perspectives. I think he was unfair to many patient advocates and many patient organizations. I appreciate his candour on another point. He did acknowledge the PMPRB has not done a study of the impact on research and development of the proposed new rules. I submit to this committee that this warrants or is cause to pause and reflect before going full steam ahead and changing four different things at the same time.

[Luc Thériault, Bloc, Montcalm, QC]

Do you think—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies.

Mr. Davies, you have two and half minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Adams, on the Best Medicines Coalition website, it says, “The Best Medicines Coalition seeks and receives corporate funding in the form of sponsorships and grants and receives in kind support through collaboration and partnership from its member organizations.” Can you confirm whether any of that corporate funding comes from the pharmaceutical industry? If so, how much?

[John Adams]

Yes. Actually, in my opening statement I confirmed that, sir, but I'm happy to clarify. Our budget for the last four years has been about $220,000, on average. Yes, we seek unconditional funding from pharmaceutical companies.

[Don Davies, NDP, Vancouver Kingsway, BC]

How much of that $220,000 or so annually comes from the pharmaceutical industry?