Evidence of meeting #13 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pmprb.
A recording is available from Parliament.
Board Chair, Best Medicines Coalition
The majority of it. I don't have the number off the top of my head.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Ms. Fuller, I'd like to ask you about the issue of the relative weight given to the evidence of improved benefit of medication and other factors, like prices in comparator countries. I would be interested in hearing your comments on how you think that should be weighed by the PMPRB in assessing adequate pricing.
Representative, Independent Voices for Safe and Effective Drugs
I think that the issue of evidence is very important. CADTH, for example, the Therapeutics Initiative and other similar agencies in Canada look at evidence and assess whether or not the asking price is worth a recommendation to provincial drug plans to list or not list.
If the prices review board had been looking and relying on the evidence for Lantus insulin, which is the example I used in our brief, I don't think they would have approved a $5.50 per unit introductory price for that insulin if the evidence had weighed in the way it should have.
I've been involved in a lot of these issues around insulin. I've had diabetes for 52 years, so I've seen every single price of insulin for the last half-century in Canada. When I was first diagnosed with diabetes in the late 1960s, insulin cost my family about $1.17 per vial. The price of that insulin went up over the years and when it was finally withdrawn in the mid-1990s it was $11 per vial.
The price of newer branded insulins has gone up just incredibly. They're no better than the insulin that I began using in the late 1960s. I'm not saying that we should be paying $1.17 per vial, but the cost of insulin on the market today is completely unjustified. The prices review board needs to be able to use better tools to assess whether or not those prices are justified.
Now, the highest-priced insulin in Canada is about $150 for a 7.5 millilitre amount. These insulins are not lightening the burden on people with diabetes who use insulin. They're certainly not lightening the financial burden of diabetes either. I think that if the decisions at the board were made on the basis of evidence, we would not be seeing these prices for insulin in Canada. At least, I hope we wouldn't be.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Davies.
That brings round two of our questions to a close.
We don't have time for a full third round. We have 20 minutes left. I am going to try cutting the five-minute slots back to four minutes and the two and a half-minute slots back to two minutes. That will get us in right under the wire. I'll be very brutal about the timing.
We will go ahead now with Mr. d'Entremont, please.
You have four minutes, sir.
Conservative
Conservative
Conservative
Larry Maguire Conservative Brandon—Souris, MB
I noted that in his opening comments, Mr. Adams made a reference to unwisely taking on unnecessary risks.
Can you just elaborate on who is unwisely taking the unnecessary risks? What are your thoughts on that? Can you expand on it?
Board Chair, Best Medicines Coalition
Thank you very much.
First of all, there are the regulations and there are the guidelines. The regulations were decided by the cabinet of the Government of Canada. The problem of the unwise combination of risks—doing four changes all at the same time—is baked into the regulations. With respect, the principal point of accountability is the cabinet of the Government of Canada.
The guidelines are the work of the PMPRB in fine-tuning and how they would implement that. They're taking their marching orders from the cabinet. The short answer is the cabinet.
Conservative
Larry Maguire Conservative Brandon—Souris, MB
Thank you.
To our witnesses from Boehringer, I know you do work with ventilators, COPD, lung cancers and that sort of thing. To tie it a little bit closer to COVID, maybe you can be responsive in this area. Our long-term care facility seniors are taking the biggest hit in Canada. Eighty per cent of the deaths are from that area. A lot of COPD and lung conditions are fatal with COVID.
You plan in generations, with your Bridging HOPE program and that sort of thing. Could you elaborate on that as to how responsive people have been during this pandemic in regard to trying to solve our situation—the biggest part of the disaster of COVID—under the present rules and perhaps under the changed rules?
Executive Director, Patient Access, Pricing, HealthCare Affairs Solutions, Boehringer Ingelheim Canada Ltd.
I'll start, and Mehmood can complement.
We work with the health care system in many different ways. We work with patients and with many stakeholders in health care, and of course everyone has been committed to improving the situation, including us. We mentioned in our opening statement that we, like other companies, are working very hard towards continuing to provide better treatment options.
It's worthwhile to note that many of our partnerships as well help the health care system. That's not factored into what the PMPRB would look at. These partnerships go beyond even R and D investments. Our company is unique in many ways. We work with the system to improve system change, and all of us are hard at work on this. We're concerned that the PMPRB guidelines will in the future limit our ability to do so.
Conservative
Larry Maguire Conservative Brandon—Souris, MB
Mr. Alibhai, you mentioned that you're working in the area of a digital health policy framework. Would things be similar in that area as well?
Director, National Policy and Patient Access, Boehringer Ingelheim Canada Ltd.
One thing we find as we are working with indigenous communities as well is that they are even more challenged with regard to optimal access during the time of COVID.
Just this morning, for instance, I had a discussion with Greybox, which is a Quebec-based virtual technology digital platform, and an indigenous group concerning how we—Boehringer Ingelheim is partnering with Greybox—can bring Greybox into the picture with this indigenous group, which manages pan-Canadian optimization of diabetes care. We just finished a discussion this morning.
Liberal
The Chair Liberal Ron McKinnon
Thank you. I'm going to have to cut you off there. I'm sorry.
We'll go now to Mr. Van Bynen, please, for four minutes.
Liberal
Tony Van Bynen Liberal Newmarket—Aurora, ON
Thank you, Mr. Chair.
For those of us who are not too familiar with PMPRB, these conversations are always enlightening. I thank our witnesses for joining the committee today and sharing their expertise.
Even with the third-highest drug prices in the world, the drug industry is falling short of its own 1987 commitment to invest 10% of Canadian revenues back into R and D to be performed in Canada. Current industry investments in Canada are 4% and falling. Annual industry investments in Canada would need to increase by $800 million a year to meet their own commitment and by more than $3 billion to be comparable with what other countries already receive by way of R and D. The evidence suggests that pricing is not the main determinant of industry investments.
My question is to Ms. Fuller. She offered two alternatives. One was compulsory licensing and public manufacturing. To what extend would this help reduce the high cost of drugs?
Representative, Independent Voices for Safe and Effective Drugs
As I mentioned, when Connaught was manufacturing drugs in Canada, they provided those drugs at cost to public and private insurers, and to consumers. Obviously they weren't paying dividends to shareholders, they weren't raking money off the top and so on and so forth, so they were able to do that. The pharmaceutical industry is not able to do that. They have an obligation to provide a return on investment to their shareholders and so on. I think that a public manufacturer would go a long way towards contributing to a better cost picture in Canada for drugs.
Compulsory licensing is a tool that Canada used to use and it was also something that we abandoned during the period when we were negotiating free trade deals and so on. These things have undermined our ability to not only have greater control over the prices that we pay for medicine and vaccines, but also our ability to supply drugs to Canadians if the industry is not able or willing to supply them. The industry right now is basically saying that they're not going to supply new drugs in Canada if the guidelines go through. We're not the only country that they've issued that warning to.
I think one of the ways to respond to that, to counter that, is to ensure that if they don't, if they choose not to supply drugs in Canada, we have the capacity to supply them ourselves.
We're looking at this now. There's been a big debate in Canada around the COVID vaccine, as another example. We're not making the COVID vaccine in Canada. We're relying on global manufacturers to supply that. It's not that they're saying that they refuse to supply us. It's that they're saying they'll get around to it after they have supplied these other markets that they have obligations to, or whatever. I think we need to figure out a strategy to deal with that.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Van Bynen.
We're now going back to the Conservatives. Is it Monsieur d'Entremont, or is it Mr. Maguire?
Mr. Maguire, please go ahead.
Conservative
Larry Maguire Conservative Brandon—Souris, MB
Mr. Chair, I had asked Mr. Alibhai to elaborate on the issues that he was dealing with around the outbreaks that we've had in COVID in some of the indigenous areas. I wonder if he would have more to say on these companies being prohibited from expanding in order to be able to work to solve some of these problems in our own country.
Director, National Policy and Patient Access, Boehringer Ingelheim Canada Ltd.
As we shared with you, we are here today because we find the PMPRB consultative process to be ineffective. The feedback provided by not just us but patient organizations has been ignored, as is reflected in the number of significant increases in the number of negative submissions on the guidelines when you move from the initial consultative process to the August timeline.
Patient groups are concerned. The way BI, Boehringer Ingelheim, approaches it is that we are solution solvers. That's what drives us based on the opening...and we continue to work with indigenous communities and with other partners to address their concerns and challenges. In effect, we are reconsidering a number of initiatives, a number of investments, because of the uncertainty and unpredictability that these guidelines have posed.
As I mentioned, we are the first company that negotiated a successful pan-Canadian negotiation. We built the system with the payers. We are committed to optimal, sustainable access for Canadians. We find that the consultative process with PMPRB was not effective.
Conservative
Larry Maguire Conservative Brandon—Souris, MB
Thank you.
Here is a quick question to Mr. Frank from the Canadian Life and Health Insurance Association. You mentioned that you hold the insurance for 99% of all the health care insurance programs in Canada and said that 29 million Canadians were insured. Does that mean that—what are we at, 35 or 36 million Canadians now?—as a corollary there are six or seven million people not insured under your programs, or can you give me a more accurate number?
President and Chief Executive Officer, Canadian Life and Health Insurance Association
That's right. The difference would be those who are maybe on seniors programs in the various provinces or on some of the other provincial support programs.
Conservative
Larry Maguire Conservative Brandon—Souris, MB
You went on to say, I think, that 87% value that coverage.
Can you elaborate a little on how some of the pricing review changes would impact premiums, insurance companies and individuals? I think you said that most of it is paid through their companies, but can you elaborate?
President and Chief Executive Officer, Canadian Life and Health Insurance Association
That's correct. The price of the medication is a pass-through from the insurer straight to the employer and straight to premium. Any reduction in cost, any reduction in price would pass through to the employer who is the plan sponsor, or those who have individual coverage would see their premiums reduced.
