Health Committee on Dec. 11th, 2020

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

Thank you very much, Mr. Chair.

I had a bunch of questions. I need to go back to this. Maybe this is for Boehringer, and maybe others.

We talk about the importance of drugs in our health care system, the availability of therapeutics. Why does it seem that drug companies have become the big bad wolf in all of this discussion? Why do governments seem to have to push back on pricing all the time? Is there a disconnect? What have we missed over the last number of years?

It's probably best for Madam Beauchemin or Mr. Alibhai.

[Mehmood Alibhai]

I will leave it up to Annie. Did you want to address that?

[Annie Beauchemin]

I think the issue here is.... We've spoken about organizational mandates and our values and we are a company deeply focused on patient needs. We're here to represent the fact that the issue with the regulations is that the original intent of the PMPRB was to prevent abuse of patented drugs with respect to excessive pricing.

What's happening now is that these guidelines go well beyond this. You've heard multiple times from multiple people here today that they are highly complex. They have created a great deal of uncertainty and they will make it difficult for companies to make a sustainable contribution to commercialized medications in Canada.

That's the heart of the matter for us, and that's our concern.

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

Thank you very much.

Maybe I'll go back to Mr. Adams for a second. You brought it up in your opening statement when you talked about whether organizations are taking money from pharmaceutical companies, and that's a bad thing. One of your last recommendations was to create some kind of funding for patient groups so that they can speak on behalf of their organizations. Can you talk to that one just a little bit more?

[John Adams]

I'd be delighted. Thank you very much.

I'm a volunteer. There are a lot of patient organizations where the office is a desk in somebody's bedroom. That applies to our little PKU group. It's a very big deal to try to engage with PMPRB—I'll use them as one example but it's not the only one—in order to understand their processes and understand the appropriate opportunities, or lack of them, for the patient voice, the unique perspective of patients as the users of prescription drugs, to engage in the process. I think there's a lot of opportunity for improvement of that in the PMPRB and its processes.

There are other aspects of the health care system. The initial regulatory review by Health Canada for safety and efficacy and quality of manufacturing is very time-consuming. Then there's the other phase, the health technology assessment process. There is a window of opportunity now for patients, individuals and groups to make submissions into that. That's a huge burden of effort for many volunteers in many of the smaller patient organizations. It would be very helpful and I think it would improve the quality of the process and protect the integrity of each of those processes—the price review process, the safety efficacy review process and the health technology assessment process—if the patient voice were strengthened.

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

Thank you very much.

I know I didn't really get in any questions to Ms. Fuller, but maybe I'll ask her a quick one because I know I'm running out of time. I have about a minute left there.

How could the industry work a little more collaboratively together? I just look at how R and D is done across the country. Is there a better way to be doing it, or are the suggestions from PMPRB the only or just one step in that process?

[Colleen Fuller]

When you the say industry working together do you mean with each other, or with the board?

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

I would say the industry together because what we see is that pharmaceutical companies seem to be put to one side. They have their way of doing things. We have universities that seem to be doing their own thing. We have companies and governments that want to have a piece of that. I'm just wondering if there's a better way for some of these to go. I'm going to run out of time there.

[Colleen Fuller]

Am I able to answer the question?

[The Chair, Liberal, Ron McKinnon]

Please be quick if you can and then we'll move on.

[Colleen Fuller]

I think that there's remarkable cohesiveness across much of the industry. I think that they act in concert. They are members of a large organization that lobbies on their behalf and that is threatening to pull out of Canada or not to supply drugs in Canada if the guidelines go through. I think that they do.

One of the things I would like to mention is that, on the issue of investment in R and D, a lot of the significant drop, as one of the witnesses said, since 2018 is a drop that didn't just suddenly happen in 2018. It's been going on for a while is my understanding. Maybe I'm wrong about that, but it is my understanding. The industry has never lived up to its obligations under the free trade agreement to invest in research and development to what is, I think, about 10% of profits. All of this about the guidelines is one thing, but they've never stepped up to the plate in the way that they were committed to doing in the past.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Fuller. I'm going to have to cut you off there.

We'll go now to Dr. Powlowski.

Doctor, please go ahead for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I would like to follow up on Mr. Davies' question.

Mr. Alibhai said that a whole bunch of new drugs haven't come on to the market in Canada or asked for approval by Health Canada in the last couple of years. He's said that the number of drugs undergoing clinical trials in Canada has gone down—

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, there's a problem with the interpretation. The volume for Mr. Powlowski, who I greet, seems to be too low. The interpreters can't work.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Dr. Powlowski, just say a few words for the translators to make sure that we have you properly on sound.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Merry Christmas to all if I don't get around to that.

[The Chair, Liberal, Ron McKinnon]

We're good to go. I'll start your clock again now.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I wanted to follow up on Mr. Davies' question.

Mr. Alibhai, said that in the last couple of years there's been a significant drop in the number of new drugs either asking for approval from Health Canada or coming on the market. He's also said that, in the last couple of years, there's been a significant decrease in the number of drugs that are in clinical trials in Canada, and he either said or implied this was a result of the uncertainty arising from the proposed changes to the Patented Medicine Prices Review Board. He can correct me if I'm wrong on that.

I'm not a big opponent of pharmaceutical companies. I realize that, in order to encourage research, pharmaceutical companies have to be able to recoup their cost of the development of new drugs, but I'm sorry. With the decreased number of drugs getting on the market and the fact that there are drugs being approved elsewhere that aren't even being brought before Health Canada for approval, and you're not bringing your drugs to Canada for clinical trials, it looks to me like you're holding sick Canadians for ransom because you want to prevent these new changes from going through in the Patented Medicine Prices Review Board. I have to say this is not a pretty picture for the pharmaceutical companies.

[Mehmood Alibhai]

Thank you for that question, honourable member.

There's a process in place in Canada that has been in place for 10 years, which the provinces have implemented. It is called, as you are aware, the pan-Canadian pharmaceutical alliance. Boehringer Ingelheim was the first company that went through the successful negotiation on the pCPA process for a stroke prevention drug, the first drug in 50 years that demonstrated improving stroke outcomes. We built the negotiation framework with the provinces. That demonstrates our commitment to ensuring Canadians' access. Subsequent, to that, we've been through 17 successful negotiations.

Paramount, honourable member, is that there is a process in place, which has been in place for over 10 years now, that falls under the provincial jurisdiction of pricing negotiation. It has worked really well and has led to Canadians' receiving access to innovative treatments. The federal government has joined the pan-Canadian negotiation, as they see how effective it is. The substance, then, is that there is a process in place in Canada. What is being proposed by PMPRB oversteps, respectfully, its jurisdictional boundaries as a patent abuse regulator and circumvents the provincial jurisdiction of price negotiation, which has been demonstrated to be very effective.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

With all due respect, I don't think you're really answering my question, which is that it certainly looks to me as though the fact that the pharmaceuticals aren't asking for Health Canada approval for their medications is a brazen attempt to get sick Canadians to start advocating on behalf of pharmaceutical companies to have changes put in that will basically allow you to maximize your profits in Canada.

That's the way it looks to me. I have no big chip against pharmaceutical companies, but that's the image you're giving Canadians. I'd like you to respond to that. If this image isn't a true one, then why isn't it true?

[Mehmood Alibhai]

In any business, honourable member, you require certainty and predictability over a three- to five-year horizon. Introducing a drug in Canada requires investments in clinical trials. It requires more than just getting a Health Canada approval.

What has happened with the PMPRB regulations is that they have impacted upon the predictability and the certainty of the business model, which is to ensure that beyond just introducing a product, we can ensure that the product supports clinical research on an ongoing basis and supports some of the kinds of initiatives, from a health system perspective, that we've spoken about and supports patient needs for the long term.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you. I'd like to address the question to Mr. Adams.

I know you advocate for patients. Am I totally wrong in my perception of what the pharmaceuticals are trying to do here?

[John Adams]

Let's be clear. There have been some bad actors among some pharmaceutical company executives who have abused market power in some situations. There are notorious examples of this. With respect, however, they are not necessarily representative of all of the companies by any stretch of the imagination.

I'm going to offer an analogy, and it may make some people uncomfortable. There have been allegations of parliamentarians not having appropriate behaviours towards certain of their staff. That isn't to say that every one of you on this committee is a sexual predator.

Yes, there can be bad actors and they deserve to be taken to task, and I think there are ways and means of doing that. On the other hand, I think some of the criticism comes from a point of view [Technical difficulty—Editor] do not have regard for—I will say it—a commercial business or profit-seeking motive. There are patients who share that value judgment, and there are patients who come from among senior business executives—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Adams.

Thank you, Doctor.

We go now back to Monsieur d'Entremont for five minutes, please.

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

Sorry about that. I was thinking it was the NDP's turn. Not that I want to give my time to him, but I'd be very happy to do that sometime...or even Luc.

I know we've been going round and round this one a little bit, but we keep hearing the same thing, so let's go back to what we're hearing mostly from patient groups. I think this is probably for Mr. Adams again. We keep hearing from those patient groups that they're worried about that lack of access. I know you had a really great example when it came to the drugs that your son might be able to receive.

Do you have any other thoughts for us before we finish up today of other organizations within your coalition that might not have a big enough voice to get before us and whose story might need to be heard? Trikafta seems to be the one we use the most here, but are there other examples like that?