Health Committee on June 4th, 2021

[Erin Little]

Okay.

Olivia lives with chronic kidney disease. Chronic kidney disease is a lifelong circumstance until it leads to a kidney transplant. So on top of cystinosis, which is what the high-cost drugs treat, she has a lot of treatments for renal issues that are not covered. Even things like OHIP+ do not cover somebody like my daughter. These are ongoing worries that we have.

[The Chair, Liberal, Ron McKinnon]

Thank you, both.

We'll go back now to Ms. O'Connell for five minutes.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you, Mr. Chair.

Earlier in the meeting, in the first panel, we heard some testimony regarding the PMPRB's being asked to appear.

I just want to correct the record while I have a chance. The PMPRB was only invited yesterday. My understanding is that they would be happy to appear. I think it is important, given the testimony we heard today in the first panel, that we invite the PMPRB.

That said, I move that the Standing Committee on Health hold an additional meeting on the Patented Medicine Prices Review Board guidelines—as we were initially scheduled to do—in place of one of the meetings to be scheduled during the regularly scheduled meeting slots prior to the end of day on June 21, 2021; that the clerk invite the PMPRB to appear as a witness; that the meeting take place for two hours; and that, in addition to the PMPRB witness, each party be allowed to invite one witness for this meeting on the Patented Medicine Prices Review Board's guidelines.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. O'Connell.

I find that this directly relates to the business at hand. Therefore, I would rule it in order.

I see that we have Ms. Rempel Garner with her hand up.

Please go ahead.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Chair.

I will note that the Liberals wasted two meetings filibustering our programming motion earlier this week. They also wasted meetings in September filibustering this. We wanted to have more meetings on PMPRB. I think this is one of those things where the Liberals are putting it forward because we did lose meetings.

For the witnesses who are here today, that is what happened.

I will note that the meetings that this this motion is trying to replace would allow any political party to put forward any witness they want. So if there are additional witnesses on any particular topic, political parties can do that.

The other thing I will note is that I tried to get the regulator in front of the committee today. We asked for anybody from the regulator to show up, and they declined.

I think this is theatre. We have a motion set....

I deeply appreciate the testimony of the witnesses, particularly by Ms. Little. I thought that your testimony was very compelling.

At the same time, I would also note that it was the members of the Liberal party who wasted two meetings filibustering a programming motion to which they didn't have any substantial amendments. The amount of heavy lifting that went on behind the scenes between opposition party members was enormous. We could have had another round of questions today.

I will be voting against this motion, because we literally just spent three meetings going through a programming motion that could have been condensed into five minutes of debate—so, no.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rempel Garner.

Mr. Thériault, you have the floor.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I am quite surprised at my colleague's proposal, especially since I recall a meeting where she found it inappropriate—to use a neutral word, which she does not often do—to interrupt a session with witnesses. She knows how important this issue is to me, and she always knows that, according to the rules, I have very little time to ask questions. I don't believe she has given any of her time to me. I have eight and a half minutes of speaking time, while her party enjoys several more minutes.

She has just prevented me from using my two and half minutes, when we had agreed on a way to operate during this saga as to how we would organize our work going forward. We came up with a compromise, which was to hold a three-hour meeting so that we could provide instructions to the analysts and make a minimum of recommendations before the reform comes into force on July 1. Unless my colleague tells me today that the government is delaying the reform, her manoeuvring means that we may not get there, when I've already made that compromise. I was the one who proposed this study and I don't understand why she is doing this.

From the beginning, we heard testimony from PMPRB representatives about the reform, which took time at the meetings. I can barely figure out what is accurate or inaccurate in the various testimonies.

I'm very surprised at my Liberal colleagues' manoeuvring, which I interpret as a lack of respect for me and for the witnesses here today. I feel it's a shame, because I have never been disrespectful to anyone around the table. I'm very disappointed, and I'm going to remember this.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We'll go now to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'd very much like to add my voice to what my colleague, Mr. Thériault, just said.

Last week the Liberals were extremely opposed to a motion that was being made while we still had witnesses here and lectured all opposition members on that. Here they are doing the same thing. I don't know why this motion couldn't have been left until after we heard from the witnesses. It would have been easy to do that.

Secondly, just this week, we had a meeting on Monday of our subcommittee on agenda to set the agenda. On Wednesday, we had a Standing Order 106 meeting to confirm the agenda. We had two full meetings this week that were hours in length and the Liberals never once made any indication that they wanted to have another meeting. They had every opportunity to call the PMPRB to this meeting if they wanted. We had eight witnesses. Each party was entitled to call any two witnesses they wanted today and the Liberals did not.

Incidentally, and as my colleague Ms. Rempel Garner said, we have four more meetings scheduled where each party has the opportunity to call any witness they want at each of those four meetings. In one of the meetings they have two, so the Liberals could easily call the PMPRB to one of those meetings, if they want.

This motion is not only is insulting to the witnesses and has not only has robbed Mr. Thériault and myself of our chance to ask our final.... I also only have two and a half minutes to go, with Mr. Thériault. We've been robbed of our chance after the Liberals got their time.

All for what? It's all to call a witness, which they could have done for today and can do in the next three weeks, at this point. That's unacceptable conduct. It's disrespectful to the witnesses and it's disrespectful to the members of this committee.

I'm not sure...this is in order. I've received no notice of this meeting. We're not in committee business. It would be nice if the members of this committee would serve notice as the other ones did.

I remember last week when the Conservatives submitted a motion on the Wednesday for the Friday, the Liberal members of this committee didn't think that was acceptable. Well, I was just served notice of this five minutes ago, orally. I don't think this is appropriate conduct.

Again, I would ask my honourable colleague to withdraw this motion. If she believes that the PMPRB is an important witness, then use one of their witness slots they have in the next three weeks to call them.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

Seeing no further hands raised, we can call the vote. If we do this quickly we will have time for Mr. Thériault and Mr. Davies' testimony.

I would ask the clerk to call the vote on this motion.

(Motion negatived: nays 6; yeas 5)

I will carry on with the questions.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Ms. Fralick, as I understand it, you want to delay the implementation of the reform, which comes into effect on July 1. You want it to be more than just a delay. You also want a roundtable to bring together the various partners, some of whom I named earlier. In response to Mr. d'Entremont, you kind of said all there is to say.

You also pointed out the inconsistency between the government's recommendations in the 2018 report by the Department of Innovation, Science and Economic Development, which reflected all that drive to stimulate the biotech innovation sector, and a reform that is strictly in the hands of Health Canada. As Ms. Perrault said earlier, the department has only a perspective in a vacuum, whereas we should have a broader understanding of the life sciences and take action on all levels.

What people want—I imagine it is what you want too—is to set up a roundtable. However, would you agree to a compromise, a phased implementation? It would mean going ahead with the reference list of countries, which appears to be a concession, from what I've seen in a number of papers, and establishing the roundtable, then sitting down and discussing the rest of the issues.

Would you agree to that proposal, Ms. Fralick?

[Pamela Fralick]

Thank you.

Through the chair, I think that would be a good departure point for the discussion. If we can get to that table with the appropriate government officials and whoever else should be there—we can determine that—then I think that would be a very useful point of departure and would generate a great deal of good discussion.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you for your answer, Ms. Fralick.

I read in some briefs that simply changing the reference basket of countries could lead to 20% to 30% in savings.

Do you have those numbers as well? Are they realistic, Ms. Fralick?

[Pamela Fralick]

There are several figures floating around. The first estimate by PMPRB, by the government, came in at about $8 billion or $9 billion over 10 years. They readjusted that. It went up to $13 billion. An independent third party did another assessment. It's about $19.8 billion over 10 years. Yes, the basket change alone would save considerable dollars and resources for Canadians.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms Fralick, we've heard—and I think we all have an imperfect understanding of this—that there seems to be this very curious way of drug pricing in Canada, such that drug companies publish astronomical list prices that nobody actually pays. Then behind closed doors the pharmaceutical companies negotiate significant discounts—we've heard at this meeting that these are between 50% and 90%—that nobody can ever find out.

Can you explain that as an industry practice and tell us whether you think that's a wise way to come to pharmaceutical pricing in Canada?

[Pamela Fralick]

Unfortunately, as an association representative, I'm not privy to the individual negotiations that take place between companies and governments—

[Don Davies, NDP, Vancouver Kingsway, BC]

That's the problem—nobody is. That's not just with governments; it's also with insurance companies.

[Pamela Fralick]

Yes, “private payers”, I should have said more appropriately. I just don't have a line of sight on that. Unfortunately, I can't help you.

[Don Davies, NDP, Vancouver Kingsway, BC]

The reason I ask is that it's not just an issue of expanding comparator countries. I don't think anybody can argue that expanding the present system—which has, I think, five to seven countries with two of the expensive two and 11-country comparisons that's much more representative—is....

Also, aren't there fundamental issues of transparency? How do we set appropriate pricing in this country if pharmaceutical companies are negotiating secret agreements, and then any attempt to shine a light on those agreements so that we can find out what actually is being paid is being resisted by the pharmaceutical industry? Who benefits from having private, secret prices paid when drugs are such a public necessity in this country?

[Pamela Fralick]

Again, through the chair, you're dealing with sensitive commercial issues. As an association representative, we don't have guidance, policies or best practices that direct how payers and companies deal with this, but understanding that this is a tension, I think if we were to get to a table, this is another point that could be discussed.

[Don Davies, NDP, Vancouver Kingsway, BC]

That's the point. It's not just a private commercial transaction. The public grants a patent to private companies, which then have 20 years of protection. Someone has to protect the public interest in this, otherwise a pharmaceutical company could say, “We want a billion dollars a pill, and if you don't pay it, we're just not going to make the drug available.” That clearly can't happen.

I'm going to go to Ms. Little for my last question.

Ms. Little, should we proceed with these PMPRB changes, and what would be the impact on your family and your daughter of those reforms going ahead?

[Erin Little]

Yes, I do believe we need to move forward. They might not be perfect, but they're progress and that's what we need.

Mr. Davies, I'd like to answer your question, but I just want to say one thing.

Ms. Rempel Garner, I appreciate your calling my testimony today “compelling”. As a patient, I'm not here to be compelling. I, too, run an organization and sometimes I feel that I am dismissed because I tell a story, but I tell the story that everybody at this table serves. We are the customer of this product.

Somebody once said to me that our story is a bit like being suddenly cast adrift in a vast and stormy sea in a lifeboat surrounded by unmarked ships that are being piloted by either the Mexican drug cartels or the Coast Guard, but there is no way of knowing which is which. Sometimes that's how we feel, with government on one side and pharma on the other. Even within the advocacy space, we need to know that we are being supported and that our children and our patients are being protected.

For that reason, I do feel that we need to move forward.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

Thank you to the committee members for all of your great questions.

Certainly, thank you to the witnesses for sharing with us your time today and your expertise and helping us with our study.

That said, I believe our business is done today and I declare the meeting adjourned.