Health Committee on May 23rd, 2024

[The Chair, Liberal, Sean Casey]

Can I get you to wrap up, Ms. Thériault, please?

[Celeste Theriault]

Marsi. Thank you. Thank you for your attention.

[The Chair, Liberal, Sean Casey]

Thank you.

Next we have Dr. Francoeur, representing The Society of Obstetricians and Gynecologists of Canada.

Welcome. You have the floor.

[Dr. Diane Francoeur, Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada]

Thank you, Mr. Chair and members of the committee.

My name is Dr. Diane Francoeur. I am a practising obstetrician and gynecologist, as well as the chief executive officer of The Society of Obstetricians and Gynaecologists of Canada.

I am here today to discuss the aspect of Bill C-64 that proposes to offer universal coverage of a full range of contraceptives for Canadian women. Specifically, I wish to highlight why this measure is important and long overdue; why it's not just a women's issue or a nice-to-have measure but a necessary economic policy that benefits all of society; and why we hope that you, as legislators, will ensure that coverage of all forms of birth control is included in the final bill and that the bill passes without any undue delay.

Today, somewhere in Canada, a woman will have to choose between buying groceries, paying her electrical bill, filling up her gas tank or paying for her birth control. It's no secret that the rising costs of almost all goods and services have become a significant burden for many Canadians. However, nine million women of childbearing age in Canada bear the additional cost of preventing unintended pregnancy, a basic need that often flies under the radar but that is no less fundamental to the way of life of millions of Canadian women.

Contraception allows women to plan their lives, their families and their pregnancies. They are more likely to finish school. They participate more fully in the workforce. They enjoy more economic stability and they have healthy pregnancies when they do choose to have children.

Canadian women spend, on average, 30 years of their lives shouldering the associated cost of trying to avoid a pregnancy, but financial barriers can limit birth control options for many women, as you so rightly said.

Canada currently has a patchwork of coverage for contraceptives, which varies according to income and where you live. This forces some women to choose the cheapest method, and not necessarily the most effective or best method for their bodies. In some cases, they may not be able to afford any birth control at all. This can result in an unintended pregnancy. I see this every week in my practice.

We can do better than that for Canadian women. Approximately 40% of pregnancies in Canada are still unintended. This doesn't impact only women and their families, but also the economy. The direct cost of unintended pregnancies in Canada is estimated to be at least $320 million per year, a figure that doesn't include the downstream cost to society or to parents. The B.C. modelling indicates that the health system will save $5 for every dollar it invests in contraception every year.

We urge you, as legislators, to ensure that Bill C-64 passes smoothly and without undue delay.

To fully implement the commitments in this bill, Ottawa will need to negotiate agreements with the provinces and territories, which will take time. Any parliamentary holdup would only force women to wait longer for this much-needed assistance. Already, my patients, my neighbours and my nurses with whom I practice every day have been asking me when this coverage will become available, because it's never soon enough for those in difficult economic situations.

We also urge you to ensure that the final version of the bill and any budget measures attached to it include coverage of a full range of contraceptives, including the pill, the patch, the ring, the IUDs, the shot and the implant. By ensuring that all options are available, nine million women in Canada will no longer be forced to make decisions about their family planning based on their income.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Francoeur.

We will now begin with rounds of questions, starting with the Conservatives.

Dr. Kitchen, you have six minutes, please.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you, everybody, for being here at this late hour and on such short notice. It's greatly appreciated.

I think that's part of what Canadians want to see—true conversations and discussions of what this piece of legislation says and what this piece of legislation means. Canadians want to be able to decipher it in such a way that the average person watching this evening can understand what is going on and the challenges that we have.

To you, Ms. Thériault, thank you very much for your comments and your insight.

In my past life, before I became a member of Parliament, I was a consultant for the FNIHB, the First Nations and Inuit Health Branch, so I'm aware of things along the lines of providing health care services to first nations through different avenues. I'm wondering if you could explain that to those watching who don't understand, because FNIHB is covered by the Government of Canada.

What could you say on the coverage for diabetes and other coverages that might be available?

[Celeste Theriault]

You mean under the NIHB program, correct?

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

That's correct.

[Celeste Theriault]

In the NIHB program, specific diabetes medication coverage is more extensive than in the formulary list that was the backgrounder list that was circulated. There are some disparities between the NIHB list and the Canadian practice guidelines that are published. They're not all-inclusive and comprehensive in the first place, if we really wanted to pick them apart, but they are better than the formulary list that was proposed here as a base minimum. There are some that are covered only if specific requirements are met, such as being an insulin user to get a specific medication covered.

It varies in terms of all of the medications. One big one that we see that is not included is GLP-1s. That's something that our indigenous people use extensively to manage their blood sugars in a way that works for them.

I think that we need to look very holistically on what it also provides outside of pharmacological care, because pharmacological care is only a certain portion of what is covered under non-insured health benefits.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

To be clear, you're basically saying that what's being proposed in this legislation is less than what is available for first nations at this present time, under the understanding that the services that are provided to first nations are universal across Canada. They don't vary from province to province.

[Celeste Theriault]

First of all, it is for status first nations and Inuit beneficiaries. Yes, for status first nations and Inuit beneficiaries, the NIHB program currently provides more coverage.

Now we are missing an entire other population of indigenous people, and also our non-status individuals within that scope. We cannot make a sole judgment just based off that one thing, but yes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you; I appreciate it.

Granted, you did touch on the fact that you weren't able to have conversations with all groups because of how quickly this came about. Are you aware of whether the government talked to first nations about this before this piece of legislation came about?

[Celeste Theriault]

I am not aware, and I wouldn't be privileged to that information in my current role and position, but I do make it clear that our Minister of Health does need to have those conversations.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

That was going to be my next question.

Do you think it's important that this Minister of Health should be talking to our first nations before we even get this out on the table?

[Celeste Theriault]

I believe that our Minister of Health has to have conversations with provinces and territories as well as our first nations, Inuit and Métis, and not just first nations governments. That can be done in a good way through moving the bill forward. I think that the minister said today that he cannot have concrete conversations with the provincial and territorial governments, that he would be in breach of Parliament, or something along those lines.

We want to make sure that the indigenous voice is heard first and foremost. I think everyone can work together towards that.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Likewise, as you indicated, it should be also for the provinces and the territories to have those conversations.

[Celeste Theriault]

Of course.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Ms. Walker, thank you very much. I have huge respect for the pharmacists I have, my own personal pharmacists, because of the advice that they provide.

A lot of Canadians don't understand the knowledge base that they have. Oftentimes they are much more knowledgeable on all medications, more perhaps than even the doctor who's providing that information. I don't mean that disrespectfully; it's just that you spend four years studying to become a pharmacist.

Your comment about the expert committee, I find, is very discerning about this piece of legislation, because it doesn't clearly define what that committee will be. It doesn't say how many people will be on that committee. It doesn't say what their role will be or what qualifications they need to have. Your comment about having a pharmacist on it I think is very important. I wonder if you could expand on that.

[Joelle Walker]

Absolutely.

I think it's very natural to think of your pharmacist first and foremost as the person who's managing your medication treatments on an ongoing basis. They really can provide a very practical, real-life view of what any changes would propose.

Whether the legislation goes in any particular direction, the end result is it's going to be an interaction between the pharmacist and the patient at the pharmacy counter. The pharmacist needs to be able to explain what the change is and why the change has been made.

Depending on the spectrum of the changes that are considered, changing millions of people from different programs could be hugely challenging, just from a logistics and burden perspective. Having somebody like that on a committee would be essential.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Walker.

Next is Mr. Jowhari, please, for six minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to the witnesses for coming.

I want to follow up on what Dr. Kitchen talked about.

I want to also thank you for advocating for pharmacists. One of my very good friends, my mentors, and the one whom I trust with all of my medication, is Akil Dhirani, who's running many practices. I often go to him for advice on many things, especially around pharmacare.

I'll ask you a very simple question. I believe you are familiar with the health care plan that we have. If I develop type 1 diabetes, what would be the scenario today for me? What would be the difference between today versus tomorrow, when this bill passes? What would it be when I go to Akil and say, “Akil, now I have type 1 diabetes, but insulin is universally available now. What change would I see in treatment? What change should I anticipate from my insurance provider?”

[Joelle Walker]

It really depends a little bit on the treatment that you're currently using. We certainly fielded an enormous number of questions from pharmacists when the PSHCP transition was made, because there were changes that affected patients.

Some members might be familiar with one of the biggest ones, which was compliance packaging for elderly people. That was a service that was provided with an understanding from the pharmacist and the physician that was noted in the file, but now the patient has to apply, go into their paperwork and get a response back from the plan provider. I'm illustrating that just to mention that there can be additional processes to go through.

The difference might be that if you're on a drug that isn't currently envisioned on the list, such as a GLP-1, the question will be whether your current plan will cover that and pick that up.

We're also very familiar with the challenge that employers will be looking to cut the costs of their plans. If a drug class is already covered, they may look to reduce those costs so that they can invest in other areas of their plans. Those are the questions that we would ask.

If you're not currently covered.... This is sort of what happened with some people. In Ontario, the OHIP+ program for kids was introduced, and pharmacists had to do a lot of triaging of patients who had lost coverage for a particular drug and had to apply for special exemptions. That just adds to the burden that's already existed on a very pressured profession and health care system at the moment.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Making it simple, if I am covered today, the pharmacist's concern is whether the amount of coverage would potentially be reduced because of the type of diabetes medication that's made available as part of the universal plan. That's one area that you're....

The other one is that if I don't have medication, if I don't have coverage, that means at least I'm one step ahead in being able to get the medication that I need. Is that a fair summarization of what the concerns and the benefits are?

[Joelle Walker]

We've always advocated that the best way to serve patients is to help fill the gaps for people who don't have coverage or to help people who don't have enough coverage. Those are slightly different issues, and they need to have really tailored solutions.

Absolutely, this could be a step up for somebody who doesn't have coverage, and we would support that, but in terms of the legislation, we would like to see a more explicit reference to maintaining private coverage so that it would go to that private coverage first.

[Majid Jowhari, Liberal, Richmond Hill, ON]

If you were going to make one recommendation along those lines, what would that recommendation look like?