Health Committee on May 23rd, 2024

[Dr. Diane Francoeur]

I'll let you play politics. I'll just stick to the medical side of things.

Obviously, these are excellent questions and they should be asked. Nothing is free. That's Canada's issue. In my current role, I work a great deal with other countries, including England and Australia. Their systems are comparable to ours. Our system is extremely complex. The system is federal and the provinces manage health care. We must find a solution. We're one of the last countries in the Organisation for Economic Co‑operation and Development, or OECD, to not provide free access to medication. The situation is becoming a bit embarrassing. This is affecting people's health.

To answer the question put to me earlier, remember that women in Canada still die in childbirth. Contraception prevents this.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

I understand.

Dr. Francœur, I don't want to embarrass you. I simply want to talk about some positions that you previously supported. You said that you know the Quebec system well, so you're in a good position to talk about it.

From your perspective, what can the federal government do that the Quebec government can't do?

[Dr. Diane Francoeur]

Of course, I don't know all the state secrets. I think that our system in Quebec was a good starting point. It would be good for the other provinces to also reap the benefits of this system. However, I can't know how the negotiations will go, since I don't have access to these secrets.

That said, it isn't just drug coverage that sets Quebec apart. Ontario's day care system makes things difficult for young families. The service costs a fortune and prevents women from returning to work. Yet we're facing a labour shortage across Canada. Delivery rooms are being closed, and emergency services will be shut down over the summer.

Given the current significant labour shortage, it's necessary to take care of women and determine what they need to return to the job market.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Francœur.

Mr. Julian, please go ahead for two and a half minutes.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thanks, Mr. Chair.

I'd like to come back to you, Ms. Thériault. Thank you so much for being here.

I asked a question earlier of Mr. Bleskie, a witness who is diabetic, about what would happen if he were unable to take his medication. What he described was horrific. I don't know if you were present and heard his testimony.

You specifically flagged Métis people and non-status indigenous people who don't have access to medication right now. What is the impact if you do not have that medication? What would be the positive consequence of ensuring a large number of Métis people and non-status indigenous people can access all of the diabetes medication and devices that are prescribed to them?

[Celeste Theriault]

It's important to note that I don't live with diabetes, although it affects many of my family members, and we are Red River Métis.

What I see in my personal family network is that we don't have type 1 diabetes—I did hear the testimony earlier today—but they do live mostly with type 2 diabetes. It's extremely hard to get a CGM device covered when you're a type 2 diabetic, by the way, but that's what we know is needed. If you get calloused fingers and you have a desk job and you're typing all day, you're able to monitor your blood sugar levels so that you have better in-range time.

We also see it with regard to insulin, because some people will ration insulin just to make sure they can put food on their table. I don't think that's a choice that people should have to make when it comes to their health. People should have access to the things they need in a timely manner so they can manage their health in the way they need to.

That's for Métis, non-status and status first nations, Inuit beneficiaries. It's all-encompassing.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Do you have an estimate of how many Métis and non-status indigenous people would benefit from this universal access who can't access it now through the NIHB program?

[Celeste Theriault]

I don't have specific numbers, but I have some percentages here in front of me. This is older data, because we struggle with some data points and with data collection from governments sometimes. For Métis, it's 7.3%, but that is from 2010, and the most recent 2022 “Framework for Diabetes in Canada” report stated it has found an increase in the prevalence of diabetes across all indigenous populations since 2012. It didn't specifically outline the percentages.

We don't have data for non-status people; they get lumped in with non-indigenous people, because they're not recognized. I would probably refer to some of the organizations that do work on behalf of non-status people to answer that question. I can make some inquiries to see if we can get those answers.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Thériault.

Next we have Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair, and thank you to the witnesses for being here.

Ms. Walker, you're a pharmacist, and you're still working as a pharmacist. Is that true?

[Joelle Walker]

I'm actually not a practising pharmacist. I work for the Pharmacists Association and with those members to navigate some of the issues they encounter in their work.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Great. Thank you for that.

One thing that is not captured in Bill C-64 and that Canadians have relied on now for many years is the expanded scope of practice in the professional life of pharmacists. Is that something that you think should be captured in this bill?

[Joelle Walker]

Absolutely. I think there are many services that pharmacists are delivering now to Canadians across communities. In many rural and remote parts of the country, the pharmacy is the closest access point that they have to health care.

Pharmacare, as we mentioned, isn't just about the cost of the drug, but really the care that goes around it. It would be like dental care without dentists. We absolutely see that, and increasingly pharmacists are doing a lot more to serve their communities.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I was going to say something smart, but there is a dental care program without any dentists. Anyway, that's a whole other issue.

It's interesting, though, especially when we're talking about diabetes, because many pharmacists are diabetes educators, which helps diabetics better control their blood sugars. Often there is a cost now built into provincial plans and private plans to pay for that, but this bill in particular doesn't capture any of that cost.

Do you think, on behalf of your members, that it would be an important piece to have as part of this legislation?

[Joelle Walker]

There are a number of different services that are associated with drug management. Clearly there's the dispensing aspect, which makes sure that the person is getting counsel, that they're getting their drugs safely and effectively and that there are no drug interactions with other things. Then there are things like medication reviews for people who might be on multiple medications, and appropriate use is really important.

We know that many aging Canadians are taking medications to address a side effect of another medication, and that's an unfortunate way to live. Certainly for smoking cessation, diabetes management and care, and hypertension, there's been a lot of evidence showing that those services provided by pharmacists actually improve the quality of life of Canadians and the use of those medications.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

It's interesting, Ms. Walker, that you talked about looking at the plans and this concept of a universal single-payer program that's introduced here in this bill. In your experience, on behalf of your membership, would you suggest that it would mean that the federal government would be the first payer? Is that not true?

[Joelle Walker]

Some of the questions that we've so far heard, and that we've posed ourselves, question how that's interpreted in the legislation. I think what we're looking to see is a clearer definition of which payer would come in and whether a private payer will be maintained. I think a number of the provinces that have spoken publicly on this issue have also raised the fact that they would be looking to add to their current public plans while maintaining the private aspect that they have in their jurisdictions.

It really would come down to some of the negotiations that would take place. In the legislation, we would recommend that there be clear reference to a mix of public and private payers to make sure that this mix is maintained in looking forward beyond diabetes and other potential medications that might be under consideration.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

What I've heard you say is that this would be an incredibly important part of our rapid deliberations in our clause-by-cause consideration of this bill, which must happen by Monday.

[Joelle Walker]

Yes, I think we would support that, absolutely.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Great. Thank you.

One of the things that have been talked about in this last panel a bit and in previous panels is semaglutide or Ozempic, which is a drug used to treat diabetes. It's been an absolute blockbuster drug. Do you have any information for the committee with respect to the cost on a monthly basis of Ozempic or semaglutide?

[Joelle Walker]

I don't have that number handy, but I will share a couple of examples that might be helpful in your deliberations around Ozempic.

It's obviously not covered under the proposed list of medications. It's widely used. We've recently had a shortage of Ozempic across the country, and my association works very regularly to address shortages that are a growing problem in the country. When we talk about pharmacare, it's not just about the cost of drugs or the services that are being offered; if that medication is not available in the country, no amount of coverage is going to help that.

One thing that we've noted is that the number of available medications in each drug class can decrease significantly, depending on how many companies are in the market, and we are most vulnerable to drug shortages if only one or two manufacturers are producing a particular drug.

Let's say that there's a national disaster in one country that's producing some of the API, and the one company there can't produce that drug, and the other companies aren't able to readily increase their production. In cases like that, we've really suffered significantly with many drug shortages, so I think there's a really complicated ecosystem that this pharmacare approach needs to also recognize.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Walker and Dr. Ellis.

The last round of questions today will come from Ms. Sidhu for the next five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being with us. My first question is for you, Ms. Thériault.

With the dental program, we know that within three weeks 100,000 Canadians got benefits and one million have already registered. With this legislation, could you elaborate on what the biggest barriers are for indigenous people seeking care for diabetes prevention? With this legislation, what do you think about contraceptive care? Do you think it will be of benefit to indigenous people?

[Celeste Theriault]

Yes. Certainly there will be a benefit to indigenous people. That's without a doubt.

To comment on your first question, we need to also ensure that we are making wholistic—with a “w”, for the note-takers—decisions around public policy that affects our health and doesn't look at just the pharmaceuticals and all those things. I know that we're here specifically for the pharmaceuticals, but there are so many other things that impact health, such as socio-economics and social determinants of health. I think this is the first step in the right direction for opening up the conversation and the dialogue to all those other sectors that this bill obviously does not cover.

Of course, indigenous people, if unfortunately their medication cannot be covered—and most likely they cannot afford to even take the medication—may not even get the prescription filled, as we know. I think that would be interesting data to look at. They will also make sure they feed their family first, or do whatever they might need to do first, before taking care of their own health. Often we're faced with that decision every day, that hard decision.

My chair often speaks very openly about the ideal type of diabetes treatment for her as a person living with type 2 diabetes in Alberta. It is currently not available to her because of the lack of coverage, and it simply would be way too expensive for her and her family of six children to afford. Therefore, it is just not an option. She has to look at other alternatives.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Dr. Francoeur, you talked about teen pregnancy and sexual and reproductive health. Could you outline what the biggest barriers are for Canadians seeking contraception? What would you recommend to combat this?