Health Committee on May 23rd, 2024

[Michelle Boudreau]

No, I think what I would say is.... I would refer back to my earlier comments that we do have different pathways for Health Canada to approve the product.

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

Thanks, Madame Boudreau. I heard that part.

Do we or do we not have a problem with the length of time it takes for getting a new drug approved in this country?

[Michelle Boudreau]

I referred earlier to the 300 days, and that in fact is fairly close to what happens in the U.S. and quite close to what happens in the EU.

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

Yes. I don't think that's what I asked, though. Do we have a problem, or do we not?

[Michelle Boudreau]

I'm sorry, Mr. Chair. I don't know that I can add anything further to my previous answers.

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

Okay, fair enough.

I'll say, on behalf of Canadians, that there was an opportunity here to change the Canadian drug agency and to have oversight, but the officials and the Minister of Health, in spite of the fact that all Canadians know it takes an excessively long time, as referenced by the data in the study, don't think that's a problem. Perhaps that's why we have a problem.

The other part that I'll return to is new drug launches in Canada.

It appears from the evidence here in front of me that new drugs are not being launched in Canada as frequently as in other countries. Do you think that's true?

[Michelle Boudreau]

You are, I guess, looking at some data that I don't have in front of me, so I can't comment on that, but I would like to come back for a moment and speak about the Canadian drug agency and clarify for the committee that the legislation does not set out the CDA and does not propose a particular mandate or establish the CDA. It speaks to the types of functions that the CDA will do, and it also speaks to a couple of specific functions.

If you'll permit me to conclude, the CDA is not being contemplated to be an agency that would review drugs—

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

Absolutely. I totally agree with that. The difficulty is that the Canadian drug agency could have been mandated to have better numbers, and you've chosen not to allow that to happen, or at least the minister has.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

We'll go to Dr. Powlowski, please, for five minutes.

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

Our committee is tasked with reviewing this legislation. We're going to go through it line by line. With that in mind, I read the legislation, and I have what may seem like some mundane questions.

There's one provision here, and I don't understand what you mean by it. Perhaps you can explain it to me.

Let me start off by saying that I've been a long-time doctor. I also have a few law degrees, including one in health law. I worked for WHO, writing health law, and I was part of drafting some pharmaceutical legislation. I've now been in Parliament for five years. If there's anyone who should be able to read things and understand them, I would have thought I'd be one, but I don't understand this bit on principles.

The minister is to consider a bunch of principles when they're consulting with the provinces and territories on implementing national universal pharmacare. It says that one of those principles is to “provide universal coverage of pharmaceutical products across Canada.”

I don't see, within that wording, a clear indication of what that means. Universal coverage means that every person will receive pharmacare and pharmaceutical products from the government. Which pharmaceutical products are included? Is it all pharmaceutical products?

It seems very vague to me, almost to the extent that it nullifies any meaning at all. What do you mean by that statement?

It says—and it's rather weird wording—“The Minister is to consider”. Usually it's “shall” or “will” consider, but here it's “is to consider”. What are they supposed to be considering here? What is the goal of that?

[Michelle Boudreau]

The section sets out principles, as you've set out. Very much as is stated there, in moving towards the implementation of national universal pharmacare, you've heard the minister refer to this as a first phase. You've heard the minister also refer to the other section of the bill that speaks to contraceptives and diabetes as part of that first phase.

This sets up the framework generally for the broader discussions that will take place in a step-by-step manner to create the national universal pharmacare program.

“Universal” has the meaning that I think most people would consider it has, which is that everyone—every resident of Canada, everyone who's living here—would have access to a pharmacare program.

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

The term “pharmaceutical products” isn't defined, so which pharmaceutical products does it refer to? Is it all pharmaceutical products? Is it products on an essential drug list?

What does “universal coverage” mean? We've already talked about how this isn't meant to replace pharmaceutical coverage in a pharmaceutical plan provided by an employer. This isn't intended to replace that, but if you say, “provide universal coverage”, it would seem to me to imply that all of us are going to be provided with a pharmacare program, but that doesn't seem to be the intent.

Why put this in? Again, I'm a little mystified by the intent of this section.

[Michelle Boudreau]

If it's helpful, I would refer you to the definition of a pharmaceutical product, which is set out in clause 2 of the legislation, and reads as:

...means a prescription drug or related product that is funded, in whole or in part, through a pharmacare agreement to which the Government of Canada is a party.‍

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

I'm not sure if that helps me a lot, but let me go on to clause 6, which talks about first-dollar coverage.

I understand that perhaps in the industry there's a recognized definition of first-dollar coverage. Again, you would think I'd be someone familiar with such a term, but I don't know what it is. What is first-dollar coverage?

[Michelle Boudreau]

You're correct that there is, if I can use the phrase, a bit of a term of art within the insurance policy business. “First dollar” means that as soon as an insurable event occurs—in this case, having a prescription filled—the insurance would apply: That is, the coverage would apply before any other payments.

In other words, the person coming to the pharmacy is not paying a copay or something first. It's the insurance coverage that would pay that full charge.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Boudreau.

Thank you, Dr. Powlowski.

Mr. Blanchette‑Joncas, you have the floor for two and a half minutes.

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

Thank you, Mr. Chair.

My questions are for Ms. Boudreau.

Ms. Boudreau, you're an associate assistant deputy minister at the strategic policy branch of the Department of Health. When it comes to strategy, we typically know what people want and what people have.

I'd like to confirm that your department received the motion unanimously passed by the National Assembly on June 14, 2019. In other words, it was supported by all parties representing the people of Quebec. In that motion, the National Assembly of Quebec wanted to “reaffirm that Quebec has had its own general prescription insurance plan”, “indicate to the federal government that Quebec refuses to adhere to a pan‑Canadian pharmacare plan” and “ask the Government of Quebec to maintain its prescription drug insurance plan and that it demand full and unconditional financial compensation from the federal government if a proposal for a pan‑Canadian pharmacare plan is officially tabled.”

Ms. Boudreau, did officials at your department provide you with this motion?

[Michelle Boudreau]

Yes. I'm aware of that letter or motion.

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

All right.

For you, strategically speaking, does a unanimous decision by a parliament have democratic value?

[Michelle Boudreau]

Sorry, but I'm not sure I understand your question.

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

I'll repeat it. Does a motion unanimously passed by a parliament have democratic value?

[Michelle Boudreau]

I lack the necessary expertise to answer that question. You're in a better position to answer it than I am.

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

Let me put this in context, Ms. Boudreau.

If the Canadian Parliament were to unanimously pass a motion, your department would take it into account. True or false?

[Michelle Boudreau]

True, but if I may, I would like to repeat what the minister said. In a context—

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

That's all right. That answers my question, Ms. Boudreau. Thank you. You understand the democratic importance of a unanimously adopted motion. I hope that the people representing a political party with the word “democratic” in its name are also taking note.

Ms. Boudreau, I'll continue with my questions for you.

Are you familiar with the pan‑Canadian Pharmaceutical Alliance?