Health Committee on May 23rd, 2024

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Okay. Then is “indigenous peoples” not a defined term?

[Michelle Boudreau]

Again, that's in order to ensure consistent drafting and to respect drafting conventions with other legislation. That's why that term is defined as it is. It's to be consistent with other legislation throughout the Department of Justice legislation that we have in Canada.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

It concerns me because it should be possible for a piece of legislation to be read as a stand-alone entity and be understood. While we have, effectively, a four-page pamphlet that is quite light, this is billed by the government as being quite substantive, although we have heard conversation that it's effectively a pilot. I'm not quite sure what we're actually dealing with here.

What's the rush? Was it just because of the timeline of the supply and confidence agreement? Is that why this legislation looks like it was basically pieced together?

[Michelle Boudreau]

No. I can tell you that we worked on the legislation for several months. In fact, it was probably almost a year. We also work with Department of Justice drafters, legal drafters and people who look at whether the French and the English are consistent. In fact, a great deal of time was spent on developing the legislation.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Was the timeline several months or a year? There's a difference between those two.

[Michelle Boudreau]

I'd have to go back and look, to be honest, because it has been a long path for us, but it's certainly been a number of months. Also, before leading to the legislation, you do all the policy work as well.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I appreciate all of that.

We have a guillotine motion, effectively, for a programming motion, so we have very limited time. Therefore, not understanding whether this was worked on for several months or a year is actually quite important when we're coming to making these decisions.

I would ask that you submit to the committee by tomorrow the exact time this started being worked on, so we can ensure that we have the adequate information as we're drafting amendments and considering the rest of this bill.

If it was a year, was that not enough time to adequately consult with provincial health ministers prior to bringing forward this legislation?

[Michelle Boudreau]

The legislation sets up a framework for that consultation. If you look at the preamble, you see that a couple of things are important. One is that it's very clear on the jurisdictional work and the role of the provinces and territories. That is set out very clearly in the preamble.

Also, throughout the legislation, in just about every substantive section, there's a clear statement that there will be consultation with the provinces and territories. This is, in essence, the beginning of those consultations.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Within a day of this legislation being put forward, we had Quebec and Alberta both coming out very firmly against it, saying they wanted to opt out of it. Is that not terribly concerning?

Saskatchewan also came along not very far thereafter, indicating their concerns with it. Is that not something that concerns you? The provinces and territories are responsible for the delivery of health care, by and large, in this country, and they are already opting out.

Also, many of these provinces—all of them, in fact—already have their own plans. There could have been work to try to expand their plans, but instead, we have a pamphlet of sorts that is a plan to create a plan to possibly create a piece.

The timelines of when this was worked on are extremely important.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge.

We're well past the time. If you have a brief response, go ahead.

[Michelle Boudreau]

I will simply point out that in the legislation there is a clear commitment to consult with the provinces and territories, a recognition of their jurisdiction and a recognition of their role in drug coverage. This would build and expand on their coverage, as the minister mentioned; it would not replace it.

Finally, I'll just say there will be a lot of discussion in the context of bilateral agreements, which is also set out in the legislation.

[The Chair, Liberal, Sean Casey]

Thank you.

The last round of questions for this panel will come from Mr. Jowhari for five minutes, please.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to the officials for the hard work you've done on this and for coming here today.

Unfortunately, I'm going to follow on the same theme as my colleague Dr. Powlowski, who has led us down this path.

In clause 2 of Bill C-64, pharmacare is defined to mean “a program that provides coverage of prescription drugs and related products.‍” I understand “prescription drugs”. “Related products”, however, are not defined. I think that may leave a lot of room for interpretation.

What does “related products” mean in the context of Bill C-64?

[Michelle Boudreau]

“Related products” are also referred to in the pharmaceutical product definition. In terms of its intention, for example, if you look at the contraceptives, you will find that some of the products that are contraceptives are actually medical devices, like intrauterine devices. That's the idea with the term “related products”.

Similarly, there could be drug coverage for something like syringes, if that was chosen. Again, that's not a pharmaceutical product, so that's why that term is used.

[Majid Jowhari, Liberal, Richmond Hill, ON]

You talked about the contraceptives. Subclause 6(1) of the bill refers to “specific prescription drugs and related products intended for contraception or the treatment of diabetes.” I think the two examples that you gave—IUDs and the syringes—would be an example of a related product. Is there a list of prescription drugs and a list of related products that will be published later on?

[Michelle Boudreau]

The minister referred to the list in his remarks as well. There is a list that was put forward when the bill was first introduced on February 29, and as the minister noted, this is the starting point of those discussions with provinces and territories, so yes, there is a list available.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Okay. There is a list, and the list is available. Thank you.

I want to go back to clause 4 of the bill, which states that the minister must, when working with the pharmacare partners to implement national universal pharmacare, consider principles relating to the accessibility, affordability, appropriate use and universal coverage of pharmaceutical products across Canada. The minister must also consider the Canada Health Act.

Can you explain the similarity that exists between the principles outlined in clause 4 of Bill C-64 and the criteria set out in the Canada Health Act?

[Michelle Boudreau]

There is some similarity around, for example, accessibility and also universality. There are also some differences, though. For example, under the Canada Health Act, we speak of portability, which is not a type of term that you would use when you're speaking of drug coverage. The principles that are reflected here are more closely aligned with the principles that would be more appropriate in speaking of drug coverage.

[Majid Jowhari, Liberal, Richmond Hill, ON]

You talked about portability. Can you explain what that is? It's not included in pharmacare under Bill C-64.

[Michelle Boudreau]

Portability would relate to what many of us would experience if we needed to go to a hospital or see a doctor when we're perhaps visiting family in a different province. It's a bit different with a drug plan, because if you're covered under a drug plan, it tends to be the plan that is reimbursed by that province, so you wouldn't necessarily be able to receive the same coverage in another province. That's what the term ”portability” refers to.

[Majid Jowhari, Liberal, Richmond Hill, ON]

I have about 40 seconds, which I'll yield back to the chair. Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. Jowhari, and thank you to our officials for staying on. Thanks for all of the work that you've put into this piece of legislation to date, and for your service to Canadians.

We are going to suspend briefly to allow for this panel to take their leave and for the others to get set up, and for you to have coffee if you wish.

The meeting is suspended.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order.

Welcome to our second panel of witnesses. Thank you all for being here. I know the circumstances didn't allow you to have that much notice, but you're here and in person, and we greatly appreciate that.

We have with us for the next 90 minutes the Canadian Generic Pharmaceutical Association, which is being represented by Jim Keon, president, and Jody Cox, vice-president of federal and international affairs.

From the Canadian Health Coalition, we have Steven Staples, national director of policy and advocacy, and Mike Bleskie, advocate for type 1 diabetes.

From the Canadian Life and Health Insurance Association, we have Stephen Frank, president and CEO.

From the Office of the Parliamentary Budget Officer, we have Yves Giroux, Parliamentary Budget Officer, and Lisa Barkova, analyst.

Welcome to all of you. We're going to invite you to start with a five-minute opening statement in the order in which you appear on the notice of meeting, so we're going to start with the Canadian Generic Pharmaceutical Association for five minutes.

Welcome to the committee. You have the floor.

[Jim Keon, President, Canadian Generic Pharmaceutical Association]

Thank you, Mr. Chair.

The Canadian Generic Pharmaceutical Association and its Biosimilars Canada division would like to thank the committee members for this opportunity to contribute to the study of Bill C‑64, An Act respecting pharmacare.

Making medicines more affordable and accessible is the key value proposition of generic and biosimilar medicines, which today are used to fill more than three-quarters of all prescriptions in Canada. Expanding the use of generics and biosimilars helps drug plans to fund innovative treatments for patients and contributes to the overall sustainability of drug plans.

Not surprisingly, maximizing the use of these cost-efficient treatments to help fund pharmacare was a key recommendation of the pharmacare advisory council report in 2019.

We have provided a brief to members and will focus our remarks today on three main areas: the medications to be covered for patients under the proposed pharmacare regime, guiding principles for bilateral agreements, and bulk purchasing, which has not been defined.

On the list of drugs, expanding access to ensure all Canadians can benefit from the life-saving and life-altering medicines they need is an important objective. However, the list of diabetes and contraceptive medications in the February 29 pharmacare announcement is not comprehensive. There are important gaps that need to be addressed. We have highlighted these in our brief.

The current non-comprehensive approach also raises patient equity concerns, as it could lead to suboptimal prescribing of the medicines that are made available to the public for free and lead to suboptimal health outcomes for patients.

We are also concerned that the non-comprehensive approach may provide a disincentive for public drug plan formularies to continue their coverage of a broad range of prescription medicines and provide a disincentive to expand coverage to include new drugs in the future. These same concerns apply to drug plans provided by Canadian employers.

We recommend that all diabetes drugs and contraceptives that are currently reimbursed by public drug programs in Canada be covered if pharmacare is implemented. This principle should also apply to medicines added in the future.

On guiding principles, under Bill C-64 the federal government must negotiate and enter into bilateral agreements with individual provinces and territories. An important guiding principle for drug formulary management that is already employed by public drug programs in Canada is to reimburse for only the low-cost alternative product of a pharmaceutical active substance.

In order to help ensure the sustainability of the plan, Bill C-64 should be amended to clarify that only generic and biosimilar medicines will be reimbursed once they are authorized for sale by Health Canada and enter the Canadian market. This principle should be included in all bilateral pharmacare agreements.

On bulk purchasing, “bulk purchasing” is not defined in Bill C-64. It is not clear what this means. It is important to recognize that Canadian governments already combine their purchasing power to negotiate internationally competitive drug prices for Canadians. They do this through the pan-Canadian Pharmaceutical Alliance, or pCPA.

It is critical that the pharmacare regime respect the existing pharmaceutical pricing infrastructure to ensure stability of the Canadian drug supply. This will ensure that Canadians continue to benefit from access to both cost-saving generic and biosimilar medicines and the innovative new medicines Canadians need.

Prices for generic medicines are controlled through the pCPA tiered pricing framework. This provides a stable and predictable environment for generic manufacturers to continue to provide existing medicines for Canadians and make the investments to launch new cost-saving drugs.

According to pCPA, joint efforts between pCPA and CGPA have resulted in savings of more than $4 billion to participating drug plans over the past 10 years. These savings will continue to grow through a new three-year agreement between CGPA and pCPA that came into force on October 1 of last year.

The pCPA also negotiates prices for biosimilar medicines that are set to be significantly lower than the list price for the original biologic drugs. The expanded use of biosimilars has saved public drug plans hundreds of millions of dollars that have been reinvested into coverage for innovative new therapies and the overall sustainability of drug programs.

We recommend that governments continue to exercise their power to collectively negotiate drug prices in Canada through the pCPA.

In closing, thank you again for inviting the CGPA and its Biosimilars Canada division to appear as witnesses on Bill C-64. Jody and I would be pleased to answer any questions you may have.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. Keon.

Next, on behalf of the Canadian Health Coalition, is Steven Staples, national director, who I presume will start us off.

Mr. Staples, you have the floor. Welcome to the committee.