Health Committee on May 23rd, 2024

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

How long is that? Is it a few weeks?

[Mike Bleskie]

If I had to stop taking insulin, I would probably be in the hospital within a day or less. It can be that fast.

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

Thank you.

I can't understand why anyone would oppose this legislation.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Julian.

Ms. Goodridge, please go ahead for five minutes.

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

Thank you, Mr. Chair.

Thank you to all the witnesses.

I have a series of questions, but I'm going to start out with you, Mr. Frank, on workplace benefit plans.

If a workplace decides that they want to add a particular drug or service, is there a possibility to add just one service?

[Stephen Frank]

Well, yes, certainly, if you mean by “service”.... A typical plan will cover prescription drugs, will have dental and vision coverage, and will have all the paramedical services and travel coverage, so there are a suite of solutions that can be provided there, and employers can have some flexibility in what they want to offer. At the end of the day, the package that they want to offer to their employees is their choice.

With respect to the drug class, yes, we absolutely do see employers covering certain classes of drugs and not others. You tend to see that in the higher-cost areas—in some of the rare disease spaces, as examples. Certain medications are considered on and off, and different employers will have a different tolerance for how much risk and cost they're prepared to sustain.

We do have a variability in what's offered to Canadians and—

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

Based on that, if this bill were to go forward, would you be concerned that employers will come to you asking to have these two classes of drugs removed from their current plans, thereby driving up the cost to taxpayers?

[Stephen Frank]

That is a concern, and I think, again, if you read the legislation, it doesn't stop at those two drugs. I think that's one of the big things we need to keep reminding ourselves about. It contemplates, within a year, going well beyond that, and so if you get into a situation in which hundreds or thousands of medications are covered, then employers are absolutely going to start asking themselves, “Why should I be still in the game?”

We work really hard to educate them on the value of the programs that they're offering their employees. As I said, it tends to be more flexible and much broader than what they might get on a public plan, but that pressure and those questions will start if this bill, two years down the road, comes to fruition.

Again, that's not the vision that we heard from the minister today, so I think that disconnect is what's giving us pause.

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

I appreciate that.

I really do appreciate, Mr. Bleskie, your sharing your lived experience when it comes to the OHIP plan or OHIP+. As someone from Alberta, I'm not terribly familiar with Ontario's plan, so I did find that to be quite insightful.

I'm frustrated, in large part, that as we're studying this bill, we don't have the opportunity to hear from all the different provincial plans and to hear where those gaps are in particular, because I don't necessarily know whether those gaps are the same in every province.

By going down this path, are we potentially solving a problem that might not exist equally across the provinces and creating a situation in which we are going to reward provinces that have done very little and perhaps don't provide that? That would therefore raise the question of whether provinces would continue to offer these kinds of plans if they were to not do this. It becomes this very circular question of creation and complications.

Mr. Giroux, when you put forward your prescription costings in your most recent budget, did you factor in the record-breaking inflation we're facing in the future costings?

[Yves Giroux]

Yes, we took into account inflation, past inflation as well as our projections for future inflation.

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

Did you also factor in the effect if provinces were to drop some of these drugs from their existing plans?

[Yves Giroux]

No, we did not include any provinces potentially reducing coverage for diabetes and contraceptives.

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

Could this potentially cost substantially more if provinces and territorial plans decided to remove these drugs as a result of this legislation?

[Yves Giroux]

It is indeed a risk, as is the case if some employers decide to reduce their coverage, knowing that there is a public plan that would cover their employees.

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

Effectively, we have very little idea how much just these two drug categories will cost the federal government, so we're being asked to vote on something whose cost we have no clue about.

[Yves Giroux]

Well, I wouldn't say we have no clue, but there's quite a bit of uncertainty regarding the costing of such a plan, given the potential for public plans and private plans to off-load some of their responsibilities onto the public plan.

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

I find that very concerning.

I want to thank all of you guys for being here today.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Goodridge.

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

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much to all of you for being here and for the interesting testimony.

Just briefly, Mr. Giroux, to follow up on some of your answers, I note that there's no territorial analysis. Is there a reason? Is it a difficulty in obtaining data? Is it about small numbers, or...? Can you just clarify why territories are not included in the analysis?

[Lisa Barkova]

It just simply comes down to the fact that the data we used for this analysis contains only provincial data. Had we had territorial data, of course we would have liked to include that in our analysis.

[Brendan Hanley, Liberal, Yukon, YT]

Yes. We'd love to see that included in a future analysis. Thank you.

Forgive me for perhaps not understanding the part about economy-wide savings as well as I should, but maybe I'm representing Canadians to some extent as well.

You say that drug expenditures in Canada would be reduced by having a single payer due to a few factors, including increasing negotiating power. Could you just comment on or give me a bit more explanation on what you mean by “economy-wide savings”?

[Yves Giroux]

Sure. You're probably referring to our October 2023 report, where we costed a Canada-wide single-payer universal plan that would cover most drugs. In that case, we assumed that the bargaining power of the federal government would allow the single payer—well, I say “the federal government”, but it could be individual provinces. Let's not get lost in these details.

A single payer would have a negotiating power and could presumably also be able to negotiate additional rebates. That's where the economies would come from. They would probably more than offset the coverage of those who don't have any coverage right now. That's why we say that there would be overall economies if you look at the cost of drugs as a whole, as a big bubble.

[Brendan Hanley, Liberal, Yukon, YT]

Okay. Thank you. That's very helpful.

Mr. Staples, perhaps I can turn to you for a comment. You've been very helpful in your passionate testimony, whether you've talking about system-wide concerns or the individuals you've been hearing from. On what Mr. Frank talked about—putting the money into just targeting where the need is and leaving the rest alone—what are your thoughts?

[Steven Staples]

I mean, I hear you. We want to make effective use of public dollars and we want the money to get to places where it is needed most, but the aim of the program, of the legislation, is not just to provide medication to Canadians; it's also to get the price of drugs lower. We have to get the price down.

Again, it's no surprise to hear criticism of bulk purchasing in the discussion today from certain quarters that don't want that, but I think Canadians do. Our health care system does. Right now we spend as much on drugs in our health care system as we do on doctors. In fact, only hospitals are the next higher up. We have to get the overall price of drugs down to a lower level. That will require a coordinated bulk buying strategy.

You know, not all provinces pay the same amount for pharmaceuticals. There are different arrangements that are made. As Mr. Giroux mentioned in his very interesting October 2023 report, increased transparency from a bulk buying strategy will help lower the costs to everybody, because all provinces will get the same price, as opposed to one—

[Brendan Hanley, Liberal, Yukon, YT]

I'll cut in here, because I want to hear from Mr. Bleskie before my time is up.

Mr. Bleskie, you may have noted that Yukon Territory was the first jurisdiction in 2020 to cover CGM. Other provinces have now come on board with that. When you look at the piecemeal approach versus a coordinated national approach, how do you feel about doing better with a coordinated national approach, incorporating Bill C-47 into this?