Health Committee on May 23rd, 2024

[Jim Keon]

Thank you.

We would remove the term. We don't like the term. I mentioned that we negotiate our prices with provincial governments. The three large federal plans are included in those negotiations. Our prices apply to all Canadians. Publicly and privately reimbursed prescriptions are all at the same price for generic medicines. It is a universal plan. It is a national plan that we have. It is negotiated with our industry and the experts who run the drug programs and know what the drugs do.

The most recent one just came into force in October. We would like to see that continued and respected. We think the term “bulk purchasing” is very unclear, and we're not sure what it means in the bill, so we would like to see it removed.

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

Thank you you for that. I appreciate it.

Mr. Giroux, it's good to have you here. I recall one of the first meetings we had when I was chair of the government operations committee, and the discussions we had about finances. In many ways, I felt you were apologizing for the fact that where we had been using the terminology of millions of dollars, we're now using the terminology of billions of dollars. I think Canadians need to understand that. They really don't understand that we've made.... As I said to you at the time, my wife and I used to talk about nickels and dimes. Now, instead of talking about millions of dollars, we're talking about billions of dollars with this government and the huge amounts and costs.

When we look at the costs, in particular, you talked about $1.9 billion. One of the things I'm wondering if you can clarify—I have your report here with me—is your mention of how the public drug plans will cost $14.8 billion in 2024 and increase to $17.3 billion in 2027-28.

People who hear these numbers being thrown about will question them. They ask, “What are we talking about here, when we hear $1.9 billion over five years, versus numbers like that?”

[The Chair, Liberal, Sean Casey]

Dr. Kitchen, you're over time. If you can get to your question, we'll ask for a brief response.

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

Could you just comment on that, please?

[Yves Giroux]

The costs that we referred to in our October 2013 report are the aggregate expenditures on public drug plans. They are expected to increase. That's the cost of the drugs that would be covered under a national pharmacare program.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Giroux and Dr. Kitchen.

Next up is Ms. Sidhu, please. You have five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

My first question is for the Canadian Health Coalition.

Mr. Julian touched on this a little bit. We know that one in 10 Canadians with chronic conditions have ended up in emergency rooms due to worsening health because they were unable to afford prescription medications. This is a serious burden on our nurses, doctors and health care teams in general.

Do you have any numbers to share with this committee on how this legislation would reduce the burden on the health care system?

[Steven Staples]

There's a term I've read, “cost-related non-adherence”. It refers to people cutting pills and skipping the medication their doctor or care provider has prescribed to them because they can't afford it. It's not even just a simple matter of having insurance, because many insurance programs have copays, and some of these copays can be very big.

I live in the community of Regent Park in Toronto. It's a very mixed community. I was in my drugstore just the other day, and there was a customer in front of me who went up to the counter and had to ask what the copay was. The pharmacist said it was $14 for whatever he was getting. He paused and mumbled to himself, “I think I can get that cheaper,” and turned and left. I don't know what happened. How long does that go on? Do they end up in a hospital somewhere?

We've seen this. I've had nurses tell me they've seen patients who have cut their medication and have ended up in very serious condition in the hospital. As I mentioned, I would refer to the study from St. Michael's that found $1,600 per year per patient could be saved by giving people free access to their medication. That's just a start.

I'm very excited to see what this program brings in for these two classes of medications. We'll have the expert panel. We'll get a report back. I think it's going to be very encouraging.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Mr. Bleskie.

You said insulin is a necessity, not a luxury. Before this, I worked on Bill C-237 to establish a national framework for diabetes. I know untreated diabetes has serious consequences.

Do you feel that this legislation would definitely impact quality of life for a person like you? Do you want to elaborate on what you think about that?

[Mike Bleskie]

Absolutely.

This is something I have been asking for and advocating since I was in grade 7. One of the very first things I did as a type 1 diabetic was attend an all-candidates debate in 2006 and ask how I could make my life more affordable.

I know that there are so many different diabetics out there who want to be able to say, “I have access to the life-sustaining therapy that I need.” As has been said before, rationing is a huge problem. It means that people are facing the complications of blindness, nerve damage and amputations. I believe that if every single person with type 1 diabetes had access to the medications they need in order to survive, the overall burden on the health care system would be measurably reduced.

Personally, I've had those scares when talking to an expert about what my eyesight will look like in 10 or 20 years. I can be more comfortable knowing that my eyesight is being protected and that I'm not going to have to face permanent disability. Those are the kinds of things I look forward to if this bill comes into play.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Mr. Giroux.

Your report mentioned the behavioural effects of this legislation.

Have you considered possible savings to our health care system through increased support for people with chronic conditions, thereby avoiding them going to the emergency room and reducing the health care burden and cost?

[Yves Giroux]

The short answer to your question is no.

The mandate of my office is to provide costing and cost estimates. We rarely do cost-benefit analysis for that very reason, unless we're specifically mandated to do that through a very focused request. Generally, we don't do that.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Sidhu.

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

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

Thank you, Mr. Chair.

I'll continue with questions for Mr. Giroux.

Mr. Giroux, I have here your analysis report on Bill C‑64. Under the heading “Sources of Uncertainty”, which is quite striking, it states the following: “The estimate has high uncertainty and is contingent on the number of drugs listed for coverage. Drug expenditures have several cost drivers and the projections are highly sensitive to the projected growth rate of those cost drivers….” You also mention “behavioural effects such as substitution from the drugs not listed on the formulary to the drugs [currently] on the formulary.”

I have a simple question for you. Could the number of drugs covered decrease after pharmacare is implemented?

[Yves Giroux]

Possibly. Based on our understanding of Bill C‑64 and the technical documents included with the first portion, there's a list of drugs that will be covered. There may be other types of contraceptives or diabetes drugs, but they wouldn't be covered. There may also be a behavioural effect such as substitution. In other words, people would be encouraged to use or obtain prescriptions for drugs that are covered, rather than drugs that aren't covered.

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

Okay.

Does your report contain any other essential elements that you would like to share with us, for the common good of the committee?

[Yves Giroux]

No.

I don't know if Ms. Barkova would like to add anything.

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

In that case, I'll ask Ms. Barkova a question.

I noticed that you did draw data from organizations such as the Canadian Institute for Health Information. Obviously, your findings and analyses of the data they provided to you only involve the Office of the Parliamentary Budget Officer. However, I'm trying to get a more accurate picture, because at the moment, it's very much hypothetical.

We have a picture of the government's directions, but what additional data would you need from the government to do a truly in‑depth analysis and a much more specific exercise?

[Lisa Barkova, Analyst, Office of the Parliamentary Budget Officer]

The first thing that comes to mind is having clear terms and requirements for the program, such as a specific list of drugs. We know now that it's still to be negotiated. Once we know for sure which drugs are included, it will help us have a better understanding of how to cost such a program and provide a better estimate.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Barkova and Mr. Blanchette-Joncas.

Next is Mr. Julian for two and a half minutes.

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

Thanks, Mr. Chair.

Mr. Bleskie, I want to come back to you.

My question to you in the last round was this: What would happen if you couldn't go into your line of credit? If you simply don't have contracts and are unable to take your medication, what does that mean in terms of your own personal health?

I think that's important to share with the committee, as all members need to understand what the impacts are in the current situation when people can't pay for their medication.

[Mike Bleskie]

If we're talking about the hypothetical of cutting down my insulin, either by rationing it or stopping it entirely, it means things like becoming blind due to diabetes-related macular problems, or diabetic retinopathy. It means neuropathy, which starts with a tingling and numbness in your legs that end up turning into excruciating pain. It also means there's low blood circulation in your limbs, so you're more susceptible to injuries and cuts. As you don't feel those injuries, they fester. Those complications end up leading to amputations.

Other effects are long-term kidney damage and long-term liver damage. All that sugar in your system has to be flushed out somehow, so your kidneys and liver end up working overtime to get that glucose out of your system.

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

Is that reversible?

[Mike Bleskie]

No, pretty much any change as a result of high blood sugar.... There are acute symptoms, and then there are long-term symptoms.

The long-term symptoms are completely irreversible, which eventually leads to fatalities, especially when it comes to ketoacidosis, which is the most acute form of high blood sugar. Oftentimes, that comes on very quickly as soon as a diabetic loses access to their insulin.