Health Committee on May 24th, 2024

[Carolyne Eagan]

Thank you for the question.

I would say that indeed this is time well spent. We look at what a great risk it would be to make decisions around people's health care and people's drug coverage. That impacts the lives and the productivity of our workforce, our seniors and those who are underserved. It's important to do this right.

That said, this is why the Smart Health Benefits Coalition has advisers who work in offices, in machine shops, in union shops and in every aspect of every business in Canada to help them design their benefits packages. Every day, we see the pain points and what works well as Canadians navigate between the public and employer systems.

We have great insights that we would love to spend time on to help us take the right path. We all agree on the destination, but the path of getting there is so important. To have communication and clarity around this is essential.

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

Thank you very much, Ms. Eagan.

Through you, Chair, for Ms. Eagan, do you believe that there are people out there who are afraid they will lose their private coverage should this national universal single-payer system come into existence?

[Carolyne Eagan]

Absolutely. I think we can point even to recent examples with our national dental plan. There are some great things in place there where people had no coverage, so we did fill those gaps. However, thousands of our advisers have received thousands of phone calls and engaged in discussions with regard to the misperception that people can go ahead and cancel their plan and essentially replace it with the free plan, not knowing what is on that list of coverage and who it's intended for.

My own mother, who is turning 80 this year, got her letter. She was completely confused and figured that she would cancel her plan and have free coverage with everything included. Luckily, I'm in the business and could explain it to her.

It is a risk. There's a great risk to employers and Canadians. Thinking they would lose access to a longer list of medications when their health is stable on the treatment plan they have been prescribed.... Losing that access puts everything at risk. It puts the sustainability and health of Canadians and families and our workforce and productivity at great risk.

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

Thank you very much.

Mr. Morin, thank you very much for your testimony.

Do people fear that rural pharmacies in Quebec may shut down?

[Benoit Morin]

Yes, there's a concern. Some 371 pharmacies shut down when a universal plan was introduced in New Zealand.

We're afraid that, if there's no mixed system in Quebec, pharmacies will find it hard to be profitable, which will result in closures and force them to set up in major centres rather than rural areas.

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

Thank you very much.

Since my question involves some technical terms, I'm going to ask it in English. I apologize for that.

The issue is around expanded scope of practice for pharmacists. Obviously, as you mentioned in your opening remarks, that now has become an incredibly important part, sadly, of delivering primary care in Canada because of the crumbling health care system, which is on the brink of collapse. I don't think that's too much to say.

Obviously, in this bill there's no mention of funding for the expanded scope of practice, but maybe, on behalf of your members, you could explain to Canadians how important it is now to the delivery of care in Canada.

[Benoit Morin]

Thank you for your question.

On at least two occasions, Quebec has enacted various statutes that have expanded pharmacists' scope of practice. Last year, more than 7 million clinical acts were performed at pharmacies, including vaccinations and acts for the management of chronic illnesses. Pharmacists enjoy considerable independence and may prescribe many drugs for common minor ailments such as urinary tract infections in women, for example. We hope our scope of practice is expanded so we can do more.

However, these activities need to be funded. They're currently funded by prescription dispensing fees. This is what enables community pharmacies to be relevant and to have an available area where they can conduct those activities. It's essential for us that pharmacies maintain their financial health so they can continue playing that role.

I'd say that, for a few years now, we've had to do more and more with less and less in the way of resources. Needs are increasing and labour is scarce. Consequently, it's important that we maintain this stability so pharmacies can continue to play their role and meet the expectations of Quebec patients.

[The Chair, Liberal, Sean Casey]

Thank you both.

Ms. Sidhu, please go ahead for six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being with us. I really want to say thank you to everyone who's working on the ground, especially Diabetes Canada and JDRF. However, my first question is for Mr. Williams.

Mr. Williams, as we worked together for many years, especially on the framework for diabetes, thank you for the work you are doing on the ground for people living with diabetes, especially in Brampton. Even though I just wanted to acknowledge that, you're also sending reps from Diabetes Canada to educate people. Thank you so much from the bottom of my heart.

My first question is on the implementation of the national framework for diabetes. We know that coverage of diabetes medications and devices is an essential component of the framework. Can you give a brief update to this committee on the implementation of the framework? Also, what recommendations can you give to this committee about the best way the diabetic devices access fund can serve patients with diabetes?

[Russell Williams]

Thank you very much for the question.

The framework that I referred to actually has improved access for medications and devices as one of the six main components. Across the country the provinces are working, to their own levels, on implementation of the framework. I don't have time today to go into it, but I can certainly give details to the committee later on. There's a real engagement of provincial health bodies to take the six pillars of the framework and implement them, so I see this as part of the next step.

As to how we do it, still there are a lot of questions, and I think you talked about this in terms of education. A lot of people in this country don't know how the health care system works or how pharmaceuticals are delivered, and I think there probably is a need for greater clarity. I also very much encourage that, in the next phase of this law, we take the discussions of the framework that we're doing and add concrete discussions with the provinces on how pharmacare will work within that context.

[Sonia Sidhu, Liberal, Brampton South, ON]

However, as the minister said yesterday, the bill will not impact access to private insurance, and people with diabetes will continue to have access to the full range of medications that are provided through their current insurance plans. This will add to the existing plans and does not take away anything. What do you think about those comments from the minister?

[Russell Williams]

At our meeting with the minister, those words were very reassuring because, when you take a look at the bill, there are a number of interpretations, which we heard about today, that cause a great deal of concern—excitement in some areas and concern in other areas—so the clarity from the minister is important. We did also talk about how the list that the government tabled is certainly not all-inclusive and doesn't reflect the clinical practice guidelines that Diabetes Canada creates with experts, and he assured us that this is a minimum list and one they'll start to work on. We supplied the committee members with a comparison between the clinical practice guidelines and the Bill C-64 list, as well as the NIHB list, which is a list of the government.

Ultimately, the care and management of diabetes is not one-size-fits-all. It's very individually focused, as you know. We have to make sure we build a program that will, on one hand, not just seem that there's a certain level of coverage but will actually be effective coverage for people with diabetes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

It is important to acknowledge the need for education, but it's also important to acknowledge the leadership of some provinces in their work implementing the national framework for diabetes. Also, some provinces, like Quebec, which you already talked about in your testimony, have a good hybrid model for pharmacare.

Let's talk about the human cost for patients. It's clear that patients just want a system that works for them. However, from the meeting, we understand that we need to work with patients during the rollout. How would you like the Government of Canada to approach the outreach component to educate patients with diabetes on the rollout of the pharmacare program?

[Russell Williams]

This is fundamental. We have to have patients at the table and fully involved in the discussions. That hasn't happened too much up to this point. With the limited debate, as a former politician, I'm concerned about limited debates, but that's the decision that was made.

We have to get out in the community and we have to get concrete. We need to talk to patients, and I would say we should set up a large education program. We should start a full engagement discussion, and Diabetes Canada would be pleased to help. However, we should also sit down and—again, speaking as former provincial politician—talk to the provinces and say, here's the direction we want to go in. We want to try to fix this for vulnerable Canadians. How would you do it in your province?

I mentioned one in terms of Quebec, the province I come from, but we work with each and every province. That's why I mentioned, in my remarks, that we should build on the creativity and diversity of our health care systems across the country in both the provinces and the territories.

[Sonia Sidhu, Liberal, Brampton South, ON]

My next question is for JDRF.

Ms. Diniz, not so long ago you joined me in Brampton, where one in five Canadians live with diabetes, for the third annual World Diabetes Day flag-raising. It is great to see you again virtually.

This is my question for you. Investment into research allows innovative companies to provide new solutions and devices, such as pumps, continuous glucose monitors and other devices. The diabetic devices access fund is the key to unlocking access to the newest technologies for patients who have diabetes. How can this fund best serve Canadians?

[Jessica Diniz]

First, it's very nice to see you again, and thank you—

[The Chair, Liberal, Sean Casey]

Please give a brief response, if you could, please.

[Jessica Diniz]

I'm sorry. First, thank you for the question.

I agree about the special devices fund. It is critical that we get this right. Access to continuous glucose monitors for people with diabetes is so critical. It improves health outcomes, and it actually reduces complications. It will reduce our long-term health care costs if we can get better access to continuous glucose monitors for Canadians.

Therefore, we would propose an open engagement with the minister's office, as well as with the provinces, to see how we can get more Canadians having access to CGMs. It is critical, and we will have better long-term health outcomes.

Thank you.

[The Chair, Liberal, Sean Casey]

Mr. Blanchette‑Joncas, you now have the floor for six minutes.

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

Thank you, Mr. Chair.

Greetings to the witnesses and thank you for being here.

My first question is for Mr. Morin, from the Association québécoise des pharmaciens propriétaires.

Mr. Morin, as you are on the front lines, you necessarily understand the observation that was made regarding the cost of certain medications. Like many others, I wonder whether people currently covered by a drug insurance plan will be able to continue using it. Yesterday the minister seemed to say yes. According to one credible witness, Stephen Frank, president and CEO of the Canadian Life and Health Insurance Association, there are some ambiguities and the bill doesn't necessarily afford any confirmation in that regard. You also say in your brief that imposing the program on Quebec would really jeopardize the viability of private insurance plans.

I'd like you to tell us a little more about that.

[Benoit Morin]

Thank you for your question, Mr. Blanchette‑Joncas.

It's obviously nonsensical to think that private insurance plans could act as supplementary insurers. There's no viability there. I'm not an insurance expert, but based on what's done in Quebec, it wouldn't work. These are comprehensive plans that provide comprehensive drug coverage in most cases. This also gives SMEs access to private insurance plans, to group plans. SMEs aren't required to join those plans; they could decide not to join one and then get public insurance. However, for marketing reasons or reasons of their own, they can opt for a group plan. I think that's a good thing; it's a good arrangement to offer their employees. I think that should continue as is.

In addition, these plans frequently offer broader coverage than the public plan. The public plan in Quebec already offers broad coverage. If you compare Quebec's scope to what's offered in the national plan for diabetes, you can also see a major difference in molecule access.

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

Thank you.

Realistically, if we lost the private plans, and even if we kept them, do you think it would be financially realistic for the government to operate with no deductible and to maintain the same drug formulary?

[Benoit Morin]

I don't think that's realistic.

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

Why? I'd like to hear what you have to say about that.

[Benoit Morin]

It's because of the increase in drug costs. Choices will have to be made. If coverage is comprehensive, if it is 100% covered by the public plan, tough choices will have to be made regarding the technology, which is advancing quickly.

The new drugs are extremely costly. It's possible to treat rare diseases, and chronic diseases as well, with biological drugs, for example, which work miracles but are extremely expensive. I think it's problematic to consider a completely universal plan.