Health Committee on May 24th, 2024

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

Thank you, Dr. Wong-Rieger.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Wong-Rieger.

Thank you, Dr. Kitchen.

Next is Dr. Powlowski for five minutes.

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

We've heard from the Canadian Association for Pharmacy Distribution Management and the Canadian Organization for Rare Disorders. I think both of them sounded a note of caution about Bill C-64 being potentially a threat to access to drugs for rare diseases. Perhaps I'm not so surprised about that coming from Ms. Berg, but I am a little from Dr. Wong-Rieger.

Certainly, this bill does not create a single-payer system. We don't know as yet what national pharmacare would look like. Potentially, though, it would be a single-payer system.

I would have thought, particularly for Dr. Wong-Rieger, that there would be benefits with a single-payer system. I would have thought it would be more efficient. There are certainly cost savings to be had. There are certainly economies of scale in having one system. Right now, we have all these different providers. Each of these providers has its own management, and each of these managers and CEOs takes a bit of that money. This is money, in an employer-employee drug plan, that would probably otherwise be going to the employee. Instead it goes to the profits of the company providing the plans.

If you were to have one big plan administered by the government, you get economies of scale. There would be no money being siphoned off for profits, and there wouldn't be these many bureaucracies dealing with these different plans. There would be savings. In addition, if you buy 10 million pills at one time, you're going to get a better deal from a manufacturer than if you buy 100,000. If there was more money overall in Canada to buy drugs for everyone, wouldn't we then be able to afford drugs for rare diseases, which are often expensive?

Also, Ms. Berg, you were talking about shortages. Wouldn't we have money to provide for an emergency stockpile of medications, so we wouldn't have those shortages?

Perhaps I'll start with you, Dr. Wong-Rieger.

[Dr. Durhane Wong-Rieger]

Thank you very much.

I love your ideal approach here. This is absolutely what we would love to see—the ability to move these drugs through in a timely fashion, make them available to everybody at the same time and certainly, as you say, have equitable access right across the provinces.

What we know—this is where the details come in—is that, with the way the system works now in the public plan, they get bogged down. They get bogged down in many steps of bureaucracy. Quite frankly, we know the drug plans themselves do not allocate enough money. In many countries—let me get outside of the U.S.—there is a sense that the best drugs are an investment. I heard what Ms. Silas was saying. The trouble is that, if you're not providing people with their optimal therapy or not making sure they get the medication that's actually going to keep them alive or out of hospital, if you're providing everybody with the same therapy, which is sometimes what happens or you won't invest in the best therapies, then, in fact, it doesn't work.

That's our concern. In many cases, it comes down to the lowest-common-denominator drug.

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

You're concerned that any government-provided plan would get the basic medication. If you needed something a little better than the basic medication or a variation on it, you wouldn't be able to get it in the public plan. This wouldn't necessarily be the case, though.

Is that your concern?

[Dr. Durhane Wong-Rieger]

It is the case right now, and that's the problem. The public plans balk. They put in very high restrictions in terms of access, so this is the problem. Look at the recommendations coming out. The recommended price they'd be willing to pay is so low. You're asking a company to take a 90% reduction off the proposed price. Companies are not going to do that. In many cases, they won't even come to Canada.

I'm not saying this cannot be done. I'm just saying that, when you have a bulk plan that says, “Fine, we will negotiate, but we expect you to give us a 90% reduction”.... If you read the recommendations coming in and see what's going into the pan-Canadian drug alliance, that is exactly what's happening.

In reality, this is the problem. Ideally, I would love your plan.

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

Can I suggest, then, that maybe your argument isn't so much with the public provider, but rather with the fact that the providers are limited in their willingness to go outside the box and want to stick to a formula? In that case, perhaps you don't have any problem with public systems per se, just the way they are administrated.

[The Chair, Liberal, Sean Casey]

Answer briefly, please.

[Dr. Durhane Wong-Rieger]

As a patient, I don't care who's paying for it. We need to make sure it's paid for and affordable to the patients, quite frankly. Yes, we very much agree with the idea of having that single price available, but it needs to be done in a way that's realistic.

The problem we have is that, if we roll out the public plans we have now, and if we make that the only plan, it means people are going to be waiting two or six years to get access to the best medicines.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Wong-Rieger.

Mr. Blanchette‑Joncas, go ahead for two and a half minutes.

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

Thank you, Mr. Chair.

I'll continue putting my questions to Ms. Silas.

Ms. Silas, I entirely agree with what you said earlier, that it isn't for politicians to decide what's on the formulary of drugs available under pharmacare. I repeat: some 8,000 drugs are covered by the plan and are on the present drug formulary in Quebec.

However, I do wonder who will decide what's on that formulary. Is it the Canadian Drug Agency? Is it the Institut national d'excellence en santé et en services sociaux, or INESSS, which already manages a formulary of 8,000 drugs? Who would be the best people for that job? Someone with 30 years of experience in drug insurance or someone else who knows the field and could somehow improve Quebec's present drug formulary by adding to it?

[Linda Silas]

I think you just answered your own question.

As MP Robert Kitchen said, the bill states that it's really up to the federal minister to conduct consultations with the provinces, territories and experts in order to determine what will be on the formulary.

We obviously have to work with Quebec and its experts, but we also have to look at what's going on beyond our borders. Canada is a small country with a population of 38 million or 39 million inhabitants. Experts around the world are far more advanced than Canada. Some countries have a public drug insurance plan and formularies of essential drugs that work very well.

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

Thank you very much, Ms. Silas.

We're already at 40 million inhabitants. That's world-leading demographic growth.

[Linda Silas]

They must all be New Brunswickers.

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

You'd have to check New Brunswick's demographic growth. However, I can confirm that Canada has the greatest demographic growth of all countries in the world.

When I asked you my questions, I wanted to know what more the federal government and the Canadian Drug Agency could do than what INESSS, the Institut national d'excellence en santé et en services sociaux, is already doing.

[Linda Silas]

That's beyond my expertise. However, when I listen to the comments from Ms. Wong‑Rieger, with whom I have appeared many times, I realize there's a red tape problem in the way drugs are approved and distributed. It's a major problem, and we have to look into it. I don't think it will alter the bill under study here in committee, but the government definitely has to look into this red tape issue.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Blanchette‑Joncas.

Next up is Ms. Zarrillo for two and a half minutes.

Welcome to the committee. You have the floor.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Thank you so much. It's a pleasure to be here.

My questions are for Ms. Silas. It's nice to see you today.

I want to talk about two things. One is gender equity, which you brought up earlier, and the other is poverty. As the critic for disability inclusion, I know that the Canada disability benefit is not going to fill that gap to help lift people at least to the poverty line.

First, I want to understand, based on your experience and that of your members, how poverty affects health and how this pharmacare bill could help alleviate some of those outcomes that are tied to poverty.

Second, could you follow up on the gender equality note that you introduced? For instance, how is the access to free contraceptives going to generate equality in our society?

[Linda Silas]

Poverty has a long list of issues to be dealt with, and I don't think anybody is suggesting one solution. This proposed act is not one solution to eliminate poverty, but it's one solution to give equal access to the necessary prescription drugs, regardless of whether you have a high or low income or you are living in poverty. That's where nurses come in. Getting your prescription drugs should not depend on your level of income or whether you're insured. That has been the case for as long as we've been supporting a national pharmacare program.

In regard to gender, if I look at our nurse practitioners and our regular registered nurses, the whole contraceptive movement is changing day to day. It is not the same way it was when I was in my mid-twenties, when it was just one pill. Today, it's a concept where the health domain has expanded and is helping women of all ages. This is one way to help more than 50% of the population, and it's important to go forward with the bill to make sure we do that.

Again, it's one piece of the puzzle to help gender equality, and it's one piece of the puzzle to help our poverty situation.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Silas.

Next is Dr. Ellis, please, for five minutes.

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

Thank you very much, Chair.

It was interesting, when our colleague from the NDP, Mr. Julian, was here previously he was perhaps making some disparaging comments about lobbyists who were here yesterday. Ms. Silas, you too are a registered lobbyist. Is that not true?

[Linda Silas]

Proudly. Do you want to a pair of socks?

[Voices]

Oh, oh!

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

No, but thanks. I am afraid that might be a conflict of interest, lobbyists giving gifts to parliamentarians—

[Linda Silas]

They're below $50. You're safe.