Health Committee on May 24th, 2024

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

Although you may get benefits as an employee, with those private plans, a certain amount of the money goes to the profit of the provider. Instead of that money going to the profit of the provider, perhaps that money could be used to provide better pharmacare for all Canadians, if there are efficiencies in having a government system.

Is that not the case?

[Carolyne Eagan]

I can tell you, from working in this business for 28 years and having done the analytics on renewals line by line, the profit margin would be surprisingly lower than what you're thinking. It's a lot lower.

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

The profit margin for...?

[Carolyne Eagan]

I mean the profit margins for running a benefits program. That money alone would not even be a drop in the bucket for what we need to achieve as a country. We need to work together in a multi-payer system to achieve.

If you could allow me a brief example here, I'm going to say there's a patient A with a $100 claim and no coverage. Let's get them that $100. Patient B has 80% coverage through their employer. The employer plan pays $80 and the patient pays $20. Now that patient is struggling. Let's figure out how to get them that $20. In the third example, if I may, there's an 80% coverage. The employer pays $80, the patient pays $20. For four out of five people, that's working great. Why disturb that?

The last one is a fourth scenario, where two spouses have 80% and they coordinate. They're zero out of pocket. It works great.

With scenario one, with a single-payer, the government pays $400. In scenario two, it's $140.

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

Can I interrupt, please?

I want to ask a question because pretty well everyone said a limitation of a single-payer system—and I would challenge this—is that those systems are all kind of limited in what they provide. What if you want a newer medication? How about if you want a brand product? That's not allowed in those kind of single-payer systems, but it could be. There's nothing to stop it.

There's nothing to prevent an employer, if there's a single-payer system, from offering additional benefits—kind of a top-up system. Just as now, if we go to the hospital, because we get Canada Life insurance, we can get a single room or a room with one other person or something. That's a benefit that you get from Canada Life that you would otherwise not get. That's what's offered.

Couldn't an employer offer a system that provides that kind of top-up coverage, so there would still be that choice if people wanted it? A number of people have said that this is the problem with the single-payer system.

[Carolyne Eagan]

Here's the challenge—

[The Chair, Liberal, Sean Casey]

Give a brief answer, please.

[Carolyne Eagan]

The challenge lies in confusion. Look at dental. How many people think that the coverage is the same? They go to cancel it, and then they're left with nothing.

This way, shifting that cost entirely to the public system, would be at great risk. We have a longer list of covered medications that get...faster under the employer system that we need to protect and have in place. We need that system to help people who can't afford both base medications and those high costs.

Let's keep innovation coming to Canada with those therapies for cancer and other conditions that are costing patients, who are struggling to afford them even a 10% copay, tens of thousands of dollars.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you.

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 stay with Mr. Morin.

Mr. Morin, according to some of my parliamentary colleagues, the status quo would be a disaster for Quebec, and I'd like to know what you think about that.

Wouldn't it be preferable to have a right to opt out with full compensation and, as we've done for 30 years now, to be able to improve our own public pharmacare program?

[Benoit Morin]

Absolutely. That's what the Association québécoise des pharmaciens propriétaires, the AQPP, is proposing.

Earlier I said I thought the system wasn't perfect. It's a mixed system; sometimes you have to pay out the full $1,000 ceiling amount if you're insured privately. There should be some protection against that.

Perhaps other, simpler measures should be adopted. We mentioned how hard it is to access exception status drugs, for example, where it's difficult because people don't have access to doctors. Sometimes it's an obstacle course for patients. The professions should be decompartmentalized so that other professions can provide access to those products. There are rumours that that's what's happening in Quebec.

Furthermore, Quebec's Institut national d'excellence en santé et en services sociaux, the INESSS, makes scientific decisions on what should and shouldn't be included in the formulary. As a pharmacist and scientist, I support those decisions in 99.9% of cases because they're based on effectiveness, efficiency and relevance rather than feelings of being deprived of a product or not having access to this or that.

We know the pharmaceutical industry works miracles, but is it always necessary to cover the thirtieth molecule, which costs more? The answer is no.

INESSS conducts those analyses, and I think that improves the quality of the Quebec system.

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

Mr. Morin, according to a study conducted by the Canadian Pharmacists Association, 94% of Canadians agree that governments should expand and fund community-based care such as health services in pharmacies.

The federal government was supposed to pay 50% of health care costs through transfers, including to Quebec, but it now pays 22%. Is that really something that will help improve health care services in pharmacies and community-based health care?

[Benoit Morin]

We don't discuss clinical services in pharmacies in our proposal; we only discuss distribution. Diabetic patients and young women who use contraception methods, such as the morning-after pill, need more than just the drug.

These activities should be adequately funded so the drugs are properly and rationally used.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Morin.

Mr. Julian, you now have the floor for two and a half minutes.

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

Thank you very much, Mr. Chair.

I come back to you, Mr. Thibeault. You just started to talk about Amber, who is a young woman with type 1 diabetes, and I want you to continue informing the committee about her situation.

[Glenn Thibeault]

Through you, Mr. Chair, thank you, Mr. Julian, for allowing me to continue because, for the story that you told about Amber, we could go into every single riding in every single constituency across this country and, unfortunately, we would have a similar story.

My colleague Mr. Williams talked about the calls that we are getting to our 1-800 line. Very similarly to what Ms. Eagan was saying, we receive calls from individuals who have no coverage, like Amber, and who are spending, in her case, like you said, $1,000 a month just to get the care that she needs, and that's devices and medications. We also have individuals who are living with either type 1 or type 2 diabetes who have private insurance. It's at, let's say the 80% level. However, the 20% level is still difficult for them to meet at the end of the month, so they're rationing, as my colleague Mr. Williams also outlined in his opening statement.

That's why we continue to talk about our three recommendations, because those are the key points that we think.... The debate about what is universal, first-dollar, single-payer—as Mr. Powlowski talked about—hasn't been defined yet. We keep talking about the under-insured and uninsured. We have an opportunity here—“we” being everyone at this table, diabetes organizations, contraception organizations—to actually look at making sure we can fill those gaps, and if that isn't the right term, let's figure out what the right term is to make sure that the choice and the opportunity to continue to move forward is still there while we're figuring out how we make this work in the negotiations that happen with the provinces.

We talk about that fulsome and robust consultation that we would like to see with persons with lived experience, like me, like Mr. Kitchen and everyone else across the country. Let's look at the comprehensiveness. In the bill it talks about section 4 and looks at how the Canada Health Act can be included, and some of our legal interpretation talks about making sure that we look at the comprehensiveness of that choice and then, of course, what we're calling “do no harm”. We need to ensure that individuals who have wraparound care still have it, but let's not forget about Amber or about anybody else we could talk to, in any one of these constituencies across the country, who needs that support.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thibeault.

Thank you, Mr. Julian.

Next we go to Mrs. Roberts, please, for five minutes.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you, Mr. Chair.

I have two questions for Mr. VanGorder and I would like some answers. Many seniors in my communities have concerns with the pharmacare plan, and I'll explain why. They're very disappointed in the dental plan, and they don't trust this current government to deliver any plan. They feel that it has failed them at every level.

In Ontario, seniors pay a flat fee and receive their drugs for the remainder of the year, so once a year they pay a flat fee and they receive their drugs. How is this plan going to impact the provinces and territories?

[Bill VanGorder]

Thank you for the question.

Through you, Mr. Chair, that's a key point, because they don't know. They're confused. The seniors who are watching today—and I know many of them are—are going to see that, if there are this many questions about the coverage for those with diabetes, what's it going to mean for the rest of us? What will it mean for those of us with heart and other conditions, and for people who need the coverage?

They're confused, they're worried and they're fearful. I'm not just assuming this. Our members write us weekly, if not daily, about their concerns. Why is this going so quickly? Why don't we know what's going to be covered?

I had a woman call me the other day to say that her husband had retired last fall and then he passed away. She still had his drug coverage, but couldn't afford her payment part and was told that she couldn't get rid of it and get onto the new program.

Whether or not this is going to be changed in the future, that's the kind of thing that's worrying seniors. When they hear a discussion like they're hearing today, whether they're in Ontario, in Nova Scotia where I am or in B.C., they're worried about what they see as an incomplete framework.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you for that.

You mentioned in your opening statement the Ontario plus plan and how it didn't have any benefits for young people. We know what happened in 2018—the provincial Liberals got killed.

What did you mean by that?

[Bill VanGorder]

I meant that there was confusion in its operation. When it first came into play, there were many people who fell between the cracks. Eventually, it seems, most of those were picked up; however, there were people who were without the ability to get their medications from the time the program was introduced until they got through the paperwork of getting it.

If seniors and older Canadians have to stop even for a month or two taking their medications, that's going to create very severe problems. We can't let that happen with this plan.

[Anna Roberts, Conservative, King—Vaughan, ON]

I guess what we should do is put the patients back in patient care instead of the government. Would you agree with that statement?

[Bill VanGorder]

I would absolutely agree. What we have now—one of my colleagues pointed out—is like a kind of mismade quilt. It's a patchwork, with gaps in it, covering everybody.

What's being proposed now is more like a burlap sack. It's the lowest common denominator with holes in it. We need a tightly knit quilt. That's what seniors are looking for and want to have. Whether or not the future will allow us to see things better and changed, right now they're really wondering why we're rushing this through with no consultation—with our group and very few others.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you for that.

I have a question for Carolyne, if I can call you that. You've explained the plan to us. You said there's not a huge profit for companies.

Can you tell me the difference between what the government is offering on the pharmacare plan and what it eliminates for current plans that people have?

[Carolyne Eagan]

When it comes to that list of drugs—I think this is what you mean—it would be far less expensive. We've been talking about that a lot today.

Overall, province by province and employer plan by employer plan, it's a 40% to 50% difference in the drug list of what is covered. That's the main difference—there's a higher list of drugs and a longer list of drugs. If we spend the money with smart solutions, we can get that right coverage to people for more health conditions or a longer list within the fields of the conditions we're talking about today.

What I want to also add is that with our advisers on the ground—the thousands I mentioned across Canada, who look after the 65,000 employer plans—we see, province by province, the models of how they are built today. We see what's working, what's not working and what the pain points are. They look after not only the drug portion, but the dental, vision, disability, paramedical, and mental health and wellness aspects of plans.

This is a comprehensive package that, again, four out of five Canadians are enjoying and seeing work well. Let's pay attention to the one in five who are having affordability and access challenges.