Thank you very much.
My name is Marc‑André Gagnon, and I am a professor of public policy at Carleton University. I have been working on pharmaceutical policy issues for the past 20 years and have written more than 150 articles, chapters and technical reports on those same issues. I have no commercial conflicts of interest.
I am always astounded by the way our governments kowtow to the power of pharmaceutical companies and commercial lobbyists to the detriment of the Canadian public.
The evidence is clear: As recommended in the Final Report of the Advisory Council on the Implementation of National Pharmacare, the Hoskins report, a universal public pharmacare program would help to provide better access to drugs for all Canadians and to lower costs by approximately 20%.
However, the government still hesitates and has only announced coverage for contraceptives and diabetes drugs, while trying to maintain the present hybrid private-public system, which has become a model of inefficiency and waste all around the world.
The problem stems from the fact that drug coverage in Canada is a system of fragmented and disparate parts. It is an unfair and ineffective system lacking any consistency or overall objective. There are some who believe we can solve the problem by adding new parts, but the fundamental problem is that the system is fragmented.
Let's remember that Canada is the only country with a universal public health insurance system that doesn't include prescription drugs, as if the latter weren't an essential health care service. Canada ranks third, after the United States and Germany, among countries with the highest per capita drug costs in the world. Canada remains one of the countries with the biggest percentage of citizens who, for financial reasons, can't access the drugs they need. More than 10% of Canadians avoid filling their prescriptions for financial reasons.
Today I've heard many people with obvious conflicts of interest proposing that we introduce a mandatory private system such as the one in Quebec. By the way, Quebec is the only province in Canada where per capita drug costs exceed those of Germany. Thus, by following Quebec's example, Canada could become the country with the second-highest drug costs in the world after those of the United States. That would mean that we essentially want a publicly funded Quebec-style system with expensive drug coverage for high-risk patients receiving the highest-cost treatments.
A Quebec-style system would increase drug spending by $5 billion a year and would do very little to lower financial barriers for access to the drugs people need. We would be introducing a mandatory private plan that is incapable of providing coverage for the most costly patients, who constitute a bad risk and would be offloaded to the public plan for expensive drugs.
In short, we would be asked to pay more to create an inefficient system by making private plans mandatory and undermining our ability to negotiate lower prices, while demanding public funding to cover the risks of the private plans. We want a mandatory private insurance program that doesn't cover risks. It's quite fascinating. That's what we're demanding. That's what I've been hearing.
There's a dangerous barrier to the introduction of a universal public plan as the Hoskins report recommends, and that's the fact that too many stakeholders, including provincial and territorial governments, benefit from the present system of unclear prices and whisper discounts. The provinces' public plans don't know how to contain costs and merely shift them around within a fragmented system.
Take Repatha, for example, an anti-cholesterol drug. Its official price is $6,000 a year, and the whisper discount is an estimated 90%. So the actual cost of the drug is $600 a year, and the difference is a rebate that goes to the payer. In Quebec, patients insured under the public system pay a deductible of $23 a month, and their copayment is 33%. To buy Repatha, they will ultimately have to pay $1,200 a year out of their pocket for a drug that costs only $600 a year. In addition, to be guaranteed this kind of coverage, they are required to pay a premium of $731 a year. This isn't insurance; to a certain degree, it's a scam.
On the other hand, the private plans, innocent as doves, have to pay the full price of $6,000 a year without any whisper discounts, not the government-negotiated price of $600 a year.
The present system has become an opaque institutionalized scam, which is unacceptable. Too many actors are lining their pockets and have every interest in preventing anyone from eliminating waste.
We need an efficient universal public program to contain costs for Canadians; we can't just shift costs elsewhere in the system onto the shoulders of the patients and workers. We need a universal public plan with the necessary institutional capacity to ensure that we get value for our money and promote good prescription habits based on solid evidence, not the arguments of corporate marketing campaigns. We need a rational insurance plan, as proposed in the Hoskins report. I would remind you that the Trudeau government has committed to following that report's recommendations.
I will be pleased to answer the committee members' questions.