Health Committee on May 24th, 2024

[Linda Silas]

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

Quebec's program is recognized around the world, but it's also one of the costliest to any government.

Quebec's unions and health coalitions are asking the federal government to get involved to a greater degree.

In fact, every federal agreement will recognize Quebec. I'm not concerned. What does concern me and what concerns the nurses and health professionals of the Fédération interprofessionnelle de la santé du Québec, for example, are those who slip through the net, the ones who aren't represented by a program offered by their employer and those who aren't represented by a provincial program. This program should cover everyone.

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

I'd like to go back to the cost of prescription drugs.

You mentioned that this is one of the most costly programs. As you know, the Pan-Canadian Pharmaceutical Alliance is trying to buy wholesale in an effort to lower prices.

However, I'm trying to make the connection with health transfers. I know that the federation, in particular, is in favour of them.

Under the initial agreement between the federal government, the provinces and Quebec, the federal government was supposed to pay 50% of health, health care and social services costs. That percentage declined to 22% some years later. We were realistic and reasonable, and the figure was then set at 35%. For Quebec, that represented $6 billion, but Quebec has only received $900 million.

If we're supposed to receive $6 billion, but have only received $900 million, we may have less money to invest in modernizing and improving pharmacare. What do you think about that, Ms. Silas?

[Linda Silas]

We're on the same wavelength, Mr. Blanchette‑Joncas.

I don't understand the bureaucratic problems involving the federal, provincial and territorial governments. It's absurd that the $1.5 billion that was promised for rare diseases a year ago hasn't yet been spent. Ms. Wong-Rieger discussed that. The same goes for the federal transfer negotiated last year. It makes no sense that the provinces and territories haven't received that funding. The Minister of Health needs to address this.

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

I agree.

Ms. Silas, I'd like to tell you a documented true story.

The federal government has cut its health transfers. If it introduces pharmacare and ultimately decides to withdraw its investments, what impact do you think that might have?

The provinces are juggling two health care systems. They have to make decisions and cut services. As you can see in the system right now, we're witnessing the increasing privatization of certain services, particularly nursing services. I know that's a major concern for you, and I can tell you it is for me as well.

If we have a good idea, how should we go about making sure it's implemented as efficiently as possible and that the selected solution is permanent?

[Linda Silas]

That's a tough question. In 2019, the federal government committed to introducing a national pharmacare that would provide for a formulary of essential drugs.

Then came the pandemic. However, in the negotiation they conducted, the NDP and the Liberals took a cautious approach to the two classes of drugs and guaranteed that we were headed in the right direction.

They couldn't say at the time that they would adopt all the Hoskins report's recommendations, but Canadians can be given a guarantee regarding two classes of drugs. We'll join the plan once we can test it and confirm that it works. I'm very confident about that.

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

That's excellent. All right.

Ms. Silas, witnesses told us yesterday that they're concerned about the potential loss of certain drugs. The Quebec plan covers a formulary of approximately 8,000 drugs. That's not perfect, but we could improve matters in many respects.

We've been told, however, that national pharmacare might lower the number of approved drugs on its formulary, such as Ozempic, even though it's a well-known drug. For the moment, there aren't even any plans to put it on the formulary.

I'd like to hear your comments on that matter. How can we make sure that we don't lose what are considered essential drugs?

[Linda Silas]

I tip my hat to Quebec and British Columbia because their formularies of 8,000 drugs are among the longest in Canada.

As I told Mr. Hanley during one of my appearances, it's not up to politicians to decide what drugs will be on the formulary, and no advertising campaigns should be used for that purpose either. I honestly don't even think doctors should have a say; it should be up to expert committees.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Silas.

Next, we'll go to Mr. Julian, please, for six minutes.

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

Thank you very much, Mr. Chair.

Thank you to our witnesses.

Ms. Silas, there is no doubt that Canada's nurses are the folk heroes of the pharmacare act. You'll recall three years and three months ago, we were working together on the Canada pharmacare act. It was a bill I sponsored on behalf of the NDP.

Canada's nurses did an extraordinary job. Some 120,000 Canadians wrote to Liberal and Conservative MPs to tell them to pass this legislation. We were all profoundly disappointed, as were most Canadians who supported pharmacare, that the bill went down to defeat with both Liberal and Conservative MPs voting against it.

Now, three years and three months later, you're testifying on behalf of the pharmacare act, which is extraordinary. You've sent a message to all parliamentarians. You wrote:

Passing this bill will help patients with diabetes and women who face the impossible choice between buying groceries and filling their prescriptions. This is not just a health care issue; it is a matter of fairness, equity and access. Investing in pharmacare will save lives, reduce overall health care costs and enable people in Canada to lead healthier, more productive lives.

We need you—

You are speaking to all parliamentarians:

—to act quickly and decisively. Your job is to protect and help build a public health care system that works for all people. Nurses across the country are doing their part, so put aside partisanship and let us make Pharmacare a reality.

That is an extraordinarily important message you're sending to all parliamentarians and to members of this committee.

I'd like you to tell us: What have Canada's nurses seen on the front lines with the lack of pharmacare, the lack of medication being available and people struggling to pay for their medications? What are some of the stories and the things that Canada's nurses have seen with the current system that lobbyists say are fine, but that Canadians want to see fundamentally changed?

[Linda Silas]

Today, what we hear on the news is about the long lineups in the ERs, the long waits for surgeries and of course the shortage of nurses and other health care professionals.

The reality is about the simple things. The reality is those families that cannot afford their medications and stay in the hospital longer. Doctors and nurses will, for the health of the patients, keep those patients in the hospital longer so they can get their full treatment. That is where nurses get frustrated. We have patients in hallways because they don't have any other choice.

We have to do better. We're the only country that has a public system.... I guarantee you that I'd stand on any tribune to defend our public system, even as difficult as it is due to the attack the pandemic had on us, but we need to give that extra to our doctors and nurse practitioners.

Right now, they're stuck. If they don't have a sample to give to that family that doesn't have an insurance plan, the patient has no other choice but to go in the ER and get their treatment. That's not fair.

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

What does that mean in terms of cost to our health care system, when people are being kept in an acute care bed because nurses understand that if they're released, they won't be able to pay for their medication?

[Linda Silas]

It's the cost of hospital days, but it's the worse than that. It's the human cost.

Go take a walk in any of our hospitals today. The hallway nursing is scary. I feel for those families, especially our seniors, for what they're going through in hallways. It's a ripple effect. They're in a hallway because there's a bed for somebody who can't pay for their medication or didn't adhere to their prescription.

Family docs, specialists and nurse practitioners know what they're doing. If they prescribe a medication or a series of medications, we should have a system that continues to protect them and continues to give them access to their medication.

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

When people don't have the ability to pay for their medication—I know you and Canada's nurses have done remarkable work on this—what does that mean in terms of the cost of human lives?

Are Canadians dying because they can't afford to pay for their medication? What does that mean in terms of numbers?

Are we seeing Canadians losing their lives because of the lack of universal pharmacare in this country?

[Linda Silas]

MP Julian, you're really hitting a hard line with the nurse in me.

We did a report a few years ago on the number of patients dying. Just with two categories, which were diabetes and heart disease, we are talking in the thousands who are dying every year because of the lack of medication.

I didn't even understand that Stats Canada was collecting the data of patients who were not able to take their prescription drugs and the impact it would have in the long term and in dying. That's the extreme. What we're talking about today is giving them a chance with these two types of drugs to have a healthy life, to have more control and to not enter our hospitals or our emergencies to get their prescription drugs.

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

Ms. Silas, do you recall the numbers per year?

[Linda Silas]

I don't recall them. I was looking at my notes. They're not there because that's a report from probably 2013. I will provide it to the committee.

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

That would be very helpful. People are losing their lives because they're not able to pay for their medications. This is extraordinary that in a country like Canada we would permit that.

When company lobbyists come forward to this committee and say that everything's fine the way it is, would you agree with that assertion—that everything's fine the way it is—when people are dying?

[Linda Silas]

After that report, the Heart and Stroke Foundation partnered with us to lobby for a national pharmacare program, realizing that heart disease is big and it's the same thing with diabetes.

It's hard to understand.... As I said in my statement, we believe in a national pharmacare program because we believe in the care we provide to our patients, and we want to do the best job possible on pharmacare—

[The Chair, Liberal, Sean Casey]

Thank you.

[Linda Silas]

Others have other motives.

[The Chair, Liberal, Sean Casey]

Thank you.

Next we have Dr. Kitchen, please, for five minutes.

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

Thank you, Mr. Chair.

Thank you, everybody, for being here. It's greatly appreciated, especially on such short notice to get through this quickly.

I think most Canadians who have been following this expect us to be discussing the legislation. They want us to be here to discuss the legislation, to sit around the table and come up with changes that we think need to be done to make it an even better piece of legislation, and that's a challenge as we move forward. They assume that, when we come up with points that are pertinent points, they will get passed. The unfortunate part is that they probably may not get passed. That's unfortunate, because Canadians who are watching us and hearing what has been going on expect this legislation to be improved. It's scary to believe that this coalition that's trying to push this through may not do that.

A number of people have brought up an issue I would like to address to start off with. Many of you, in particular Ms. Berg and Dr. Wong-Rieger, mentioned the issue of committees and experts and how we address that. When you look at where the legislation does that, it doesn't talk at all about how big this committee of experts will be, who the members will be and what their qualifications are—will they be from each province, or will they be from a select group that's determined by the minister and by the minister only?—not to mention the cost, etc.

My first question to you, Ms. Berg, would be this: When we look at that from a pharmacy point of view, last night some of our witnesses from pharmacy brought up the issue of having a pharmacist as one of those experts. I'm wondering if you would be able to comment on that.

[Angelique Berg]

Certainly. I think that the Canadian Pharmacists Association yesterday made a great assertion to have a pharmacist on that expert committee, and we fully support that. CAPDM's distribution members get medication to patients, but they also arm our professionals with the tools of the trade. They're extremely important, and they should be on that expert committee.

We would like to participate on that expert committee. We're very concerned about the unintended consequences on the supply chain that delivers medicines to Canadians. We would like to work with government and make sure that we're helping inform you to be sure there's enough money to support that.

We're at a precipice where there has been so much expense driven out of the distribution system that we're really at a place where the only way to take the impact of any further price reductions is to cut services. That's going to hurt, and nobody wants to do that. We'd really love to be part of that as well.

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

Thank you, Ms. Berg.

Dr. Wong-Rieger, you also indicated that in the aspect of that advisory role. I would like to hear your comments on what you see that role being.

[Dr. Durhane Wong-Rieger]

As I said, we have the implementation advisory group right now with the rare disease drug strategy. I've been on other advisory groups with the government as well. The challenge, I think, is that in many cases we're not really advisers. There are already decisions being made. The decisions are oftentimes being made behind closed doors. We've been begging the government to tell us what's going on in terms of these bilateral agreements. What are the talks that are taking place? What are the drugs that are being considered? Can we provide some input in terms of what those drugs are? We're given no opportunity to do that.

I think the challenge is that, if we're going to have these committees, they must be transparent. There must be accountability. We've been asking for the opportunity to let the public know what the progress and plans are, and again, we've not been given that opportunity. I think part of the challenge is in the details and making sure.

The other thing I'd like to say is that, as we've heard already, it takes so long to get drugs through the public drug plans. I'm not saying whether or not things can be improved through the public drug plan, but we know that, if you have private insurance today, if a drug is approved, a rare disease drug, you almost always get it as soon as possible. I've had two or three years with patients on a public plan asking, “Where's my drug?”, and it's not yet there. Even though it's going through so-called expert committees, there's no the transparency and there's no ability to have the right people push for those decisions.