Health Committee on May 27th, 2024

[Daniel MacDonald]

I think the essence of the response given last time when we gave witness testimony was referencing the fact that the nature of policy development is not necessarily linear and continuous, such that it has a defined start and end.

That is all a way of saying that the process of developing something, all of the options that got assessed and the advice that was provided to the minister during the course of it—this was actually prior to my joining the unit itself—has been going for more than two years. That's an easy estimate.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I didn't ask about the policy development. I asked how long it took you guys to draft this legislation.

[Daniel MacDonald]

Drafting of legislation and all the work that goes into that tends to occur concurrently with the policy development, because the two go hand in hand.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

In this case, did it happen concurrently, or was this an anomaly?

[Daniel MacDonald]

There was nothing anomalous about this process. When you're developing legislation or you're developing the policy advice that will lead to the instrument, the legislation, you do work with all the elements of the public service that support legislative drafting through that process.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

Thank you, Mr. Chair.

[The Chair, Liberal, Sean Casey]

We'll go to Mr. Doherty and then to Dr. Ellis.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you, Mr. Chair.

I had my hand up and was on the speakers list for CPC-8. It then was withdrawn. The point I wanted to make with it is that I asked an honest question regarding the ruling on it, and our colleague from the NDP took the opportunity to go on and take a partisan shot, suggesting that we were filibustering just because I asked a simple question. It's theatre for him, because the cameras are on and he takes every opportunity to slam us.

It was an honest question that I had regarding CPC-8 and the words “Indigenous peoples” and “Indigenous governing bodies” within it, which is why I'm using the opportunity now to bring this up. Just because we ask a question or are bringing forth reasonable amendments, it's not a filibuster because we're asking these questions. We honestly want to get this right for Canadians.

The question we have and the point we are making is, again, that this is not a pharmacare bill. I'll draw the attention of the committee to page 4 and clause 6. It starts with:

The Minister may, if the Minister has entered into an agreement with a province or territory to do so, make payments to the province or territory

The last line says:

for [the] specific prescription drugs and related products intended for contraception or the treatment of diabetes.

Our colleague from the NDP brought up his concerns regarding heart medication.

They will stand up and they'll say that they got this done for Canadians, for every Canadian or whatever the stats are—the 9 million Canadians who are diabetic or whatever those stats are for that. We have said that this is important for those Canadians who struggle with those issues.

Why didn't they fight for the heart medication, for the folks who are cardiac patients? Why can't this bill be amended or why couldn't they have fought for those Canadians who are struggling with other serious long-term diseases and medical issues that require access to medication? They want to bill this as pharmacare, as a pharmacare bill or as a national pharmacare program. Well, why wouldn't they have fought for that when they were sitting around the table with their coalition partners?

Mr. Julian will grab the microphone more times, probably, throughout the course of this evening, and talk about his constituent who pays $1,000 a month for heart medication. I'm certain that Mr. Julian would have known about this when he was at the table negotiating this piece of legislation. Why didn't he fight for that at that time? How many millions of Canadians require that medication? Does he have those stats?

It's frustrating—again I use that term—because, again, this is not a pharmacare piece of legislation. It deals with contraception and the treatment of diabetes, and nothing else. CPC-9 is a reasonable amendment, again dealing with what this piece of legislation is about, is truly about, and that's it.

Mr. Julian has already stated his intention to vote against it. I will suggest that he's going to vote against all of the CPC amendments, because, well, they're common sense, and we've seen that in the NDP, at least within the last number of years, common sense has gone out the door with the costly coalition.

It is frustrating for me when we ask a simple question. My question regarding CPC-8 was short and to the point. I was asking for clarification, and Mr. Julian probably should have just looked at the camera and spoken directly to Canadians, because that's who he was putting on the act for. It was not a filibuster at all; it was simply to get clarification, and I take offence to the fact that he says we are filibustering that simple point and simple amendment.

Thanks.

[The Chair, Liberal, Sean Casey]

Dr. Ellis, please go ahead.

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

Thank you very much, Chair. Could I perhaps direct a couple of questions to the officials?

Mr. MacDonald, I was paying attention, but maybe I missed some of the nuance of what you were saying. This is not well defined in the bill, and that's probably what's creating the difficulty. Are you suggesting that a national bulk purchasing strategy, as talked about in this bill, will then see the elimination of the pCPA?

[Daniel MacDonald]

No, that's not at all what I was implying.

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

I'm sorry, sir. Could you maybe move closer to the mic? I'm struggling to hear you, and I couldn't put my earpiece in.

[Daniel MacDonald]

I apologize for that.

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

Oh, that's great. Thank you.

[Daniel MacDonald]

That sounds better.

No, that is not at all what I was suggesting. I was simply stating two parts of the response to the question.

The first is the existing coordination of price negotiation that provinces and territories have set up through the existing pan-Canadian Pharmaceutical Alliance, and I was simply distinguishing that from the advice the minister, under Bill C-64, would be seeking from Canada's drug agency to suggest a future development or a move forward. My remark was not intended in any way to suggest there would be a replacement of existing activities; it was just about supporting the discussion among provinces, territories, indigenous peoples and other partners and stakeholders about where to go next and what improvements might be made.

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

Thanks very much.

Mr. MacDonald, are you saying that in a forward-looking bill, the CDA, which has just been newly formed, would do pricing negotiations? Is that what you're suggesting? Again, on behalf of Canadians, I'm seeking clarity here and I'm not obtaining it. I apologize for that. Is that what you're saying?

[Daniel MacDonald]

Not at all. What the national bulk purchasing section of Bill C-64 refers to is—I'm just seeking a term here—more improvements in the existing price negotiation steps that are taken in the pharmaceutical management system in Canada today: Where might improvements be sought? How might that be affected?

It's intended to be an expert-guided conversation, and Canada's drug agency is suited to guide that conversation, but it is not intended to be in any way a replacement for the pCPA. I just want to be clear about that.

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

Thank you very much.

If this is not a new national bulk purchasing strategy, then in my mind, the word “continuation” of a national bulk purchasing strategy would be most appropriate. If you're telling me that Canada's drug agency is not about to replace what exists now within the pCPA, then “continuation” would be most appropriate.

It's not setting up something new. Is that what I heard?

[Daniel MacDonald]

The activities of the pan-Canadian Pharmaceutical Alliance are ongoing now and continuing, and what the bill references is the development of advice that would support a conversation among provinces, territories, indigenous peoples and other partners and stakeholders about where to go next and what might happen in the future development of national pharmacare.

It's distinguishing between the actual activity that's occurring now—that's the pCPA you're referring to, which is not being terminated in any way—and the development of advice to support a conversation about the future of pharmacare.

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

Thanks very much.

Mr. MacDonald, doesn't that advice already exist from the newly named CDA, formerly CADTH? Did they not already create advice around pricing, risk-benefit and cost-benefit analysis and pharmacoeconomics? Was that not already part of their mandate?

[Daniel MacDonald]

That was generally part of their mandate as a health technology association; you're correct. This is about the minister's being able to seek a specific piece of advice about where in Canada, as part of future pharmacare, coordinated price negotiation or improvements might be made, because it is an important element of pharmacare as a total package.

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

Thanks very much.

and I will continue along that line of questioning. This is about transparency.

Listen, I know I'm here as a parliamentarian, but on behalf of the average Canadian, what it appears to me that you're saying in a multitude of different ways—and I don't believe that you're trying to be obtuse in your answers—is that the future vision of pharmacare would suggest that Canada's drug agency would do what the pCPA is doing now. Without understanding what the costly coalition's vision is, it becomes very difficult for me to understand what it is you're saying, not because I don't understand English—I do—but because your answer is obtuse without perhaps meaning to be.

I don't mean to be negative toward your answers, but I don't have an understanding of what the negotiated vision is, because you might have been part of it and we were not. We who represent the opposition were not part of that conversation around what the vision is on behalf of Canadians.

Do you know what? I think that Canadians deserve to know what the vision is. If the vision means that there's going to be a new national bulk purchasing strategy that will be under the purview of Canada's drug agency, then they need to hear that. If it's not, then the wording in this amendment, which talks about, as my colleague eloquently pointed out on page 4, I believe, paragraph 6, is specifically about diabetes and contraception, and it's also about the continuation of a national bulk purchasing strategy.

I'm going to ask you to be concrete, which I know you don't want to be—I understand that—but either this is the creation of a new pathway under the auspices of Canada's drug agency or the continuation of a national bulk purchasing strategy. I ask you, sir, on behalf of Canadians, which is it?

[Daniel MacDonald]

There are two parts there. First, this does not create a new role for Canada's drug agency in the realm of price negotiations. I want to be very clear about that.

The bill sets up a future conversation about the future of pharmacare. Now, as part of that, the bill sets out that the minister may request advice from Canada's drug agency on two elements to develop expert advice to support that conversation.

One of those two pieces is to guide the development of advice on where Canada might go in terms of realizing improvements in its price negotiation strategy today. The reason for that is that previous advice by expert panels—I'm referring specifically to Hoskins—on how pharmacare might work have always pointed to the savings that would be realized from coordinated, negotiated drug acquisition. That's the element that Bill C-64 refers to: the development of the advice or further understanding about how and where that might work. It is not intended to be a reference to the existing activities of the pan-Canadian Pharmaceutical Alliance at all.

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

Well, I want to say thank you, but I'm still very unclear, because the pCPA has the ability to do a national bulk purchasing strategy. Is that not true?

[Daniel MacDonald]

The pan-Canadian Pharmaceutical Alliance acts on behalf of all of its members, all provinces and territories in Canada, and, in doing, so coordinates the purchase for their public drug plans, and, indeed, some federal drug plans are a part of that as well. It has the ability to conduct those price negotiations.

Bill C-64 authorizes the minister to seek advice from Canada's drug agency in its position as having expertise in the field to guide the development of advice to support that future conversation among decision-makers about how there might be improvements that could be realized. It doesn't commit that they would be adopted. It merely supports the development of advice to support a conversation.