Evidence of meeting #118 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pharmacare.
A recording is available from Parliament.
6:05 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Through the chair, on behalf of everyday Canadians, the pCPA, for all intents and purposes, is a national bulk purchasing strategy. Is it or is it not?
6:05 p.m.
Director General, Office of Pharmaceuticals Management Strategies, Strategic Policy Branch, Department of Health
It is the coordinated price negotiation upon which the letters of intent that are signed at that process are used by public drug plans to—
6:05 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
I'm sorry, Mr. McDonald. I'm going to interrupt you. I'm not asking you for the Caramilk secret here. That's not what I'm asking you on behalf of Canadians. Is there another national bulk purchasing in secret that Canadians don't know about? If there is, on behalf of Canadians, please tell us.
For all intents and purposes, for public plans, is the national bulk purchasing arrangement that we have at the current time not through the pan-Canadian Pharmaceutical Alliance?
6:10 p.m.
Director General, Office of Pharmaceuticals Management Strategies, Strategic Policy Branch, Department of Health
Yes. It is through the pan-Canadian Pharmaceutical Alliance that all public drug plans coordinate their purchasing—their price negotiation to subsequently purchase.
6:10 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
As I said, I'm not asking you to define the theory of relativity here or the Caramilk secret, whichever is more difficult. What I'm—
6:10 p.m.
NDP
Peter Julian NDP New Westminster—Burnaby, BC
Thank you, Mr. Chair.
I'm a bit uncomfortable with the line of questioning. We're getting complete answers from our witnesses.
Actually, Dr. Ellis just has to read the bill. If you look at the principles in clause 4 and how they relate to clause 9 of the bill, those answers are already evident. It is relevant, but I do find this questioning a bit repetitive. As well, these are questions that are already answered by a careful reading of the bill.
6:10 p.m.
Liberal
The Chair Liberal Sean Casey
You tried to couch it as a point of order, but it was a point of debate, I'm convinced.
Go ahead, Dr. Ellis.
6:10 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks very much, Chair.
In spite of what Mr. Julian wants, there is a significant lack of definitions inside this bill, which to me is perplexing. It's perplexing because one of the things Canadians do not understand is how medications are approved in this country, how they are purchased and how those decisions come to be.
Again, I'm sure even Mr. Julian could sit down at a moment's reading and read the four-page pamphlet. It's not that difficult to do in a single reading. It's not rife with details. In spite of the fact that the costly coalition would like us to simply pass this bill through, our job under the Westminster style of government is to provide a robust opposition to the things proposed and the willing and wasteful spending by the costly coalition.
What I'm trying to do on behalf of Canadians—unlike what Mr. Julian is wont to do, which is to allow this pharmacare pamphlet to pass without scrutiny—is to understand, on behalf of Canadians, the system that exists now. Again, I would suggest that I probably know as much as there is to know about the purchasing system in Canada and the manufacture of medications and the prescribing thereof, etc., so I would suggest that this bill is not being truthful.
Again, there is a bit of humour in there when I ask you about the Caramilk secret and the theory of relativity. I don't mean to be disparaging. We do need to have a bit of fun here. That being said, on behalf of Canadians, what we're trying to do is to understand clearly what this bill is proposing. I'm still not convinced that we are there.
Again, as I said, I don't have a problem comprehending the system that exists. I would say that I'm having a problem comprehending your answer. That's not because it's in a foreign language; it's not. It's in one that I can understand. I'm sure that if I were listening in the other official language, it would be translated appropriately. That being said, again, I'm not trying to be disparaging, but on behalf of Canadians, there appears to be an element of bureaucratic-speak that is really not clear.
I will take you a bit to task on that to say that I'm imploring you, on behalf of Canadians, to be clear. I know that you don't like yes-or-no answers, but I'd really like you to attempt to answer them.
The pan-Canadian Pharmaceutical Alliance—yes or no—is a bulk purchasing strategy that currently exists in which the public plans of Canada's territories and provinces, and perhaps a few other partners, participate at the current time. Is that true, sir?
6:10 p.m.
Director General, Office of Pharmaceuticals Management Strategies, Strategic Policy Branch, Department of Health
Yes, it is true that they jointly negotiate.
6:15 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
That's great. Thank you.
Therefore, the wording in this particular amendment, as I said previously, is related to contraception and diabetes, as my colleague Mr. Doherty has eloquently pointed out. It is clearly laid out in this bill that this is exactly what the pharmacare pamphlet is about. It is about the continuation of a national bulk purchasing strategy. It is not about creating something new.
You said there may be some forward-looking idea that at some time in the far future it could possibly change the vision of allowing the minister to ask the CDA for advice. I don't think that adding the words “continuation of a national bulk purchasing strategy” is going to harm in any way, shape, or form that potential or never-to-happen ability to ask the Canada drug agency for advice, because it now gets advice from the former arm, called CADTH, which we talked about. Part of its mandate as well is to talk about pharmacoeconomics and costs versus benefits.
I thank you again. In no way, shape, or form did I mean to be disparaging towards your answers, but I think it's important to seek clarity.
Chair, from the interventions that we have heard and the advice that we've obtained from our experts here this evening, it's even more important, on the basis of clarity and transparency for Canadians, to understand that the amendment proposed in CPC-9 is the appropriate amendment to bring clarity and vision to the pharmacare pamphlet.
Thank you, Chair, and thank you, Mr. MacDonald.
6:15 p.m.
Liberal
Yasir Naqvi Liberal Ottawa Centre, ON
Thank you, Chair.
We will be opposing this amendment. It builds on what I presented earlier. This is framework legislation that develops a framework around pharmacare. We are talking about the first phase of that framework, which focuses on diabetes and contraceptive medications. The legislation goes beyond that in terms of developing a national bulk purchasing strategy. Limiting the scope, as this amendment suggests, undermines the essence of this framework legislation.
Therefore, we think it is counterproductive. It does not really pursue what the legislation is trying to achieve, which is to create framework legislation around pharmacare, starting with the first phase, which is to make diabetes and contraceptive medications available to Canadians coast to coast to coast.
Thank you.
6:15 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you very much, Chair.
Again, I'm not sure that I follow Mr. Naqvi's logic here in saying that this is undermining any future ability to do anything. This is a service that is already provided by the Canadian agency for drugs and therapies in health, CADTH, and certainly one would believe that if they want to rewrite the potential future intervention of the Canadian drug agency, then I would suggest that this paragraph is not where that should happen. I can't quote you chapter and verse, but I do believe there is a segment that talks about the Canadian drug agency, and if Mr. Naqvi wishes to define what that might look like, then certainly that is something we're happy to entertain.
Again, on behalf of Canadians, our expectation is that there's an honesty here with respect to the national bulk purchasing that already exists on their behalf, because if we don't define it as such, what this bill, in its aspiration, would suggest to Canadians is that they are somehow going to get a better price for their medication through this bill. We know that when the public plans negotiate these prices, adding another million people to that negotiation is not going to enable a better pricing effect, and we heard that.
If we want to talk about the facts, which Mr. Julian is often mentioning, the facts are that we heard testimony with respect to the national bulk purchasing strategy that exists. For clarity, we'll call that the “pCPA”, the pan-Canadian Pharmaceutical Alliance. What we heard from the manufacturers who were represented here was that an incredibly rigorous negotiation already exists, in a market with small margins.
Mr. Julian was also obviously at that time wanting to say that these were lobbyists, when we know that everybody who appeared here as witnesses are lobbyists. That's what they are. They are all lobbyists. To attempt to be disparaging of folks who have and run businesses and employ thousands of people across the country, to say that they are lobbyists.... Well, as I said, everybody, sadly, who appeared in the truncated form—
6:20 p.m.
NDP
Peter Julian NDP New Westminster—Burnaby, BC
I have a point of order, Mr. Chair.
I have to ask you to rule on relevance here—
6:20 p.m.
Conservative
6:20 p.m.
NDP
6:20 p.m.
Liberal
The Chair Liberal Sean Casey
I'm not sure there's been a significant veering.
Perhaps you could make the connection back to CPC-9, but I don't think you've gone that far astray, Doctor.
6:20 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Well, I don't even know what to say to that, Chair. I was clearly talking about the system that exists now, the pricing that exists now and the lobbyists who were here. I was going to say something very negative, but I shall not say it, because that would be inappropriate.
Mr. Julian, please pay close attention, and if you're struggling with that, then grab a cup of coffee.
6:20 p.m.
Liberal
The Chair Liberal Sean Casey
No. Please direct your comments through the chair. This is bound to descend into chaos if we start firing shots directly at people—
6:20 p.m.
Conservative
6:20 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Chair, maybe you could ask Mr. Julian to grab a cup of coffee if he's struggling with his attention.
I apologize for directing it directly to Mr. Julian. It's much better to say it that way.
That said, what Mr. Julian was suggesting was that the good folks who provide medications to Canadians were not being truthful with their testimony that we heard. Of course, if we had more testimony, perhaps we could have heard opposing opinions, but we didn't, because of Mr. Julian and the costly coalition. We were able to hear only 10 hours of testimony. If he thinks that what they are saying is not true, then we'd be more than happy to hear more testimony. Just for clarity for Canadians, because of their motion on closure that limited the amount of testimony that could possibly be heard, we were very limited on who we were able to hear from.
Again, what we already have is an existing national bulk purchasing strategy under the auspices of the pan-Canadian Pharmaceutical Alliance. It really is beyond belief that what both Mr. Julian and Mr. Naqvi are saying, without transparency, is that they don't think that's a national bulk purchasing strategy. They think that perhaps in the future the Canadian drug agency will provide some of that, whereas this is in no way, shape or form limiting the ability to do it because we have already established that it is occurring now. The pharmacoeconomic discussion happened previously, before May 1, at CADTH, and is now.... I'm not entirely sure what's happening.
Mr. MacDonald, maybe you could make this clear to the committee.
Is there a joint CDA and CADTH, or is CADTH no longer relevant and just out of the picture altogether? Perhaps before I go on, you could make that clear to the committee. Is the governing structure now solely the Canadian drug agency and not CADTH, or is there some sort of overlap at the current time?
Ms. Boudreau, it looks like you might want to answer. If you do, please feel free.