Health Committee on May 27th, 2024

[Michelle Boudreau]

Again, just to return to my earlier comment, the term “indigenous peoples” is used as an inclusive term here, and it's also a term that is used in other legislation. When we are looking at bringing forward legislation, we look at consistency and do that due diligence.

What I would add as well is that, in the sense that it's inclusive, it does not limit the interpretation that's being suggested—i.e., it is inclusive of exactly the wording that's being put forward, so there's a redundancy there. It's already included.

[The Chair, Liberal, Sean Casey]

Is there anything else, Ms. Goodridge?

No. You're good.

Mr. Julian, please go ahead.

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

Thank you, Mr. Chair.

I'll be voting against this amendment for that reason—that the inclusive terminology that's already present in other government bills would be confused by the nature of this CPC amendment.

I'm a little confused, because the Conservatives have certainly had since February 29 to prepare amendments to this bill. In the House, in frustration after months of Conservatives' blocking this bill, the motion of instruction was tabled three weeks ago, so there were certainly three weeks there, and you gave, Mr. Chair, notice a week and a half prior to the amendment deadline. There have been three reminders since February 29, so I'm a little surprised that the Conservatives didn't heed all of that and that they put something in at the last moment.

That being said, this is not the appropriate way of amending the bill, and that's why I'll be voting no.

[The Chair, Liberal, Sean Casey]

Dr. Ellis is next, and then Mr. Doherty.

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

Thank you very much, Chair.

Despite what Mr. Julian wants to portray, this is after considerable consultation with the legislative counsel to understand the terminology. That was a question we had. It's not something that, unlike the NDP, we just dreamed up on the back of a napkin yesterday and tried to bring forward here or through a table-dropped amendment. I take great umbrage at his ridiculous notion that this is something that was not well thought out or actually consulted upon. That's an absolutely ridiculous accusation and something that I wish didn't bear a response, but it does, because of the ridiculous and unwarranted nature of his inflammatory comments, which I can only believe are intended to be inflammatory in this context.

In spite of that, if everybody else around this table is convinced that this is not the appropriate reference, I'm quite happy to seek unanimous consent to withdraw it. As I said, this is based on the legal counsel we obtained from the House of Commons. It's not like we went out and sought separate legal counsel for this; this is the actual counsel we received, and therefore we believed it was important to do it. This is not meant to be contentious or perhaps, as Mr. Julian is thinking, part of a filibuster. This is meant to be inclusive of all the appropriate people who had come to the table who potentially can be impacted by the pharmacare pamphlet.

In your terminology, Chair, if it's the will of the room to say that in spite of the good counsel that I believe we received, this is not a helpful amendment, I'm happy to seek unanimous consent to withdraw it.

[The Chair, Liberal, Sean Casey]

Are you seeking unanimous consent?

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

Yes, sir.

[The Chair, Liberal, Sean Casey]

Is it the will of the committee that CPC-8 be withdrawn?

[Some honourable members]

Agreed.

[The Chair, Liberal, Sean Casey]

I see agreement around the table. I don't hear any nays. CPC-8 is therefore withdrawn by unanimous consent.

(Amendment withdrawn)

That brings us to CPC-9, standing in the name of Dr. Ellis.

Would you like to move CPC-9, Dr. Ellis?

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

With great pleasure, Chair.

What we have here is this:

That Bill C-64, in Clause 3, be amended by replacing lines 10 and 11 on page 3 with the following:

drugs and related products intended for contraception or the treatment of diabetes, and to provide for the continuation of the national bulk purchasing strategy.

I think there are two things to be mindful of here.

Again, I don't want to be repetitive—I heard your words from Bosc and Gagnon—but we know this is not universal pharmacare. There was absolutely no mention in the testimony, Chair, of any other classes of medication other than contraception and diabetes. Those things did not come up. If anybody can point me to testimony should I be incorrect in that, I would absolutely love to hear it. We did not hear any evidence or testimony to the contrary regarding those two things.

The other testimony we heard very clearly was that a national bulk purchasing strategy is already in existence. Again, this is not a transparent bill. This is fleecing the Canadian public by suggesting this will somehow, miraculously, create some new national bulk purchasing strategy. That is why it's exceedingly important. Words are important. Words matter.

The words are “continuation of the national bulk purchasing strategy.” It already exists. There's no evidence in this bill to the contrary, nor was there any testimony to the contrary. Again, I'll challenge anybody around the table to say there was different testimony suggesting that a new national bulk purchasing strategy would result from the passage of the pharmacare pamphlet. That is not where we are at.

Certainly, it's also important that Canadians understand, as we talked about during the testimony with respect to the pharmacare pamphlet, that there is a process. It goes from Health Canada through the PMPRB to Canada's drug agency—the former Canadian Agency for Drugs and Technologies in Health, also known as CADTH—and then on to the pCPA. There's the responsibility of the provincial—yes, I said “provincial”—ministers of health. We heard that this jurisdiction exists, and we also heard that significant delays happen with respect to this belaboured process.

We heard testimony that the length of time from the original notice of assessment all the way through the process to being listed on 50% of public formularies was often excessive. Depending on the reference, it was most often in the realm of 27 months, or more than two years and three months.

We also heard that just 44% of drugs introduced to all markets in the OECD countries between 2012 and 2021.... In the United States, 85% of those were listed on formularies, and 44% were listed here in Canada. Therefore, we have a significant problem, but this is not the problem. The problem doesn't appear to.... Well, maybe it is related to bulk purchasing. It's beyond the purview of the pharmacare pamphlet.

It's also important that the other testimony we heard is related to the number of drugs covered on private plans. Fewer than half of those are covered on any public plans. On behalf of Canadians, I think it's important. It behooves this committee to ensure there is transparency and a lack of opaqueness, and for Canadians to hear that creating a national pharmacare program for drugs for contraception and diabetes—one that is better than the plan they have now—could in fact restrict their ability to have their own private plan. We heard testimony many times from folks who said that this is very likely.

It would also disincentivize employers from offering plans for their employees. A plan that is restricted in the number of medications covered, which this pamphlet would create for these two specific disease states, could create problems for Canadians, over 80% of whom have private drug plans and actually value their plans.

When we know that this is important to Canadians, taking away that freedom and that ability to choose how they wish to be compensated from their employer and the drugs they wish to have access to for treating their conditions is very challenging, to say the best, and frightening to say the worst.

I think the other testimony that we heard, Chair, is related to single drug coverage of a generic type. I might take a minute to explain that.

For instance, on the list of diabetes medication was a drug called metformin. Metformin is probably the most commonly prescribed medication for type 2 diabetes at the current time. It's been around for a very long time.

What we know is that in Canada at the current time, there exist 22 different generic manufacturers of metformin. We also know that, sadly, Canada suffers from multiple and repeated drug shortages, such that people will often be switched from one generic brand to another.

On the list that has been put on the Canada.ca website with respect to diabetes medications, we see one form of metformin. When we begin to look at the pharmacoeconomics associated with the manufacturing and distribution of drugs, we see that there's a likelihood that the Canadian supply chain could be easily disrupted by a shortage. That could be on an international basis, with the active pharmaceutical ingredients—the APIs—that mainly come from India and China. This particular company could be negatively impacted and therefore not be able to manufacture metformin on behalf of Canadians.

When we have 22 manufacturers and we have no assurances that we could actually end up with one manufacturer, then we know that on behalf of Canadians, this could create a significant and negative impact.

Again, the rationale for this amendment is related to clarity. This is about contraception and diabetes. There is now a national bulk purchasing strategy through the pan-Canadian Pharmaceutical Alliance, which is run by the provinces and finally determined and acted upon, if deemed necessary, by the provincial ministers of health.

Let's not conflate things that this bill does and doesn't do. I know that the NDP-Liberal costly coalition wants Canadians to believe that this is a universal pharmacare bill about a multitude of drugs and about a new bulk purchasing strategy. That is not what is occurring here in this bill.

On behalf of Canadians, I implore everyone around this table to vote in favour of this amendment.

Thank you, Chair.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Are there any further interventions with respect to CPC-9?

Go ahead, Mr. Julian.

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

Thank you, Mr. Chair.

The reality is that this amendment does the exact same thing that was attempted in the other Conservative amendment, which is to limit national pharmacare.

I want to reiterate to all members that clause 11 of the bill, which sets out that a committee of experts, within one year of the date on which this act receives royal assent, will provide a written recommendation to the minister on “options for the operation and financing of national, universal, single-payer pharmacare.”

The intent is very clear, as we heard in repeated testimony from not only from those who are urging that we adopt this bill but also from those looking at phase two. The possible outcomes of that committee of experts could very well be to recommend moving immediately to the heart medication.

Earlier, Mr. Chair, I referenced my constituent, who lives a few blocks from my home and pays $1,000 a month for heart medication—

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

On a point of order, Chair, I'm not entirely sure why Mr. Julian wants to continue to mislead Canadians and go on misrepresenting the same facts over and over again, suggesting this bill is going to be more than it is. He also wants, as you said, to be repetitive by talking about heart medications, which are not in this bill at all. There's no mention of heart medications here, and he continues to be repetitive.

Chair, once again, I implore you to use your ruling about the repetitive nature of his comments.

[The Chair, Liberal, Sean Casey]

Dr. Ellis, this is Mr. Julian's first intervention with respect to CPC-9. He is absolutely entitled under the rule of repetition to make the exact same arguments in connection with every question put to the committee. There's been no violation of the rule of repetition, either technical or actual.

Go ahead, Mr. Julian.

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

Thank you, Mr. Chair, but Dr. Ellis has a point. The Conservatives' CPC-9 does exactly that. It limits this bill so that you can't go to heart medication. That's why I'm voting against this.

The Conservatives are doing what they're accusing the bill of doing, which is restricting pharmacare so that it never goes to heart medication or these other medications that Canadians are paying $1,000 or $1,500 a month for. That's why I'm opposing CPC-9. The Conservatives are saying, “Gosh, this bill doesn't do enough, but we're going to stop it so the bill doesn't do anything else.” That, of course, is a contradiction—one might say hypocrisy—that I think everyone understands.

I'm voting no on CPC-9.

[The Chair, Liberal, Sean Casey]

Thank you.

Go ahead, Mrs. Goodridge.

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

Thank you, Mr. Chair.

I believe Mr. Doherty had the floor, but I will go ahead because I was told to. I appreciate the prerogative there.

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

I'll go next.

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

I appreciate the fact that the member from the NDP is so well versed when it comes to this bill and can cite exactly which section different pieces are in. It stands to reason, because this is probably the only time the federal NDP will be responsible for drafting a piece of government legislation. I can understand the amount of effort they would put in, because this is part of their supply and confidence agreement and selling many parts of their party's soul to prop up a government. They're voting in favour of time allocation and all kinds of other pieces that would make the previous iterations of this party roll over in their graves.

To get back to this piece of this particular legislation, which is the continuation of the national bulk purchasing strategy, this legislation makes it sound as if this is somehow a brilliant new thing that is going to revolutionize the way Canadians access their medication and that somehow we're not already paying fair prices. We heard in witness testimony, although it was very limited witness testimony, that a national bulk purchasing strategy already exists.

It was frustrating when we were hearing from the witnesses. Normally, the tradition of this committee is that we find out in advance who has invited each one of the witnesses. It gives us an opportunity to better prepare as we go forward, yet in this particular case, we didn't find out who invited the various witnesses. In fact, it's worth noting for the record that we still don't know who invited which particular witness. I have some theories as to which party invited the majority of the witnesses, based on some of the testimony that came out, but we don't actually know which party was responsible for inviting most of the witnesses, which is the standard tradition here.

My question for the officials here is whether Canada already has a national bulk purchasing strategy.

[Daniel MacDonald, Director General, Office of Pharmaceuticals Management Strategies, Strategic Policy Branch, Department of Health]

There are two parts to the answer to that question.

The first is that Canada has, through the support of provinces and territories, the pan-Canadian Pharmaceutical Alliance, which has existed since 2010. It reports that as of April 1, 2023, savings from the activities participating in public drug plans are estimated to be $3.89 billion annually.

With respect to the context of the bill itself, it refers to the development of a national bulk purchasing strategy advice coming from the Canadian drug agency. That, as yet, does not exist.

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

Thank you. I appreciate that.

The continuation of a national bulk purchasing strategy wouldn't necessarily contravene anything that Canada is currently doing. Is that correct?

[Daniel MacDonald]

With respect to what Bill C-64 commits to, which is the generation of advice, upon request, to the minister, that would not be being continued, because it doesn't exist yet.

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

Thank you. I appreciate that.

Ms. Boudreau, perhaps you can answer my next question.

On Thursday I asked how long you guys had been working on this particular bill. At one point you said a few months, then a year, and then it was back to a couple of months. Have you been able to clarify how long you've been working on this bill?

[Michelle Boudreau]

We have been able to do that. I will ask my colleague to do it, simply because he wrote down all the numbers before we came. My recollection from my response was about the amount of time we had spent working on some of the policy work, and then about when we started the actual drafting.

I'll let my colleague fill in those numbers for you.