Health Committee on May 27th, 2024

[Michelle Boudreau]

In fact, CDA is being built from CADTH. CADTH continues to exist in the sense of the people who work there and its structure, etc. With the activities that are being added to CADTH, which are set out in the legislation in clause 7, as you noted, CADTH is growing into, if I can put it that way, the nucleus of the CDA.

If you'll permit me, Chair, I would like to make a couple of comments on the earlier questions. It may help to clarify the difference between the pCPA and the purchasing strategy that's mentioned in the bill. Again, in the hope that this would be helpful, I just want to point out a couple of differences in the pCPA.

My colleague noted, as you did, that it is in regard to the negotiation of prices for public plans only. It's just public plans and negotiations of prices. The pCPA, in fact, does two things.

One by one, it negotiates prices. It does have product listing agreements, product by product. Then it has a framework with respect to generic drugs, which has been in place for some time. I think whether that could be called a “bulk purchasing strategy” is really something you'd have to ask the pCPA itself. I would leave that to you to consider, but those are the two fundamental things that it does.

The other thing I want to point out is that the pCPA, in its negotiations, is a price negotiator for pharmaceutical products only. When we speak about the strategy, if you look at the term that's used, you see that we use a broader term, which is “pharmaceutical products”. That's related products. In that sense, because some of those products could be, at a point in time, in the context of bilateral agreements, it could certainly go beyond just the pharmaceutical products that are being negotiated for prices only in the context of the pCPA.

The final thing I want to note, as I mentioned earlier, is that the pCPA is the price negotiator for public plans, but there are also other procurement—I'll use the word “procurement”, even though that isn't necessarily what they do—reimbursement organizations or entities for products in Canada, such as hospitals and cancer agencies. Those types of things would not be part of the pCPA.

Finally, you noted a question on vision. I do just want the committee to know that in leading up to the CDA and the creation and context of what the activities of the CDA would be— which is reflected in the bill in the context of the minister being able to ask advice from the CDA—there was a transition office that did a lot of work looking at where there might be areas of improvement. In fact, that's the vision piece. The view is that there is room for improvement, as there often is, even though the pCPA has been in place since about 2010.

I just want to give a little bit of that context. I hope it's helpful.

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

Thanks very much for that.

Through you, Chair, I have a couple of follow-up questions related to that.

Interestingly enough, if we're going to ask the CDA to do things that the pCPA is already doing, to me that would be redundant. If we're going to ask them to do things similar to what CADTH is already doing, why would we want to spell that out? I guess that's another part of it. I would consider this a national bulk purchasing strategy, given the fact that they negotiate one price for medications for all public plans, if I'm not mistaken. If I am, please correct me.

I think the final thing—maybe I'll save it for later, but I'll give you some food for thought—is on budgets for CADTH and the CDA, and understanding that there is a cost associated with the stand-up of a new agency that should be talked about in here. I won't ask you that now, but I'd like to give you a heads-up. Perhaps you have the information with you. Perhaps you don't. If you don't, we'd love to hear that at some point.

Obviously, if we're negotiating one price for medications such as metformin on public plans, that would be, in my mind—and I believe in the minds of Canadians—a national bulk purchasing strategy, even though, as you mentioned, you could certainly add on other agencies, such as hospitals. There's no issue with that, although they benefit, certainly, from similar prices, as they do elsewhere. If the Canadian drug agency is taking over for CADTH and they already do these things, why would we need to spell that out? This would be a continuation of that work.

[Michelle Boudreau]

I may not have been clear.

In the way CADTH functioned before moving towards becoming the CDA, it was quite limited to what we call “health technology assessment”. The functions and activities that would be added are what's set out in the legislation. There will be more happening within the context of the new CDA than what is currently done by CADTH.

Finally, I'll just note that the pCPA is a construct of the provinces and territories. What you see in the bill is that before the CDA develops any advice or the minister asks for advice vis-à-vis some of the functions the CDA will do, there will be consultations with the provinces and territories as well. In fact, there will be collaboration and a lot of close work with the pCPA.

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

Thanks very much for that, Ms. Boudreau.

Through you, Chair, I guess I'm still struggling with understanding this.

We're adding another layer of bureaucracy here. That is what it sounds like to me. Even though we have something that's functioning—the pCPA—and it's negotiating the national prices for medications....

As I said, let's take this medication called metformin as a very specific instance. That price is being negotiated on a national basis for public plans. Why would we need another agency to provide more advice? If there are already negotiations that exist generally for public plans, why would we need more input? I don't understand that. If you could explain it for Canadians, I'd love to hear it.

[Michelle Boudreau]

I would come back again to the functions that the CDA will undertake that go beyond what CADTH does now: data analyses and a lot of work around appropriate use. All of these things will inform how the strategy can come together. None of these activities are currently done by the pCPA.

If you look at the activities that are set out in the bill, you will see the expanded work that the CDA will be able to do and what they will then be able to bring to inform a strategy, which the pCPA doesn't currently do.

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

Thanks for that.

Through you, Chair, it's interesting. You talk about appropriate use, and I certainly think that at some point, we'll come to that, and it would be a shame if, for this pamphlet that's being rammed through, we couldn't get to that amendment related to appropriate use specifically and debate it. On behalf of my physician colleagues, I would certainly suggest that the last thing we need is another government agency telling independent practitioners, who've been educated by our great country, which drugs to use in certain situations. To me, that seems overly draconian and a significant violation of the ability to prescribe medications.

In the system that currently exists, a prescription does not even need to have an indication on it. Therefore, having a government agency begin to encroach on the independent nature of the practice of medicine seems like significantly burdensome and troublesome government overreach. Again, it's about the vagueness of the wording that exists.

I wish I could sit here and say that I'll take the government at their word that there will not be that significant overreach and interference with respect to the independent practice of medicine. However, I don't believe that to be true, so when I look at the next several paragraphs, these are going to be incredibly troublesome, again given the potential for government meddling in independent practice. Government interference is something that I can only hope will not come to fruition, and it's certainly something that I know my Conservative colleagues and I will be quite happy to fight against.

We know that many medications are used in an off-label fashion, which concerns me significantly. Not only this bill—and I'll mention this for only a second, Chair, so that Mr. Julian doesn't lose his mind over it—but also the Budget Implementation Act that exists now talks about a significant increase in ministerial powers with the ability to limit things like off-label use, when we know that every single pediatric medication that is out there, with perhaps the exception of antibiotics, is used in an off-label fashion because there are very few studies done on pediatric patients to give a specific indication.

To me, the appropriate use clause that exists in this pharmacare pamphlet indicates significant bureaucratic government overreach and interference with respect to the independent practice of medicine.

Certainly we've seen it. I've experienced it before in medical practice, when people who have not even examined a particular patient will want to argue with the physician about the diagnosis. From afar, from a referee's chair at a tennis match, they would like to say, “Hey, this is not correct. That's not the diagnosis. It's not what should be happening”, etc., when oftentimes somebody has had a significant and long-term relationship with a patient, including multiple medical trials and multiple consultations for a diagnosis.

Looking further down the road, I'll be happy to repeat these comments when that time comes, but I want to get them on the record, because it's very likely we will not get to those amendments, and they will be rammed through on a vote without any significant consideration by this committee, much in the way the rest of this bill has been, which, I will say on behalf of Canadians, is a travesty.

Chair, if there are no other ideas, I'm certainly happy to cede the floor and move on to a vote with respect to this particular amendment.

[The Chair, Liberal, Sean Casey]

Mr. Julian, go ahead, please.

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

Thank you, Mr. Chair.

I'll note that the Conservatives have allowed one amendment to be voted on in three hours. Thousands and thousands of dollars of committee time have been devoted to this study, and the Conservatives' filibuster blocking this legislation, as they have been blocking it since February 29, has meant that Canadian taxpayers, folks who are working hard trying to make ends meet, have seen thousands of their tax dollars going into a filibuster to block legislation that is going to help people.

I want to address the national bulk purchasing strategy, because it is true that Canadians pay more, and they pay more because of Conservative government decisions to extend patent protection. It was a beautiful sweetheart deal by a former Conservative government that extended patent protection so that Canadians pay unbelievably high drug prices. It was Conservatives who caused that, and instead of saying, “Gee, we're sorry, Canada. We apologize for everything we've done to wreck your access to medication”, we have Conservatives filibustering the next step, which is having a national bulk purchasing strategy that, through universal single-payer pharmacare, would allow us to bring the cost of those drugs down.

When New Zealand did the same thing, Mr. Chair—and I know you're aware of that—the cost of some drugs went down by 90%. Not only does this bill, Bill C-64, enhance Canadians' ability to access medication—diabetes medication and contraceptive medication and devices—but by putting in place a national bulk purchasing strategy, it also allows us to start what other countries have already found, which is, rather than paying massive prices and extending patent protection to the pharmaceutical industry with the huge costs that has entailed—it's made huge profits, and lobbyists are happy—having a national drug purchasing policy that will allow us to follow the lead of countries like New Zealand that have reduced the cost by 90%.

What this Conservative amendment, CPC-9, proposes to do is stop that, freeze it in place and not allow the bill to move further so that we can have in place a national drug purchasing strategy that goes beyond diabetes and contraceptives. I oppose this.

It's been three hours. Conservatives have allowed one amendment to come to a vote. I wish they would stop doing this, as it's not in the interest of their constituents or of any Canadians for them to continue as they have since February 29 in blocking this legislation.

[The Chair, Liberal, Sean Casey]

Mrs. Goodridge, go ahead, please.

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

Thank you, Chair.

It's worth noting that Mr. Julian has found the need to interject at every available opportunity and continues to mislead Canadians by saying that it's been three hours, when the reality is this meeting had quite a late start. It's been less than two and a half hours, but that falls into a space of semantics.

I get frustrated when they continually try to say this is a pharmacare bill when the entire guise of this bill is creating or looking at two separate categories of pharmaceuticals. It's been mentioned many times in this meeting that heart pills aren't included. That variety of medication isn't included, so this is not, in fact, pharmacare. Perhaps, at very best—and this is being overly generous—it is a very small step towards pharmacare. The reality is that it's not. It's a pamphlet that agrees to certain categories and to possibly, one day, look into creating something, but it really is just a way for the Liberals to get votes so they can do whatever they want, act like they're in a majority government and have the NDP hold the bag all the way along, tanking both of their polls in the process.

This is something Canadians need to hear very clearly. If they were so proud of this bill and thought it was so wonderful, they would have allowed a bit more time for these kinds of conversations.

The fact is that while we were midway through listening to the witnesses on Friday—and witnesses are where we're in theory supposed to get some of the amendments—the due date was also the due time for having the amendments in, so it was impossible to have amendments in for all the witnesses we heard from, because any witness we heard from after 2 p.m. on Friday.... Our ability to write the amendment, get it to the legislative clerks, get it translated and get it off to the clerk was pushing the bounds of what was possible. If this government really cared about democracy, they would have extended the deadline for amendments until today. Then we could have had the clause-by-clause study tomorrow and been in a much better situation.

We're here because they decided to ram this through, since they've failed to plan to do anything they told Canadians they would do. This is a pattern of behaviour by this NDP-Liberal government. They continually tell Canadians they're going to do something, fail to do it, then blame Canadians.

I'm going to bring up the fact that this is not a pharmacare bill. I will join in some of the conversations of my other colleagues. Rather than continue to belabour the point, I will cede the floor. I hope we can have a swift vote on this and get to the rest of the amendments, because there are some that I think are very important and will make this bill better, even though I don't think this is a very good bill to begin with.

Thank you, Mr. Chair.

[The Chair, Liberal, Sean Casey]

That is all for the speaking list.

Are you ready for the question? Shall CPC-9 carry?

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

Excuse me, Chair. I'd like to request a recorded division.

[The Chair, Liberal, Sean Casey]

Madam Clerk, call the vote on CPC-9.

(Amendment negatived on division: nays 7; yeas 4)

How do people feel about a 10-minute health break? Is there any strong opposition to that?

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

Mr. Chair, if we have a 10-minute health break, I would ask that we extend the meeting by 10 minutes, considering we started late.

[The Chair, Liberal, Sean Casey]

Very well. I'll ask the vice-chair to take the chair, please.

Thank you.

[The Vice-Chair, Conservative, Stephen Ellis]

Just so everyone's aware, we just did amendment CPC-9, which was defeated.

The next question is, shall clause 3 carry?

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

On division.

(Clause 3 agreed to on division)

(On clause 4)

[The Vice-Chair, Conservative, Stephen Ellis]

We are now moving on to clause 4. There are amendments, starting with CPC-10.

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

Mr. Chair—

[The Vice-Chair, Conservative, Stephen Ellis]

Please go ahead, Mrs. Goodridge.

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

I would like to move CPC-11.

[The Vice-Chair, Conservative, Stephen Ellis]

Very good.

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

The reason I'm choosing to skip CPC-10 is we had the conversation on the verbiage when it came to the conversation around “Indigenous peoples” and “Indigenous governing bodies”. Therefore, I would withdraw it.

Can we have unanimous consent to withdraw CPC-10?

[The Vice-Chair, Conservative, Stephen Ellis]

Excuse me, Mrs. Goodridge. I don't believe it's necessary to have unanimous consent if nobody moves that particular motion.

That being said, as CPC-10 has been not moved at all, we'll move on to CPC-11.

Go ahead, Mrs. Goodridge.

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

Thank you, Mr. Chair.

I'm sorry. I was just trying to save a bit of time to get back some of the time that's been filibustered by the NDP members on this committee. I love that. At least he understands what he's doing.

Anyway, the amendment here is to amend clause 4 by replacing line 20 on page 3 with:

that is more consistent across Canada, in order to avoid a patchwork of care;

I believe it's absolutely important that we address the inconsistency in coverage that already exists in the Canadian context. This bill, as it is currently written, doesn't necessarily deal with that piece. Therefore, this is part of the amendment, which I think is a very common-sense amendment, and I would urge all of my colleagues to vote in favour of it. This will strengthen the legislation and help remove the patchwork side.