Thank you, Mr. Chair, for giving me the honour of being able to speak to the committee.
I'm Tom McLaughlin, a clinical assistant professor at the University of British Columbia and a pediatrician on the in-patient unit at BC Children's Hospital, where I take care of some of the sickest and most complex patients in the province. I also lead the Canadian Paediatric Society's work on pharmacare. I do research and policy work on children's drug insurance, pediatric formulations and, more recently, drug shortages.
Clinically, I have the best job in the world. Much like Dr. Lynk, I get to help children survive illness, thrive and develop into wonderful people. A big part of how I do that is by prescribing medications. Drugs allow us to easily treat once-lethal infections, help kids focus at school and, more recently, allow children with rare and devastating illnesses to live and lead better lives.
Despite this promise, Canadians struggle to access the drugs they need. Canada is the only rich country with universal health care that is without universal drug insurance. Almost one in 10 Canadians can't afford prescriptions, and almost a million reduce heat or food to afford drugs. This impacts all Canadians, but children face additional barriers to accessing drugs. This is because Canadian policies, largely federal policies, governing the development, approval and reimbursement of drugs, are largely designed for adults.
First, children have unique drug needs. Young children often need liquid medications. However, many drugs are available only as tablets. This means that drugs are compounded, where the tab is crushed and mixed with something by either a pharmacist or a caregiver. Almost 75% of prescriptions for kids are compounded. It might seem trivial to be talking about mixing pills with applesauce on the kitchen table, but this causes real harm. An eight-year-old boy in Mississauga named Andrew died a few years ago from a compounding error, and many more have been harmed by dosing errors.
Another unique issue in pediatrics is the prevalence of high-cost drugs for rare diseases. Despite the name, rare diseases are not rare in children. Almost one in 10 Canadians has a rare disease, and 70% are children.
A second issue is our regulatory system. Health Canada doesn't currently require manufacturers to apply for a pediatric indication or use for a drug, even when studies exist to support pediatric prescribing or where that use is expected—for example, for a new antibiotic. As a result, over 80% of pediatric prescriptions are off-label, meaning they're used in a way that hasn't been rigorously analyzed and approved by Health Canada.
Many drugs that are available in other countries aren't available in Canada at all, requiring importing drugs through our special access program. Even when drugs are approved, they aren't necessarily covered by provincial or federal public drug insurance programs that poorer families rely on.
Currently, federal agencies, or INESSS in Quebec, perform an economic analysis on new drugs, comparing their costs and impact on mortality and quality of life. For many pediatric conditions, this data just doesn't exist, so this analysis is very limited. It also doesn't capture the economic impacts outside the health care system. Treating a child with ADHD medications may help them stay at school and not require expensive educational supports, or it might allow a caregiver to go back to work. The harms of compounding aren't captured in reimbursement recommendations either.
All of this means that public drug formularies, the lists of covered drugs, can and do exclude important evidence-based drugs for kids. As a result, drug coverage for low-income families who depend on public formularies is extremely variable. In my own unpublished research, I show that children with common conditions like asthma and ADHD may have 100% of their drugs covered or 0%, up to $1,500 a year, depending on which province they live in.
What can the federal government do? The Canada pharmacare act, planned by the end of 2023, promises to ensure universal, comprehensive and affordable drug access for all Canadians, but it should also address the unique barriers that Canadian kids face accessing needed medications.
We should modernize Canada's regulatory system to reduce the need for off-label prescribing and increase access to safe liquid formulations. We should implement a pediatric rule, as many countries have done, whereby manufacturers must proactively develop pediatric studies and apply for a pediatric approval when they apply for an adult one.
We should support the national strategy for high-cost drugs for rare diseases with investment proportional to the disease burden in kids and support the pipeline for innovative treatments. I suspect my colleague, Dr. Verchere, will discuss this.
We should develop a pan-Canadian evidence-informed pediatric drug formulary, as Dr. Lynk said, that appropriately values liquid medications and the economic impacts of pediatric drugs outside the health care system. We should also work with provinces to ensure that a child's postal code doesn't impact their coverage for drugs.
Children deserve the same access to safe, effective and available drugs that adults have in Canada. I hope this committee can help us get there.
Thank you.