Citizenship and Immigration Committee on Feb. 3rd, 2011

[Normand Cadieux]

Yes, absolutely. There would still be programming to be done, because coverage under each federal program is different. So, there are some adjustments to be made. However, other federal programs—I'm not sure which ones—also use Medavie Blue Cross. Of the four agreements that we have, at least two use this company. I believe Veterans Affairs and the RCMP also have contracted with Medavie Blue Cross for reimbursement of services. So, obviously it would be quicker. Some programming would need to be done, as each agreement does not provide the exact same coverage.

[The Chair, Conservative, David Tilson]

Ms. Chow.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Sorry, my French is not good enough to express my question.

You have no problem with the federal government having a contract with Blue Cross. You want a separate agreement so you can build the electronic interface and see the list of drugs that are going to be paid by Blue Cross through the federal government. Then you will be able to give the drugs to refugees coming in, knowing full well you will get automatic payment.

Am I correct so far?

[Normand Cadieux]

Yes.

[Olivia Chow, NDP, Trinity—Spadina, ON]

We see that 265 pharmacists have signed the agreement with Blue Cross and the federal government. Does your association represent the rest of the pharmacists? Perhaps you can explain it, because I'm not from Quebec and I don't understand it. We don't have such a being in Ontario--maybe we should. So how does that agreement help these other pharmacists?

[Normand Cadieux]

I am going to answer in French.

There are 1,800 pharmacies in Quebec. The Department of Citizenship and Immigration tells us that over 200 pharmacists have registered with Medavie Blue Cross. We are not aware of that, and even if they have sent their files to Medavie Blue Cross, they cannot work with them, because the electronic connection has not been established. So even if they are registered, that means absolutely nothing because it cannot work. But when it works and the connection is established electronically, it is either going to work for everyone or no one. It cannot just work partially. The 236 pharmacists cannot use this method and communicate with Medavie Blue Cross electronically, because the connection has not been established.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Is this the agreement with Blue Cross or with the federal government? Why do you need that, as long as Blue Cross can pay directly to you?

I am covered through Sun Life, for example, and I imagine it's the insurance company that pays the pharmacy, so it sees the number and then gets paid. It's automatic. Why isn't that set up in Quebec?

[Normand Cadieux]

For example, our agreement with the Quebec government for the provincial plan has been signed with the Department of Health because the department is the insurer. The department is the administrator and it is responsible for the program. The Régie de l'assurance maladie du Québec, which is the equivalent of the Ontario Drug Benefit Program, is a go-between that administers the agreement that was negotiated between pharmacists and the department.

It’s the same thing for us: we negotiate an agreement with CIC, and Medavie Blue Cross is the administrator that handles the claims.

[Olivia Chow, NDP, Trinity—Spadina, ON]

I see. So your organization has a contract with the Quebec government and it manages the payment. Does it have a go-between person? Does it have something like Blue Cross that works with you, or is it directly with the Ministry of Health?

[Normand Cadieux]

The go-between is RAMQ, the same as the ODB in Ontario.

In Ontario, pharmacists do not negotiate an agreement because they do not have a union. They fall under corporations and corporations are not allowed to negotiate with anyone because that would contravene the Competition Act. So the Ontario government sets up its own program and submits it to the ODB to manage.

The same thing goes for Quebec. They negotiate with the government, with the department of health and social services, and the department lets the Régie de l'assurance maladie du Québec manage the program.

We can draw a parallel. In this case, the Régie de l'assurance maladie du Québec would be Medavie Blue Cross. However, the agreement has to be with CIC because CIC is responsible for the program.

[Olivia Chow, NDP, Trinity—Spadina, ON]

So you are essentially asking for the same thing as your agreement with the Quebec government. You are asking for the same kind of agreement with the federal government, together with Blue Cross. It would be a three-part agreement that could be locked into a system for our payment.

Am I correct on that?

[Normand Cadieux]

We are not asking for exactly the same thing. I believe the structure is similar. In my view, what we are asking for is more similar to our agreement with the federal government for the other four groups, meaning first nations, the RCMP, the Department of Veterans Affairs, and so on.

There already is an agreement. There is an agreement with the federal government that was signed by four different groups. All that is left to do is for the Department of Citizenship and Immigration to take the agreement and adjust the coverage of services and products it wants to pay for. It does not have to pay for the same products and services as the others. It has its own plan. If the department works with Medavie Blue Cross, it will be able to change the coverage at any time. It won’t even have to let the pharmacists know, since everything will be done electronically. So, when the pharmacist sends a claim, Medavie Blue Cross will say whether it is covered or not through the electronic system.

There already are agreements in place and they leave plenty of leeway. There was a lack of understanding on CIC's part, but they have complete freedom to adjust the coverage. CIC is in charge of that, not us. We just want to set the terms and conditions that govern our relationship with the government in order to make sure that we provide the right services and the right products, which are reimbursed under the plan, and that pharmacists will be paid within a reasonable timeframe.

[Olivia Chow, NDP, Trinity—Spadina, ON]

How long have you been negotiating?

[The Chair, Conservative, David Tilson]

Mr. Dykstra, please.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you, Chair.

First off, it's easy to sink into the details of this, but you were negotiating confidentially with the ministry on working through this. This process now opens it up for public consumption, I suppose, and could potentially hurt your negotiations with CIC. But you're here. You were invited to come here and you said yes, so I assume you are comfortable with whatever the outcome of the meetings or process with this committee is going to be.

[Normand Cadieux]

We hope the committee will help to clarify the situation in Quebec so that CIC will want to reach an agreement with us. That’s our only expectation.

[Rick Dykstra, Conservative, St. Catharines, ON]

All of the other provinces and territories deal through the provider of the service on behalf of the ministry. We went through a competitive process and Blue Cross won. Why won't you deal with them? Why is that a problem? When the federal government appoints an organization to represent it, in almost all circumstances the partner or the deliverer of the service, in this case the pharmacist, deals with Blue Cross. You want to deal directly with the ministry. Why are you special?

[Normand Cadieux]

It's because that's the way we work in Quebec.

In Quebec, we never work with third parties, because they are just administrators, go-betweens. It’s the same thing in all circumstances in Quebec, whether with the Quebec government or the federal government. It’s like that with all federal departments, with private paying third parties and with private insurance companies. Our agreements are signed with the payers, the insurers, not with go-betweens.

[Rick Dykstra, Conservative, St. Catharines, ON]

In one of the points that you made earlier after Ms. Chow's question, you said that this would be a benefit to the ministry because once the terms of the agreement are in place—

[Normand Cadieux]

I'm sorry, I can't hear you.

[Rick Dykstra, Conservative, St. Catharines, ON]

Sorry, I have a really sore throat. I need a pharmacist.

In response to one of the things that Ms. Chow had asked about, you said that this was better for the ministry because of the benefits it would bring. It seems to me that the benefits would go to the pharmacists, because you're able to deal directly with the ministry in the negotiations. I'm sure you're not allowing CIC to set the agenda of what the agreement is going to be. You're in there negotiating what you think the terms of the agreement should be to the benefit of pharmacists. It seems to me it's more of a benefit to you than it is to the ministry.

[Normand Cadieux]

I don't see how it would be more of a benefit to the pharmacist. There is perhaps some confusion on this. To date, there have been no discussions on service costs or on reimbursing the pharmacist’s service costs; discussions have always revolved around what got paid and what didn’t, payment delays, in short all the terms and conditions of the agreement. Clearly, we don’t want to deal with third parties because they are not the ones that make those decisions. It is the insurer, CIC in this case.

Pharmacists don’t have a contractual link with Medavie Blue Cross. In all the agreements in Quebec, contracts are with the insurance companies. The only link between the pharmacist and the third party, Medavie Blue Cross in this case, is a direct deposit form for bank transfers. There is no other agreement between the intermediary and the pharmacist. So we clearly don’t want to go down that path because it is not the way things are managed in Quebec. The system is already set up for all the other federal departments, so we don't see why it wouldn't be possible to reach an agreement with CIC very quickly. I believe the possibility is there. There is some resistance, and we don’t really understand why.

[Rick Dykstra, Conservative, St. Catharines, ON]

Let me back up to the very beginning.

The ministry offered up to five times prior to your January 31st meeting to try to sit down and negotiate. You said in your presentation that you were trying to get meetings with the ministry when in fact the ministry tried to contact you and set meetings up five times prior to the first meeting you had on January 31. You're smiling, so I guess you don't agree with what the ministry has told me.

[Normand Cadieux]

No. There has been no request—

[Rick Dykstra, Conservative, St. Catharines, ON]

I'm listening closely, don't worry.