Citizenship and Immigration Committee on Feb. 3rd, 2011

[Normand Cadieux]

When we make an agreement with a group or an insurer, each of the 1,800 pharmacists in Quebec are bound by the agreement that was signed. They are legally obligated to respect the agreement. Obviously, when there's a problem, they can turn to us for help resolving it.

They often automatically turn to us. Sometimes they go and resolve it directly.

[Devinder Shory, Conservative, Calgary Northeast, AB]

Just one last question, Mr. Chair, if you'll allow me.

It doesn't answer my question because my question was, have they sent any message to their membership asking for a list?

[Normand Cadieux]

The answer is no, sir.

[The Chair, Conservative, David Tilson]

At that point, we're going to conclude.

Monsieur Cadieux, Monsieur Forcier, I want to thank you for coming and giving us your views on this topic.

We will suspend.

[The Chair, Conservative, David Tilson]

Thank you, ladies and gentlemen. We're going to reconvene. We now have with us our guests, our witnesses, two representatives from the Department of Citizenship and Immigration: Dr. Danielle Grondin and Monsieur Albert Deschamps.

One of you is making a presentation. We have your written comments before us.

Dr. Grondin, you have up to seven minutes to make your presentation to us.

[Dr. Danielle Grondin, Director General, Health, Department of Citizenship and Immigration]

In fact, Mr. Chair, my colleague will give the presentation.

Thank you.

[Albert Deschamps, Director General, Regional Headquarters, Department of Citizenship and Immigration]

Thank you, Mr. Chairman.

My name is Albert Deschamps. I'm regional director for Citizenship and Immigration Canada for the Quebec region. As you mentioned, I'm accompanied today by Dr. Danielle Grondin, the director general of CIC's health branch.

I would like to thank the committee for inviting us here today and for taking notice of this important issue. CIC strives to provide refugees with the best health care possible. The interim federal health program provides emergency and essential health services to refugees, refugee claimants, and others who have not yet received provincial or territorial health coverage.

The IFHP has a transitional role only and is not designed to replace provincial or territorial health insurance programs, but provides coverage to eligible individuals prior to qualifying for provincial or territorial coverage.

The IFHP does not pay the beneficiaries but reimburses the providers of health care services the cost of such care. Participating providers, physicians, dentists, hospitals, clinics, pharmacists, etc., are reimbursed directly for services rendered to eligible beneficiaries by submitting invoices to the IFH claims administrator.

The IFHP serves approximately 128,000 recipients in Canada and about 25,000 in Quebec through a network of over 18,000 registered health care providers across Canada. In 2009-10 overall costs under the IFH program were $80 million--$20 million for Quebec. The IFHP medication costs for Canada were $14 million, of which $5.5 million were in Quebec.

On January 17, 2011, as a result of a competitive process, Medavie Blue Cross assumed responsibility for the administration of the interim federal health program.

As the committee is aware, on this date, the Association québécoise des pharmaciens propriétaires had also encouraged its members to not participate to the new electronic system put in place by Medavie Blue Cross. This was an important concern for CIC, since refugees do not have the means to pay for their prescriptions without the assurance of this program.

Today, I am pleased to report to the committee that much progress has since been achieved on this issue. On January 31, officials from CIC and the AQPP met in Montreal for an initial discussion regarding pharmacy services in Quebec and the IFHP. A temporary arrangement has been established in order to ensure that the IFHP beneficiaries who are prescribed medication can access that medication.

As of yesterday, February 2, the AQPP advised its members to resume offering regular services to IFHP beneficiaries while discussions between the parties continue.

Let me give you some background on how we got here. On January 17, 2011, Medavie Blue Cross assumed responsibility for the administration of the program, providing electronic claims adjudication services, including service standards. This modernized service will allow providers to determine eligibility of clients, services, and costs eligible for reimbursement. It would also allow for rapid reimbursement to health providers.

However, as pharmacists were being asked to register with the new administrator, the AQPP gave instructions to the software developer to not program the pharmacist's system, thus depriving them of the tool that would inform them of client eligibility, services covered and costs. It informed its members accordingly.

We acknowledge that in the past concerns were periodically raised with regard to delays in their reimbursement system, which was paper-based. However, when such claims were brought to our attention, they were fully reviewed and adjudicated. In some cases, the IFHP did reimburse the claim, but in the majority of them the claim was not eligible or only partly eligible for reimbursement. This was primarily because the product or service provided was not covered by the IFHP.

The AQPP hasn't submitted to CIC any other claims to consider in recent months, and I'm pleased to report that, as of today, all outstanding claims that we have been made aware of have been reviewed and adjudicated.

We have also reached out to pharmacists in Quebec to contact CIC if they have any claims that were submitted more than a month ago that have not yet been reimbursed.

As of January 17, as part of service standards, claims submitted electronically will now be processed in two weeks. Claims submitted by mail directly to Medavie Blue Cross will be processed within three weeks. In good faith we will continue our discussions with the AQPP, and we're hopeful that we will arrive at a solution that will satisfy both parties in order to continue to deliver health services to refugees under the IFHP.

[The Chair, Conservative, David Tilson]

Thank you, Mr. Deschamps.

Mr. Wrzesnewskyj has some questions for you.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

Thank you.

Mr. Deschamps, when approximately did the administrator start signing up with individual pharmacies in Quebec? There are 265 signed up. When did that process begin?

[Albert Deschamps]

The start date with the new administrator was January 17, and actually while they were getting ready for implementation of the new administrator, pharmacists had the possibility to register as of last November. We have been made aware that there have been some since then who have registered with Medavie Blue Cross.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

Is the number 265 correct?

[Albert Deschamps]

It has been increasing every week. I think we're over 300 as of today.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

I see.

I would assume that pharmacies in rural Quebec and northern Quebec, where typically they wouldn't get refugees coming in for pharmaceutical services, aren't necessarily signing up. Would there be a concentration of pharmacists signing up in urban areas where there would be refugee claimants?

[Albert Deschamps]

I think that's a fair statement.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

So a large proportion of refugee claimants would in fact be provided with the pharmaceutical services they require.

[Albert Deschamps]

Yes. I would assume that since most refugee claimants and other beneficiaries are in urban areas, and that the pharmacies that have registered are mostly in those areas, services to that population are being provided.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

I noticed that you listed many thousands of individual--I guess--providers that have been signed up across the country. In most cases these are individual pharmacists and pharmacy chains, etc. Is that how it works?

[Albert Deschamps]

That's correct. I think the arrangements are made between individual pharmacists and the claims administrator, which as of January 17 is Medavie Blue Cross.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

Did the department approach the association of pharmacists in Quebec at the same time or prior to, or was it only after they began the process of signing up individual pharmacists with the new administrator?

[Albert Deschamps]

My understanding is that we've been saying the same thing. We're encouraging individual pharmacists to register with Medavie Blue Cross, and we were trying to convey to the AQPP that it's in the best interest of all parties for individual pharmacists of Quebec to register with Medavie Blue Cross.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

It appears that any delays in providing pharmaceutical services for refugee claimants in Quebec would have been a consequence of decisions made by the association in its communications to individual pharmacists not to sign up with the electronic services. Would that be a fair statement?

[Albert Deschamps]

I'm not sure there were individuals who, at the end of the day, did not get their medication. It may have been more of a hassle or more inconvenient for those beneficiaries to get what they needed, but I think measures were put in place so that they would not be deprived. But there may have been an inconvenience.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

So most pharmacists in fact conducted themselves according to their code of ethics, which was referenced before, and did provide the drugs required by these refugees who would come in. None were told that they would actually have to pay out of their own pockets?

[Albert Deschamps]

I think the majority got the medication they needed on the spot. As was mentioned earlier, some were referred to front-line health services in Quebec.

I'm not aware of any pharmacist who completely refused to help a refugee claimant or other beneficiaries of the program.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

So all of the pharmacists who have signed up are currently on the electronic system in terms of verifications and checks?