Citizenship and Immigration Committee on Feb. 3rd, 2011

[Albert Deschamps]

I hope not.

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

Thank you.

I'll turn my time over to Ms. Grewal.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Thank you.

I just wonder what kinds of clients are there on the interim federal health plan, and what kinds of medical conditions might they have.

[Dr. Danielle Grondin]

I missed the first question. What type of...?

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

What kinds of clients are there on the interim federal health plan?

[Dr. Danielle Grondin]

In fact, I have some statistics here.

Basically, as was mentioned, there are refugee claimants, who are either waiting for their claims or whose claims have been rejected and are awaiting their removal from Canada. So these are covered.

There are resettled convention refugees, but there are also victims of trafficking. There are also border agency detainees. And there is a unique population, as in Quebec right now with the Haitian population, which is also covered by those programs.

As to the types of conditions, not all of the eligible clients will use the pharmaceutical services. For example, it varies from 78% for those who are refugee claimants to 48% of the resettled.

On the conditions, we have done a survey of the 200 most used pharmaceuticals. Roughly 14% to 17% are for anti-infectious medication and heart conditions. These are the most frequently prescribed medications. Then you have those for neurological disorders, to treat mental illness, depression, schizophrenia, and those types of things. Those are in the second group, and so on, concluding with gastrointestinal and others.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

As you know, the pharmacists have been complaining about fee reimbursements and payments that are overdue. How are you addressing this problem and what actions have you taken from December onward to address this issue raised by pharmacists?

[Dr. Danielle Grondin]

I can answer that, if I may, since our office has dealt with it. In fact, yes, we were aware there were delays, so we have reviewed all the claims that we received. Either they have been paid—those that were delayed, and it was a real payment—or they were adjudicated and the pharmacist was informed that either it was not eligible or...and so on. So this is one category.

Last year as well we reassessed some claims that the AQPP sent to us for reconsideration. All of these have also been reviewed and decisions were made. Of those, most of them were ineligible; that is, it was not covered or the client was not eligible, and so on.

We have heard about the allegation that there was a three-month delay; however, we have no evidence that there was a three-month delay. We have no documents, and documents have not been submitted, either by the pharmacist in question or the AQPP, that prove or demonstrate that there were such payment delays for $10,000 or $30,000, as we have heard.

We have invited the pharmacists, certainly, over the course of the last few weeks, especially those registered, to please submit. We have given an address, fax number, and everything to submit those claims. But so far, at this date, it's all adjudicated.

[The Chair, Conservative, David Tilson]

Mr. Trudeau will have the last word. I'd like to go in camera for a few minutes after Mr. Trudeau asks his questions.

[Justin Trudeau, Liberal, Papineau, QC]

Thank you, Chair.

I'd like to return to something that was established in the beginning. There was an agreement in the 1990s, and then about four years ago, according to the AQPP, things shifted. Why did things change, and is that in fact the case?

[Dr. Danielle Grondin]

In fact, with regard to this report of an agreement in 1991, we have no evidence of that. At that time, it was Health Canada that had that program under the non-insured health benefits program. It was transferred to CIC in 1994. We never received any evidence that there was such an agreement until we met Monday, and we heard it again today, which is the second time we heard about such an agreement. But we have not found it, and we have not been provided with this by the AQPP. So this is something that would be interesting.

Also, it's important to point out that the AQPP and the pharmacists in Quebec were functioning all those years, since 1994, that we had the program and never made this request for a special entente. It was proceeding relatively well, considering that it was in an era when we didn't have the benefit of a modernized electronic system that we are now applying.

[Justin Trudeau, Liberal, Papineau, QC]

One of the things that we're very aware of politically is the question of prescription drug coverage. Various groups say we should have that as part of our national medicare system. Others say it should be targeted. A lot of Canadians don't quite understand why refugees should be given prescription drug coverage, for example, in the first year of arrival. I'd like to hear from you as to why it is indeed so important that we do provide that coverage.

[Dr. Danielle Grondin]

Thank you. Well, your question--

[Justin Trudeau, Liberal, Papineau, QC]

You may answer in French, of course.

[Dr. Danielle Grondin]

Yes, fine.

First, these are refugees asking for protection and, under the law, Canadian society has the obligation to give them that protection. There is also the category of Convention refugees, and, with the commission, we have already agreed to bring them to Canada. Those international obligations also have to be honoured on Canadian soil.

The health status of those refugees, mainly the Convention refugees—though there are different characteristics—is a function of their country of origin and the conditions in which they were living. In some countries, they had no access to medical services and, because of epidemiological conditions and infectious diseases, their health status has deteriorated. It is very important for Convention refugees to receive treatment. In any event, they are eligible for those services under our provincial and territorial health plans. We cover them for the waiting period, which is normally three months, but as soon as they are eligible, our program no longer covers them.

It is also important to cover those groups for what we call supplementary coverage, for medication and all those things that may not be covered by health plans; though the plans cover them for people on social assistance, for example. We take all the provincial social assistance programs already in place and we adapt them. That allows us to reach some degree of parity in what is offered to those groups in the provinces and territories.

That is important for three reasons. First, it is important for the refugees themselves, whatever category they are in, that we are concerned about their state of health and provide the necessary care. Second, it is important for public health, especially if they show signs of infectious diseases that can be spread to those close to them and to the community. We have to provide treatment for that. Third, by assuming the costs, we ease the strain on the resources of the provincial and territorial health systems, at least with regard to the costs. That all must be seen as positive.

It is important for Canadians to realize that this coverage for refugees seeking asylum actually does not last very long. The coverage provided to asylum-seekers by the program ceases when their cases are dismissed; in other words, they are covered until they leave Canada, and then that's it. If asylum-seekers withdraw or give up their claims for protection, the coverage ceases as well. Of course, if it comes to light at any time that a person is living in Canada illegally, the coverage also ceases. It really is temporary, just until the commission has rendered its verdict. If the commission gives a person refugee status, that person becomes eligible for provincial programs automatically.

[The Chair, Conservative, David Tilson]

Thank you.

The chairman wants to speak to the committee for five minutes, so you have a couple of minutes and that's it.

[Thierry St-Cyr, Bloc, Jeanne-Le Ber, QC]

I would just like to ask one very simple question. The problem, the hesitation, seems to come from the fact that we do not want to set a precedent by negotiating an agreement with AQPP, even though four precedents already exist. Can you understand how, from the outside, it seems a little curious that you prefer to negotiate with 300 separate owners and come to 300 separate agreements when you could have one agreement with AQPP that would include everyone? It might be seen as a kind of divide and conquer approach.

[Dr. Danielle Grondin]

We are not necessarily negotiating with each person. We rely on a system, a formulary—the Quebec formulary—that has already been negotiated, that already exists. We make it the same for everyone. It is a federal program. The pharmacists are already licensed; the Ordre des pharmaciens takes care of that. They are licensed. We use the Quebec formulary, the RAMQ's, but using the lowest cost. Then the pharmacists sign up.

The coverage is already set and all the RAMQ's medications are covered. We also have the possibility of getting preapproval for medications that may not be covered. The RAMQ, for example, does not cover some anti-malaria drugs, some antiparasitic drugs for intestinal parasites. Nor does it cover vitamins and products like that. Since we are dealing with vulnerable people who are often malnourished, it is better for them to be covered. So we cover them, and they are already in the system. Everything is there. This is not like a union agreement with each pharmacy. Far from it. The pharmacists are licensed and the RAMQ already has a negotiated system for people on social assistance. We just make use of it.

[The Chair, Conservative, David Tilson]

Thank you.

[Dr. Danielle Grondin]

We have even done price comparisons, to go back to the example that came up in connection with HIV. Everything is carefully compared.

[The Chair, Conservative, David Tilson]

Thank you.

[Dr. Danielle Grondin]

If the prescription specifies no substitute medications, that will be paid for. There is really no reason for litigation, but we are continuing the discussions in order to understand what AQPP wants.

[The Chair, Conservative, David Tilson]

Thank you. We could talk a little bit more, but we're going in camera.

Dr. Grondin and Monsieur Deschamps, I thank you for coming and giving us your views on behalf of the department.

I'll ask everyone to leave, except the committee.

[Proceedings continue in camera]