Evidence of meeting #9 for International Trade in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cusma.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Maryscott Greenwood  Chief Executive Officer, Canadian American Business Council
Charles Milliard  Chief Executive Officer, Fédération des chambres de commerce du Québec
Jennifer Mitchell  Director, Board of Directors, Music Publishers Canada
Andrea Kokonis  General Counsel, Society of Composers, Authors and Music Publishers of Canada
Gilles Daigle  Consultant, Society of Composers, Authors and Music Publishers of Canada
Kathy Megyery  Vice-President, Strategy and Economic Affairs, Fédération des chambres de commerce du Québec
Michel Leblanc  President and Chief Executive Officer, Chamber of Commerce of Metropolitan Montreal
Stuart Trew  Researcher and Editor, Canadian Centre for Policy Alternatives
Mathieu Frigon  President and Chief Executive Officer, Dairy Processors Association of Canada
David Wiens  Chair, Dairy Farmers of Manitoba
Joel Prins  Partner, Prima Dairy Farm
Matthew Flaman  Chair, Saskatchewan Milk Marketing Board
Darren Erickson  Pharmacist Owner, Tofield PharmaChoice, As an Individual
Gayleen Erickson  Business Owner, Guardian Pharmacy, Tofield Medical Clinic, As an Individual

12:25 p.m.

Pharmacist Owner, Tofield PharmaChoice, As an Individual

Darren Erickson

Thank you.

We appreciate the opportunity to address this committee. Being able to describe what is happening on the ground floor in our businesses can be mutually beneficial for this and future legislation.

I grew up on the farm too, but I ended up owning a pharmacy. I'm the owner of Tofield PharmaChoice. Tofield is a town about half an hour out of Edmonton. I also manage a medical clinic beside it, and I'm the standing president of the Alberta Pharmacists' Association. My opinions today aren't part of theirs; they are my personal opinions.

CUSMA has garnered much attention for changes to the auto and dairy sectors, as we have just heard. The standing committee should be concerned with provisions of the agreement that could have important impacts on pharmacy sectors, and in turn on my patients.

I understand the original CUSMA would have extended the term of protection for data resulting from drug trials from eight to 10 years for a subset of drugs known as innovative biologics. I'll explain what these are.

As pharmacists and patients, we're very familiar with small, simple molecules that have been produced in the past 50 years, such as acetaminophen, codeine and antibiotics. They're easy to duplicate, because we can make a generic product of them, and those products come out at about 25% of a name brand product. We have used these generics since they were introduced about 35 years ago, and I was there right at the start. The availability of generic product has increased medication availability to all patients and saved millions of dollars to private, provincial and federal drug plans.

A biologic is a product that's a little different. It's a large complex molecule, usually manufactured by manipulating living cells to produce a specific protein. The most common one everyone would know is insulin. There are many benefits to biologics, such as being a unique treatment option, either with fewer side effects or better treatment for a disease. Pricing for biologics can be anywhere from five to 10 times that of small, simple molecules. I refer to drugs as molecules.

Generic products of biologics are called biosimilars, because they are not identical to the product, unlike making a generic of a simple molecule. They're very close to the same and they produce the same results in the body for a particular disease. Many provinces treat them as substitutes, although they are not interchangeable, but in comparison they're going to save payers many millions of dollars annually. Biosimilars are here, and we're using them now across Canada.

Current Canadian law provides 20 years of patent protection, which is different from data protection. Patents are just like patents for products. Data protection is a little different. Because a drug needs to be researched, it takes a long time to get it on the market. A protection is offered to companies after the drug comes on the market, because the 20 years wouldn't cover their protection.

Unlike other patents, drugs must go through trials and testing to prove efficiency and safety, which uses a large portion of the patent protection period. Data protection begins when they start marketing the drug, and it effectively provides a minimum period of market exclusivity regardless of the patent status. Data protection will prohibit the use by drug manufacturers in obtaining market approval of the safety and efficacy of the drug. When a patent company tests a product in the generic area, if people were allowed to use some of that data to get their drug on the market, that's basically what this data protection is: It protects the drug for x number of years to allow them to make some money.

Before it was signed in December, the original CUSMA had an additional two years of data protection on biosimilar molecules. This is important because that extra protection would have increased the price of the products and extended the protection for an extra two years. From what I understand, it was changed back to the eight years on the signing day, which I think was December 10 or 11.

In Alberta, we have witnessed recent changes to our publicly administered drug plans that are transitioning patients from biologics to lower-cost biosimilars. These policies were specifically implemented to decrease government drug plan expenditures. The more prevalent the use of biosimilars in Alberta, the greater the cost savings for payers and patients. Alberta spent more than $238 million in the fiscal year 2018-19 on biologic drugs, and these costs are increasing every year.

Costs per patient for original biologics can be more than $25,000 annually, with biosimilar versions costing up to 50% less than the original biologics. Alberta's biosimilar initiative will save approximately $30 million annually, which can be invested in other health services for Albertans. CUSMA's data protection change would have worked directly against Alberta's ability to access affordable biologic drug therapy in the future.

Here are a couple of examples. For a patient arriving at my pharmacy counter, the average price for Remicade, which is a name brand biologic used for rheumatoid arthritis, would run that patient or a third party payer like Blue Cross or VAC $1,553 a month, compared with a biosimilar of $848 a month. This pricing is excluding any fees or markups, and this extrapolates into a savings of about $8,460 annually.

In another example, Lantus insulin costs about $100 monthly, in comparison with $75 for a biosimilar, a savings of $300 annually. The $300 seems like a small amount, but when it is multiplied by the number of diabetics in Alberta, which is increasing, the savings are substantial. The patient on a fixed income with no prescription insurance sees no effective difference between the two products and is using the savings to purchase maybe test strips to better control his diabetes and keep him out of the hospital. We have probably 20 to 25 patients in my pharmacy alone who are making that change.

Nationally, had they extended the data protection to 10 years instead of the eight, it would have cost us over $169 million in 2029. I talk about 2029 because the patents are just being taken out for products that are going to be available then, and those are the ones that CUSMA will affect. From what I understand, for the ones that are presently licensed, there'll be a grandfather clause.

Final terms in CUSMA allow data protection to remain at eight years, from what I understand, giving continued savings to payers such as my patients and third party private and public plans, like government plans, which will allow continued affordability to patients who visit my pharmacy.

I appreciate the opportunity to talk to this committee.

12:35 p.m.

Liberal

The Chair Liberal Judy Sgro

Thank you, Mr. Erickson.

Ms. Erickson, did you have statement to make?

Please go ahead.

12:35 p.m.

Gayleen Erickson Business Owner, Guardian Pharmacy, Tofield Medical Clinic, As an Individual

Thank you so much for giving me the opportunity to present as well.

My name is Gayleen Erickson. I am the owner of Guardian Pharmacy and the Tofield Medical Clinic in Tofield, Alberta. I have reservations concerning CUSMA and the effects it will have on my business ventures.

I would like to give some basic information on pharmacy in Canada and how drug shortages have been affecting my pharmacy and our patients. We've experienced many drug shortages, and these seem to be on the rise. Shortages are caused because of many variables and circumstances. These include plant inspections revealing contaminants, access to raw product ingredients, international demands for product and, most commonly, generic product pricing that is too low. Low prices make products more popular and less profitable to manufacture. Decreased profit can persuade manufacturers to discontinue production in favour of other, more profitable molecules, causing a decreased supply and demand buffer. Pharmaceuticals have expiry dates, and this limits the amount of product in the system.

All of these concerns lead to a very inelastic supply and demand system for pharmaceuticals. At any one time, drugshortages.ca will report approximately two thousand drugs being shorted. Currently, our pharmacy is unable to supply our customers with 60 common medications because they are shorted. Additionally, any arrangements made by private payers or government can cause extra stress on an overloaded system. Here are just a few examples of these shortages.

Pantoprazole was shorted after the main public payer in Alberta favoured pantoprazole as the preferred drug to be prescribed to all patients with gastroesophageal reflux disease, also known as heartburn or GERD. That was only to save money.

Metformin, a common anti-diabetic drug, became unprofitable because of price compression from many manufacturers, and they discontinued production.

In 2017, a group of approximately 20 to 30 injectable surgical drugs were shorted after the discovery of contamination in the only factory that produced and supplied these products to hospitals and pharmacies in Canada. We were unable to supply Beaver ambulance services with product that was crucial for their day-to-day operations. Many of these injectable products remain on allocation from our wholesaler today, limiting the numbers that any pharmacy can purchase.

Valsartan was shorted worldwide when a contaminant was discovered in July 2018 in a raw product used to make the tablets. This recall, combined with price compression, has resulted in supply issues to date for the whole class of drugs called ARBs—angiotensin II receptor blockers. The majority of losartan, irbesartan, telmisartan, candesartan and olmesartan molecules are in short supply as the process dominoes.

Canadian drug stores could not supply the citizens of Canada with EpiPens in the summer of 2019. News agencies reported that individuals should use expired pens in an emergency, while the U.S. did not experience any shortages but supplied pens at a higher price in a market with higher margin. Pricing decisions by the Patented Medicine Prices Review Board, the pan-Canadian pharmaceutical alliance and provincial programs can affect name brand and generic supply. Generic pricing is often based on brand pricing.

Pharmacists are deeply concerned about U.S. policies that would enable the additional exportation of prescription drugs from Canada to the United States. Drug importation by the U.S., both personal and wholesale, is neither practical nor sustainable. CUSMA has not addressed this major concern facing Canadian pharmacies. Government needs to be aware of these shortages and the effects they have on our industry and the well-being of all our patients. Recently, Bernie Sanders encouraged the American public to purchase their pharmaceutical supplies in Canada at cheaper prices.

We were here yesterday for question period and were quite concerned to hear a motion with regard to pharmacare. We have work to do on the present problems with pharmaceutical supply issues in Canada. Price compression, manufacturing issues and recalls are still causing major problems.

To conclude, we are having major pharmacy supply issues in Canada. These problems are being ignored. They are growing annually, and our patients experience the fallout. I would like to confirm that CUSMA does not force or suggest that we supply pharmaceuticals out of our supply chain without additional supply assurances. It is imperative that future supply models take into account what is happening right now, today, in pharmacies across Canada.

12:40 p.m.

Liberal

The Chair Liberal Judy Sgro

Thank you, Ms. Erickson.

We'll move on to Mr. Kurek.

12:40 p.m.

Conservative

Damien Kurek Conservative Battle River—Crowfoot, AB

Thank you very much, Madam Chair. It is great to be able to join this committee this morning.

I want to thank each of the folks who have come to testify before us. I appreciate that there are three farmers, two business owners and a pharmacist. Your input is very valued here. I appreciate your making the trip and taking the time to share your expert opinions. Your opinions are valuable, and it is appreciated that you have come to be a part of this very important democratic process to ensure that Bill C-4 gets the review required.

I think there is large agreement across the country that free trade is important, that we need to have a strong trading relationship with our international partners, but the various perspectives that have been presented here today emphasize how important it is to have proper oversight and review of this legislation to ensure that Canadians understand the impacts.

My question will be focused on Mr. and Mrs. Erickson. Acknowledging the reality of free trade.... When it comes down to it, the role of a pharmacy as a part of the health care system is ultimately about making sure patients in this country have access to the care they need in order to get healthy, to be treated properly.

Does either of you have further thoughts about the impact of drugs being sold to the United States? Could you elaborate on how that affects your day-to-day operations? Also, for the benefit of committee members, help us understand what options there might be to address this in the future, so that folks can be aware of how serious an issue this is.

12:40 p.m.

Pharmacist Owner, Tofield PharmaChoice, As an Individual

Darren Erickson

We brought along an example of my drug order sent in on Saturday. We ordered 111 products; 33 of them were short. This is not even a list of all the items we would use. We're short, currently, about 60 molecules. Every time I hear about a busload coming up here from the U.S.... I know they need medication, but we are having supply problems here, right now, and we need to understand that's what's happening. If any of the committee members were to go to their pharmacy today and ask them if they are having supply issues with any drugs, they would get a story from their pharmacist. It's happening right across Canada. I have friends across Canada who run pharmacies; it's the same story all across Canada.

We want to get this supply issue under control. When there is a product shortage, we have quite a lot of work to do today as pharmacists. In Alberta we prescribe; we substitute product. A lot of pharmacists in Canada cannot prescribe; they have to send the patient back to the physician. It gets to be quite burdensome work to get these patients through the system.

So when I hear about pharmacare coming, about more control or cheaper product, I cannot believe what is happening here already.

Regarding sales to the States in the future, I believe we have to get our product under control here in Canada. If we can be assured of supply, and can get supply, I'm in favour of it. I realize we have to trade with the States.

12:45 p.m.

Business Owner, Guardian Pharmacy, Tofield Medical Clinic, As an Individual

Gayleen Erickson

I would just like to say that approximately 20% of the time my pharmacists spend in the pharmacy each day is spent trying to locate drugs for individuals. There is ear medication that we are not able to bring in anymore. We have had to find pharmacies that will compound the product, and that's the only way we are able to supply it.

We have issues where, because of contaminations in different factories, a product will come and it will be shorted. From there, we have to provide other options. Over-the-counter medications are being shorted, and now we are having to provide prescriptions for these individuals.

12:45 p.m.

Liberal

The Chair Liberal Judy Sgro

Thank you very much, Ms. Erickson.

You have 30 seconds left, Mr. Kurek.

12:45 p.m.

Conservative

Damien Kurek Conservative Battle River—Crowfoot, AB

I appreciate that very much. I think it emphasizes the importance of having a fulsome discussion about the new NAFTA—this CUSMA deal—or any other thing that comes before Parliament. I appreciate the perspective and even just learning about the difference between biologics and biosimilars.

Just briefly, if I could—

12:45 p.m.

Liberal

The Chair Liberal Judy Sgro

It has to be very brief. You have 10 seconds.

12:45 p.m.

Conservative

Damien Kurek Conservative Battle River—Crowfoot, AB

It is also important to acknowledge how this may affect the development of new drugs and that industry in Canada.

However, since my time is up, I appreciate the opportunity, Madam Chair.

Thank you again to the witnesses for their contributions. I really appreciate your coming and being a part of this.

12:45 p.m.

Liberal

The Chair Liberal Judy Sgro

Mr. Dhaliwal.

12:45 p.m.

Liberal

Sukh Dhaliwal Liberal Surrey—Newton, BC

Thank you to the presenters for coming.

Mr. Prins, that was a very inspirational story. When you were telling it, it reminded me of my dad. His story was very similar to yours, his days growing up in a family that was agricultural. After doing all the chores, he would bike 37 kilometres to the college and come back. It's very inspirational. I wish you all the best, and thank you for doing great work.

You said that the government should be standing up for the dairy farmers; we did. President Trump wanted to dismantle supply management, but we were able to protect it. You mentioned that 3.9% of the dairy is affected, and that has a devastating effect. I am just trying to imagine what the consequences would be if we hadn't protected the supply management. That is what I am trying to see.

12:45 p.m.

Partner, Prima Dairy Farm

Joel Prins

Thanks for the compliments on that.

I guess it's something that we ourselves don't even picture and can't fathom because we are sold on this idea of the supply management, and that's why we fight so hard for it. It's something that our families rely on. Even with that 3.9%, it doesn't seem like a lot, but it seems that it accumulates every time; it is never a clean slate to start with. We already had gone through several other trade deals where we were also giving it up, so it feels like our government's goal is to eventually get rid of it.

That is not what we hope, and that's not what we picture. We want to continue strong in what we're doing. So, that 3.9% is also added on to other ones. Now it seems like every two or three years when a new trade deal comes out, we're bracing for another one. Why do we always need to do this?

12:50 p.m.

Liberal

Sukh Dhaliwal Liberal Surrey—Newton, BC

How about the local demand? Has the local demand for milk and milk products grown over the last decade, with new immigration and different communities moving in?

12:50 p.m.

Partner, Prima Dairy Farm

Joel Prins

I think you are exactly right there. Canada is a great country, with a lot of immigrants coming in annually. Basically, it seems like any growth that we would have gotten just from people coming into the country we're now giving away. Instead of letting our dairy farmers continue to grow with the population, we are now giving away that extra growth. A lot of immigrants do love our milk products. There are a lot of new innovations as well, just from processors trying new things and new technologies so that we are able to enjoy more of the milk products.

Yes, you are exactly right that dairy has growth from within our country, but we farmers are not benefiting from it.

12:50 p.m.

Liberal

Sukh Dhaliwal Liberal Surrey—Newton, BC

Thank you.

My question is for Ms. Erickson. I agree on one of the drugs that you mentioned, the ear medication. All I remember is that it's in a yellow bottle; I will leave the names for my daughters to remember. It was shorted. I went to my pharmacist and he was blaming us. He said that we were bringing down the prices of the medications.

On the one hand, the consumer wants the prices to come down. On the other hand, when we bring this forward, pharmacists are blaming us. How can we balance that between the two?

12:50 p.m.

Business Owner, Guardian Pharmacy, Tofield Medical Clinic, As an Individual

Gayleen Erickson

What you have to do is ensure there is supply. What they are doing now is negotiating the price down so low, providing only one supplier for some of the drugs, that if there is a contamination in that plant, it shuts down the entire production of that. Then you have to get back into the supply chain at the factory, so you may have to wait three months before that drug goes into production again. During that period of time, the pharmacies have to revert to other drugs, something similar, for their supplies.

It's like olmesartan and all of the ARBs. Now all of a sudden there is a whole group of drugs that are no longer suppliable because they can't be provided by the plants and the factories anymore, so it just mushrooms and compounds.

For some of the products, like metformin, there used to be a number of different suppliers, but now they have gone down to just one, I believe. That's all we have in the pharmacy. It's a very common anti-diabetic drug, and there's no one else supplying it, so if there's a contamination in that factory, we're done. Our customers, our patients, are without.

People don't realize the severity of this. We have had heart medications.... The ear medication is just a minor one, but when you go to your doctor and the doctor says, “I'm sorry. We can't supply it. Use vinegar and water”, and you're facing the possibility of hearing loss.... This happened to our son. That's why it's very close to my heart. It's happening all over.

There was a drug for women who had bladder control problems. It was negotiated down so low in price that the companies stopped producing it. There is no medication for this.

12:50 p.m.

Liberal

The Chair Liberal Judy Sgro

Thank you very much, Ms. Erickson.

Mr. Savard-Tremblay.

12:50 p.m.

Bloc

Simon-Pierre Savard-Tremblay Bloc Saint-Hyacinthe—Bagot, QC

My thanks to all the witnesses for their presentations.

A number of witnesses from agriculture began with a summary of what you do. That seems very interesting to me because, beyond your militancy, you are showing us the human beings behind it, experiencing at first hand the effects of the negotiations, the decisions, the signings and the debates. You add a particularly interesting human face to the current situation.

First of all, my question goes to the three people here from the dairy industry, the agricultural industry. I am going to ask you the same question that I have asked a number of witnesses. Is there a consensus on the issue? I feel that you all agree that there must be compensation for your sector and for the producers who have been harmed by the negotiations.

That was the case in previous treaties. For this one, we hope that it will be announced in the next budget. Can you tell us what form of compensation you would like to see? Is it direct compensation, or another form, like investment and modernization programs?

12:55 p.m.

Chair, Dairy Farmers of Manitoba

David Wiens

I could begin to answer your question by saying that dairy farmers are looking for a direct compensation payment to farmers. The reason is that all farms are at a different point in their financial cycle.

For example, some farms have made major investments on the farm in terms of improving animal care and so on, so then it wouldn't work. They wouldn't receive a payment after something has been done. Others are planning to. Sometimes it takes longer for young farmers to get their financing together. That's why it's so important to make the direct payments to farmers, because they know exactly how best to ensure that the payment goes toward future sustainability on those farms.

12:55 p.m.

Partner, Prima Dairy Farm

Joel Prins

I would have to agree with David. Direct payment is definitely the way dairy farmers across Canada want it to be received. Even if you're the smallest farmer, the biggest farmer or anywhere in between, you still get compensated. You don't have to submit an application and hope you're one of the two hundred or three hundred who win the lottery. In that sense, the direct payment is the fairest way to go.

12:55 p.m.

Chair, Saskatchewan Milk Marketing Board

Matthew Flaman

I would like to add to that.

I agree with the direct payment as well. The reason is that innovation and investment are different on every farm. David alluded to that a little bit. In some cases, it's very new. In Saskatchewan, we have an entrant program, as does the rest of the country. In that case, maybe it would be used to pay down debt. In other cases, it may be used to increase cow comfort through better bedding facilities or ventilation. In other cases, it could be used for robotics or further innovation on the cow milking side. It does give the farmers a choice. As Joel has said, it allows every farmer to receive the chance to use it equally, no matter how large or small or how mature they are as a farmer.

12:55 p.m.

Bloc

Simon-Pierre Savard-Tremblay Bloc Saint-Hyacinthe—Bagot, QC

I see that there is a consensus, not only among yourselves, but also among all those from your sector who have come to testify before us in the last two weeks.

So your reply does not surprise me. It is important for us to hear all the witnesses confirming that this is the preferred and desirable formula.

There is also another question that a number of witnesses were asked. In your opinion, how do we calculate the amounts on those cheques?

12:55 p.m.

Chair, Dairy Farmers of Manitoba

David Wiens

I will speak to that.

After the CETA and CPTPP agreements were ratified, there was a discussion with dairy farmers and the government. For those two agreements, it was recognized—and that was by the government's own validation—that the damage was to the tune of $2 billion. That same process would have to follow CUSMA, where the dairy industry has an opportunity to have that discussion with our government at the time of ratification.