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.