Public Accounts Committee on June 9th, 2016

[Michel Doiron]

As the deputy mentioned, we are seeing a decrease. Now, whether it's causal or not, it's very difficult at this point, because we've just started to see that decrease. We are following—

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

But it's only since 2014 that it has been accepted.

[Michel Doiron]

Actually, it was more in the last year, I'll say, that we've seen it on the side of opioids and tranquillizers. But we always have to be careful not to jump to conclusions when we see a decrease somewhere. Anecdotally, as the deputy minister said, we've been told, and the veterans are actually showing us that “These are the medications I used to take, and now I smoke—whatever—a number of times a day, and here's what I can or cannot do.”

We have to be careful because sometimes they still take it, but it's a different dosage of medication. When you had certain strength—and I'm not a doctor—of medication, now their doctor is prescribing lower amounts of the drug for them to better handle whatever illness they may have, whether it's musculoskeletal, or mental health, or other issues, because marijuana can be used for various things.

But we are tracking this. We're starting to look at it to try to determine if there is a causal effect. Will that causal effect mean, going forward, that our forecasts have to change? At this point, I would not even dare to give an answer on that because I think it's way too early in the analysis, but we have seen a decrease in the use of opioids and tranquillizers.

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

Thank you very much.

I think I'm done, no?

[The Chair, Conservative, Kevin Sorenson]

You have 30 seconds. Will you give it to Mr. Christopherson?

[Alexandra Mendes, Liberal, Brossard—Saint-Lambert, QC]

Yes, I will give it to Mr. Christopherson.

[The Chair, Conservative, Kevin Sorenson]

Thank you very much, Mrs. Mendes.

We'll now move back to Mr. Christopherson, please.

[David Christopherson, NDP, Hamilton Centre, ON]

Very good.

Doctor, is it pronounced “benzodiazepine”—did I get it? Am I close?

We're getting there General, we're getting there.

All joking aside though, I wanted to complement Madame Mendès on her comments. I was having the same feeling, that we're starting to walk down a moralistic road in terms of evaluation, rather than a medical one.

Dammit, if that's what soldiers need when they come back after defending this country and they're in those kinds of war zones.... Nobody was being overly moralistic when we sent them over there; nobody was being overly moralistic with their families when there was the potential that they may not even come home alive.

Dammit, if this helps them, then it needs to be there. Nobody's talking like this about the cost of cancer drugs. We have to talk about them in terms of containing the cost, but not about whether or not morally we think such and such is an appropriate medicine to be giving to a fellow Canadian citizen who put on that uniform and went off into that war zone and got broken and came back and believed that the commitment this country made to them would be honoured.

I'm so glad you went down that road. I appreciate it and I support 100% what you said.

Having said that, though, we have an obligation involving our approach to drugs. I want to bring us back to the Auditor General's report, page 10, paragraph 4.42:

We found, however, that over the following two years Department officials did not pursue Product Listing Agreements with pharmaceutical companies. We also found that not using them has limited what it can include on its drug benefits list because the costs of some drugs are too high.

When I look at the action plan, on page 2 I see under “Cost Effectiveness Strategies”:

Continue working with other federal drug partners and the Pan Canadian Pharmaceutical Alliance to explore opportunities to enter into Product Listing Agreements

What's the problem?

I would have thought the response to the recommendation would be that yes, we've done it, or it's on the brink of being done, or we're negotiating the actual final details.

Why is it so difficult to get into this agreement?

[Gen Walter Natynczyk]

Again from my previous life, if I can lead, I'll lead and I'll take the hill. In some cases I don't have the lead, and we have to work with other government departments.

We are working very closely with Health Canada in this regard. It has the lead for the PLAs. We are trying to move very quickly with them so that we can sign up with them and other government departments. National Defence, Indigenous Affairs, and other departments have significant pharmaceutical programs as well, so as a collective we can work with various companies to land a preferred pricing schedule for some of these pharmaceuticals.

I'll ask Dr. Courchesne or Michel to pile on.

[David Christopherson, NDP, Hamilton Centre, ON]

Before you go on to that, my next question is going to be why it wasn't a bigger priority sooner. This is not rocket science. We didn't need high-priced auditors to come in to tell us that when you join these bulk-buying agreement deals, you save money. Why has it taken so long, and why such a weak-kneed response?

I hear you saying there are complications, deputy. I accept that to a certain degree, but I'm not going to accept, as a reason we're not doing it, that it's complicated and it involves other ministries. I get that. It makes the challenge greater, but it doesn't mean you just walk away from it.

Help me understand why something so plainly obvious isn't already done.

[The Chair, Conservative, Kevin Sorenson]

Thank you, Mr. Christopherson.

[Gen Walter Natynczyk]

Sir, we will move out with all dispatch to implement this as soon as possible.

[The Chair, Conservative, Kevin Sorenson]

Thank you.

We'll now go to Mr. Lefebvre and then to Mr. Poilievre.

[Paul Lefebvre, Liberal, Sudbury, ON]

Mr. Chair, before I start, my colleague Mr. Harvey wants to make a statement or ask a question.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

Thank you, Mr. Chair.

I have to leave and I don't have a question. I just want to state something for the record, since we're on the issue of the moral high ground here: my comments towards Veterans Affairs today and my questions weren't centred around the moral implications of this or in any reflect on my appreciation for those veterans, period. My comments are centred around my belief that Veterans Affairs has made a misdiagnosis of what the maximum levels should be, compared with the rest of the data from across the country indicates. The department is here today reflecting its belief that it's data on levels is correct, and I believe it's wrong.

It's not a judgment on veterans—period.

[The Chair, Conservative, Kevin Sorenson]

Now to Mr. Lefebvre.

[Paul Lefebvre, Liberal, Sudbury, ON]

I want to ask a few questions about the formulary review committee and who sits on it, because from the Auditor General's report they are responsible for reviewing, maintaining, and revising its drug benefits program, as well as making recommendations and providing guidance to its senior management.

Who sits on this committee, and now that we're talking about evidence-based decisions, how is that a change from what was being doing before? I know that you guys are reviewing it, so what was occurring on this committee before, and how has that changed now that you guys are doing your review?

[Gen Walter Natynczyk]

I will start and then I'll ask Dr. Courchesne to wade in.

The formulary review committee comprises health professionals from our own department. It includes Dr. Courchesne and our national pharmaceutical advisor, as well as the pharmacists and the medical consultants from Medavie Blue Cross. In addition, we have our service delivery specialists from Michel Doiron's team, and we also have members of the Canadian Armed Forces on that team.

[Paul Lefebvre, Liberal, Sudbury, ON]

Has that always been the case, because Madame Courchesne stated at the beginning that there were no pharmacists involved? Can you expand on that?

[Dr. Cyd Courchesne]

When I arrived, there wasn't a pharmacist in the position—

[Paul Lefebvre, Liberal, Sudbury, ON]

Okay, so there—

[Dr. Cyd Courchesne]

—from the department, but there were pharmacists on the formulary review committee, from Blue Cross Medavie.

[Paul Lefebvre, Liberal, Sudbury, ON]

There were. Okay.

Now that we are looking at evidence-based decisions, how does that differ from before?

[Gen Walter Natynczyk]

Again, what we've done is to recreate leadership in pharmaceutical advice in the department that had been lacking for a few years. While we had pharmacists, they weren't Veterans Affairs pharmacists. They were from Blue Cross Medavie and others.

Now we actually have recreated the critical mass in the core of decision-making inside the department, so we now have some structure to develop a strategy, develop a plan, and capture it in a very rigorous way, so that we know how the decisions are made; when they are made; and again, going back to the Auditor General's point, when we're actually going to achieve these things to get it done in a timely fashion.

Cyd.

[Paul Lefebvre, Liberal, Sudbury, ON]

I guess I'm asking, why wasn't that done before, and why is it being done now? Do you have more resources now? Is it more best practices, that you guys have self-evaluated?