Debates of Oct. 5th, 2017

Opposition Motion—Pharmacare

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Mr. Speaker, we have heard a lot of comments today, especially from the Conservative side, about increased taxes and the increased costs that government policy has put on Canadians and businesses especially. One of the biggest payroll taxes, something the Conservatives are always going on about, is the cost of extended health care benefits. Could the member expand on that?

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, the motion asks the government to take leadership and have a conversation with the provinces and territories so they can create something much more meaningful. We have information and results that tell us this would save significant amounts of money. In fact, is it not the job of governments to come together so we can make things better for all people, raise up the opportunities for all people, and ensure there is equal access?

I talked about the fact that health care and pharmacare should be a right of every Canadian, not a privilege. We are still in a system that is accessible for some and highly inaccessible for others. If the government is willing to take forward something its own PBO has already told it will save significant amounts of money, it would make such a profound change in our country. It is certainly time for that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, it is quite clear that the Liberals have not read the PBO report or the motion. It is clear that the Conservatives have not read the PBO report or simply are blinded to its findings.

Ordinary Canadians are far ahead of the government on this. Sixty-nine per cent of Canadians disagreed with the statement that overall the current system worked well enough and it did not need to be changed. Ninety-one per cent of Canadians supported the concept of a national pharmacare program that would provide universal access to prescription drugs.

What does my hon. colleague think the response of Canadians will be to the Liberal government's voting against a motion calling on it to simply start a discussion with the provinces within a year to begin the process of implementing universal pharmacare, which nine out of 10 Canadians want?

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I want to thank the hon. member for the hard work he has done on this file, fighting for Canadians and accessibility to health care and pharmacare.

The results are in. Like the member said, 91% of Canadians think this is an important next step for our country. I have had conversations with my constituents who have chosen to live in a van because of health care issues. They cannot afford rent and their medication. These are the types of decisions that Canadians make. I have to talk to elderly people in my riding who, as soon as January hits, will have to spend that amount of money before they start to get the subsidy and the support. They say that I should not worry, that they will eat a little less, or that they will wear more sweaters because they cannot keep the heat on. This is not a joke. This is seriously happening in communities across Canada.

Therefore, action needs to be taken. I think Canadians will be extremely disappointed if the government does not support this motion.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, I am happy to speak today to the motion of my colleague, the member for Vancouver Kingsway, because this is something that is extremely important to understand. It is something that would allow us to do so much for the health of Canadians.

Listening to all the members who spoke before me, it was clear that none of them had any doubt that implementing universal pharmacare in Canada would save us millions of dollars. I do not want to dwell too much on this point because it is so obvious. All the studies show that there would be savings to be made. No one has ever said that it would cost us more than the current system. Since that has been laid out very clearly, I will not dwell on it any further.

Someone also mentioned the system in Quebec, the first one in Canada. Quebec's system was in some ways a response to a particular situation. We wanted to make sure that everyone would at least have access to pharmacare, but it is by no means a perfect system. Even the health minister knows that it is not perfect. That is why he is interested in having a truly universal system, and why he is open to discussions. We do not usually see a Quebec health minister who is interested in a national program. In this case, he is interested because he is aware of the potential cost savings and he knows that it could be more efficient than our current system.

I will try to clearly describe the limitations of the Quebec system. If an individual does not have access to insurance provided by an employer, he or she must take the government insurance. If this person does have access to a pharmacare plan provided by an employer, they are required to take it.

The problem is that some employers have substantially increased the price of pharmacare insurance for different reasons, and contracts are individually negotiated by the employers. Given that the employees of an employer in a sector with higher risks will use more prescription drugs, that employer's insurance premiums will be higher. Thus, people are forced to sign up for a pharmacare plan that is more expensive than the government's because it is the only one they can access. They are also required to take their employer's pharmacare plan even if they do not have the money for the premiums.

Take the example of an employee who starts working as an orderly in a private centre. At first, he may work one shift a week or every two weeks, depending on the staff schedule. He might work a relief shift or an on-call shift. He might work one week and perhaps earn $100. If the pharmacare premium is $60 a month, almost his entire salary will be used to pay for the insurance that he is required to take. Employer pharmacare plans do not take into account an employee's ability to pay. Most of the time, it is a fixed monthly rate, no matter the ability to pay. That is one of the significant limitations of the Quebec system, and the minister is well aware of it. It is not a perfect system. That is why he opened the door to universal pharmacare.

I would like to talk about all the savings we could achieve if we had universal pharmacare. Granted, they are not always easy to calculate, but they are still eye-opening. Since we have medicare, we often forget how much a hospital visit can cost. We forget that a stay in intensive care can cost in the tens of thousands, and that is just for a couple of days. Hospitalization is expensive. We tend to forget that because, at the end of the day, we do not see the bill. After we go to the hospital, none of us here ever see the bill that shows how much it would have cost if we did not have medicare. Since we are less aware of this, we do not realize just how much we could save if Canadians had equal access to drugs. One thing we noticed was that people who are not covered will often wait before consulting a doctor, because they do not have the money to pay for their medication. At the end of the day, when they do decide to consult, their condition has worsened to such a degree that they now require more advanced, and much more expensive, treatment.

The same is true when it comes to medication. When people are unable to pay for the medication they need, they do not take it and just hope that they will get better. Their health deteriorates, but they tell themselves they will be careful. They finally get to a point where their health is so bad that treatment ends up costing a lot more money than if we had just been able to provide them with the medication they needed in the first place.

It costs a lot less to provide prescription drugs to a person with heart problems than to care for someone who has had a heart attack and needs a triple bypass, stents, or some other form of surgery, and a hospital stay in intensive care.

This is not necessarily as easy to quantify as just calculating the cost of the drugs, as the parliamentary budget officer did, but it is possible. When people can take better care of their health, it can save money.

A universal pharmacare program would also save money when it comes to access to information and related health interventions. Since we do not have a universal pharmacare program right now, it is very difficult to learn about doctors' prescribing habits, to find out whether they are prescribing the right drugs or if they are prescribing too many drugs. It is impossible to look at the data.

A universal pharmacare program would provide access to data that would help us get a much more accurate picture of the health profile and make more effective interventions, for example in prevention. Doctors could be monitored and prevented from over-prescribing drugs. As things stand now, that data is not easy to get because it is stored in a number of private medical insurance programs. That is another aspect that is not quantifiable.

Many times, private firms are commissioned to conduct health studies in order to gauge what is happening in the area. However, a universal pharmacare program would provide access to that data much more easily, which would translate into more effective health care interventions.

It is not easy to implement such a program. Nevertheless, with the provinces amenable to the idea, the public would be better served with a universal pharmacare program. We could better monitor various health problems and do more for patients. We would avoid complications, and we could ensure that much less expensive generic drugs were prescribed instead of brand-name drugs.

This program will result in greater financial efficiency in patient care and public health. For that reason it is very important that we move forward on this file. We must create this program for all Canadians. It will also prevent the unfairness created when some medications are covered by a private pharmacare plan while others are not. For example, some public pharmacare plans only cover oral contraceptives even though there have been many changes in contraception and birth control, with products such as patches, contraceptive rings, and IUDs, which provide more effective contraception for women who have problems with the contraceptive pill.

People do not always make the best choices when it comes to their health, because pharmacare plans often do not provide choice, even though other methods of contraception exist and the monthly cost is about the same. People have to make choices based on what their pharmacare plan offers. Unfortunately, when a decision is not based on what is best for someone in a given situation, it is less likely that it will be effective or that the medication will be taken properly.

A universal pharmacare plan providing coverage for a broad range of medications will help health professionals. They would be able to choose a medication based on the needs of their patients, while helping them better manage their health.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, I want to congratulate and thank my hon. colleague for the work she has done in Parliament to advance health policy in this country in a variety of areas.

Canadians know intuitively that a universal public health care system is the best way to deliver health care of all types. That is why we are proud of our Canadian health care system. We know that the U.S. system, which is a patchwork of private-public coverage in which some 20% of Americans are not covered, is simply an inferior system to the one we have, yet that is exactly the kind of system we have when it comes to pharmacare in this country. Twenty per cent of Canadians are not covered, and there is a patchwork of public and private plans.

We know that if we folded pharmacare into the universal program, we would get all the savings of streamlined administration, bulk buying, and exclusive licensing agreements. We would get savings from less cost-related non-adherence, meaning that people who take their medicines stay healthier and actually cost us less than if they go off of their medicines and cost the system more. These are the reasons Canadians know that a public health care system is the cheapest, best, and fairest way to deliver health care.

I am wondering if my hon. colleague can explain why the Liberals and Conservatives do not agree with that when it comes to pharmacare?

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, that is exactly what I do not understand.

All studies point to a universal pharmacare program. All the scientific evidence points to that, so I do not understand why they are not willing to get on board and support the bill. As a health professional, I can now prescribe certain drugs, such as birth control pills, because graduate nurses have made some strides in Quebec.

As a health professional, I learned to interview patients and choose the best drugs for them, but my choice is influenced by the fact that I may have to choose drugs that are covered, which is against professional standards. We want to make the best possible decisions for our patients, but we have to look at which drugs are covered. That means we are not making the best choice in terms of health; we are making the best choice in terms of what is covered and what the patient can afford. Sometimes the treatment we provide is less effective as a result.

[Pierre Nantel, NDP, Longueuil—Saint-Hubert, QC]

Madam Speaker, I would like to thank my colleague for her speech, which I know was very sincere and based on her own experience. Everyone in the House of Commons can benefit from her knowledge, much of it acquired on the front lines. She mentioned that, as a graduate nurse, she can prescribe drugs.

For those tuning in, I would like her to tell us how hard it can be for people to have to choose, regularly, between paying for food and paying for their prescriptions. Maybe she has met people like that in her own riding.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Madam Speaker, I thank my colleague for his question. I can say a few words about what I often see and what patients tell me.

Some of the patients I see in the emergency room or in intensive care tell me they cannot afford certain drugs, because even with insurance, they still need to cover 20% of the cost. I have heard patients admit to cutting their pills in half or taking their medication only every other day.

When a patient is prescribed a drug, they need to follow the dosage instructions. If patients do not take their medication as directed, not because they do not want to, but because they cannot afford to, they are not going to get better. Speaking as a health professional, we find it extremely difficult to deliver proper care to patients who are unable to follow their recommended course of treatment, not out of ignorance or a lack of understanding, but simply due to financial constraints.

[Bill Casey, Liberal, Cumberland—Colchester, NS]

Madam Speaker, I will be dividing my time with the hon. member for Brampton South.

First of all, I want to talk about the member for Vancouver Kingsway. We go back quite a ways. He was actually my seatmate one time over here, and we got to know each other quite well. We are both on the health committee. I want to acknowledge the good work he does on the health committee. He is very sincere and diligent about his work. We passed a motion in the health committee. The member agreed with that motion, and he is kind of jumping the gun now. That is all I am saying. The committee accepted the decision of the steering committee, and the hon. member is on the steering committee, "To undertake a study on the development of a national Pharmacare program as an insured service for Canadians under the Canada Health Act and to report the findings to the House”.

We are not there yet. We have not completed that motion that all of us agreed to on the committee. We are partway through the process, but we have a lot yet to know. The parliamentary budget officer's report was really interesting and very encouraging to all of us who are interested in this subject. However, in no way did it propose a model we can use or show a framework we can present to the government, the provincial governments, and all the different agencies involved. There are so many agencies and organizations involved with health care in this country, it is breathtaking.

We have heard 89 witnesses at our committee. We have had 20 meetings on this, and we are still not done. We are well along in the process, but we are not done. We still have a lot of questions. The parliamentary budget officer is scheduled to come to our committee on October 17, and I am sure the member will be asking him lots of questions, because there are lots of unanswered questions.

The report is very encouraging for those who are optimistic about this. I went into this debate on the pharmacare program with no preconceived notion or position. Witness after witness testified that Canada would be better off with a national pharmacare program. I am just speaking on behalf of my own observations and not on behalf of the committee, but there were a significant number of presentations on the strong points of a national pharmacare program. In general, I am really encouraged.

I was amazed to learn how many Canadians do not take their prescriptions because they cannot afford them. I was also amazed to learn that if they could take them, it would save our health care system a lot of time and money. It was amazing to learn about the integrated system in the pharmacare industry in Canada. They have secret deals with each other and all these things. I was amazed to learn how the pharmaceutical system works in Canada. It is very hard to get straight answers on how it works, but a national pharmacare program would eliminate all of that.

There are about 100 or so different pharmacare programs already in Canada. The provinces each have one for seniors. They have one for disabilities. They have one for social services. They have one for their own employees. The RCMP has one on the federal side. The military has a pharmacare program. The government has one for indigenous people. There is a plethora of pharmacare programs. They are all different. They all take management. They all require overhead. One pharmacare program would eliminate all those different agencies. We would have one consistent program across the country. Everyone could have access to pharmacare.

I am leaning toward a pharmacare program myself, but we are not there yet. We still have a lot to learn. Our job as a committee, as the original decision said, is to report the findings to the House when we are done our study. We are not done the study. There are so many questions.

We asked the parliamentary budget officer to do this, and it took him many months to do it. We have been at it for almost two years. Again, we have had 89 witnesses and 20 meetings, and we are still learning a lot as we go. The parliamentary budget officer came back a couple of times and asked for clarification on what he should use for formularies and a structure. We are very grateful to him and his team for doing the work. However, we still have to finish our work. We have not finished our work. Part of that work is to interview him and find the answers to some of the questions we have. I am sure he cannot answer them all yet, because we did not give him a model to use.

We talk about saving billions of dollars, but it is going to cost other organizations and levels of government billions of dollars, so we have to figure out the proper model before we start negotiations. We cannot go into negotiations not knowing what we are talking about or having a model to work with.

The Standing Committee on Health has been almost two years at this now, and we are still hearing from witnesses. We have witnesses coming the week after next. We have heard from patient advocates. We have heard from experts in medicine, social policy, and constitutional law. That is an issue we have not touched on here. The parliamentary budget officer has not touched on it either, because it is not his jurisdiction, but there are constitutional issues in creating a national pharmacare program. What are the responsibilities of the provinces? What are the responsibilities of the federal government? Where do they fit, and how can we work that out? We have to start with a model, and we do not even have an idea of a model yet.

There is a process, and we are only partway through it. The committee, in the end, is going to make a recommendation to the government, and the government will decide. We are not even ready. The member who proposed this is a member of that committee. He has kind of jumped the process to get ahead of us, which is what the motion is asking us to do. It is asking us to not complete the study we all agreed to do. He wants us to go ahead with just part of the information. It is a contradiction. It does not make sense.

I admire the member's work and his intention. Certainly the testimony we have heard has been very compassionate and compelling, but we are not there yet. Our own committee is not ready to make a recommendation, so I do not know how the government could go ahead and start a process to negotiate, without the committee, of which he is a member, coming to conclusions on how we are going to do this and developing a model.

There is no question that we have heard compelling evidence, and all the arguments for it are really good. It is amazing to sit through the testimony we have heard about our health care system.

Again, I go back to the purpose of the study we started. The reason we are debating this motion today is that it came up in our committee meeting. We proposed in our committee to have the parliamentary budget officer do this budget. We proposed it as part of the process, so we now have that. It is valuable. It has given us a lot of information, but there are many questions about who would be responsible for what areas, and we do not have those answers.

Some people say it is not even constitutionally possible. We have to nail that down. We have to get a better idea of who is going to be responsible and what jurisdiction is what. Are we going to bring it in slowly? Are we going to phase it in or bring it in with a big bang? Both have been recommended to us, but we have not come to a conclusion yet, because we have not finished our meetings.

The Canadian Agency for Drugs and Technologies in Health has a role to play. We need to hear from it. The Patented Medicine Prices Review Board will have a say in this, because pricing is everything. Part of the PBO report is based on a significant discount based on volume-buying for the whole nation, one buyer for the whole nation, effectively. We have to confirm that this discount is actually real. Right now the pan-Canadian Pharmaceutical Alliance gets a discount. We have to confirm with the alliance that this could be applied nationally, and so on.

The point I am making is that we have a lot more work to do. What formulary would be used? Everyone has a different formulary. Some approve these drugs and some approve different ones. We do not even have a formulary we have agreed upon.

I admire the member, and I do not blame him for leaning toward a national pharmacare program. Based on the testimony of the 89 witnesses we have heard, one could not come away with any other leaning than that we at least have to look at it as a country. However, we have not finished the report. We have not drawn our conclusions. We have not reported back to the House, as we all agreed to do. Therefore, we are not ready to go ahead with this.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I thank my hon. colleague for his kind words, his speech, and his leadership on the committee. It will come as not surprise to him that I may disagree respectfully with some of his points.

First of all, we have had 20 meetings of witness testimony for our study over the better part of a year and a half, and we have two more meetings to go. We are not halfway through the study, but at the 20th meeting of 22 meetings in the study. We have what can only be described as crystal clear conclusions. We know, and I do not think the government can deny it, that there are millions of Canadians who have no pharmaceutical coverage whatsoever and that their health is deteriorating as a result.

Second, we know that a universal pharmacare system would save billions of dollars. We know this from the report by the PBO and from every other report by academic researchers referred to at committee, which have shown that we would save billions of dollars. We wanted to confirm those other reports by an objective, independent study by the parliamentary budget officer. He tabled that report last week. His conclusions, using conservative assumptions, leaving out cost-saving measures, and using the broadest formulary in the country, Quebec's, were that we would save $4.2 billion.

I do not hear anyone on the government side denying any of that. However, what I hear them saying is that we do not have the details. That is what the motion calls for, for the federal government to sit down with the provinces over the next year to work out those details.

I must say that it was complex to bring in universal health care in this country. We did it in the 1960s. What differences does the member see between that and the federal government's working with the provinces to extend universal coverage to pharmaceuticals? Why is that unconstitutional or complex, when we have already done it with health care generally in this country?

[Bill Casey, Liberal, Cumberland—Colchester, NS]

Madam Speaker, it is more complicated, because when we brought in the health care there were no health care systems. Now, in this country, we have over 100 pharmacare systems. Each province has a whole whack of them. They have one for seniors, one for people with disabilities, one for indigenous people, one for social service recipients, and so on. Every province, every territory has an array of pharmacare programs. The federal government has one for the military, one for the RCMP, one for indigenous people, and so on and so forth. It is much more complicated.

The hon. member referred to little details that we have not straightened out yet, but here is one little detail. We are talking about someone spending $2 billion a year, and we do not know who or what organization that is going to be. Therefore, I think that before we can go any further on any plan for a pharmacare program, we have to finish our study and then figure out, and agree on, who is going to pay the $2 billion a year for the program. Yes, Canadians are paying $24 billion to $30 billion a year, but under pharmacare there will be one payer. Who is going to pay for it? Where is the money going to come from? We have to figure that out.

[Ken Hardie, Liberal, Fleetwood—Port Kells, BC]

Madam Speaker, the one thing I take from the point by the member for Vancouver Kingsway is a sense of urgency with respect to the people who do not have coverage, who are having to make some difficult choices in procuring the pharmaceuticals they need to maintain a quality of life and hopefully recover in regard to some things that are difficult for them.

I would ask the hon. member about a timeline. If there a sense of urgency to ensure that people have this coverage, what is the timeline for the process and the deliberations that you are undertaking right now? When might we expect some relief for these folks who are being left out right now?

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I just want to remind the member that I am not undertaking that, and that he is to address the questions to the Chair.

[Bill Casey, Liberal, Cumberland—Colchester, NS]

Madam Speaker, perhaps it would be better if you did undertake that.

We do not have a time frame, because we do not have the answers to how complicated this is, how the provinces are going to react, and how the different agencies that already have a pharmacare program are going to adapt. There is a lot of private industry involved. Private industry pays, provinces pay, the federal government pays, patients pay, there are a lot of different payers now. We are talking about having one payer in the end.

Our committee report will hopefully develop a model to work with. I do not have a time frame.

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I am thankful for the opportunity to speak on this very important issue. For Canadians, our health care system is a source of great pride.

As the opposition has moved that the House call on the government to enter into negotiations with the provinces to implement a universal pharmacare program, I would like to talk about a very important part of the health care system and the connection it has with improving the accessibility, affordability, and suitable use of therapeutic products in Canada.

Our government is committed to advancing this important work in collaboration with pan-Canadian health organizations and our provincial and territorial partners.

Since 1989, one of those pan-Canadian health organizations, the Canadian Agency for Drugs and Technologies in Health, or CADTH, has been a vital part of our health care system. CADTH delivers evidence, analysis, advice, and recommendations to health care decision-makers so that they can make informed decisions. As part of the reforms this government is implementing to ensure that prescription medicines are more affordable, accessible, and properly prescribed, CADTH's role will be expanded.

Canadians deserve the best health care in the world. However, contemporary health care is heavily dependent on drugs and health technologies. In 2014, the most recent year for which final data are available, drug spending reached $29 billion. The latest estimate, from 2012, for medical devices sold is $6.4 billion. These numbers are only expected to increase in the coming years.

Used effectively and efficiently, these drugs and other health technologies contribute to better health outcomes and deliver good value for money. However, they can also be misused and overused, resulting in harm to patients and a waste of valuable resources that could be better deployed elsewhere. For example, a recent study on unsuitable medication use found that over one-third of seniors filled one or more potentially incorrect prescriptions, resulting in an estimated $419 million being spent by provincial drug plans on the wrong drugs. The current opioid crisis provides us with another example of drugs that may not be properly prescribed. These are clearly calls for better evidence and prescribing.

CADTH, originally named the Canadian Coordinating Office for Health Technology Assessment, was created after a joint committee representing the federal, provincial, and territorial ministries of health identified the need for a new national and independent body to evaluate or assess health technologies to ensure that all Canadians would benefit from the advances being made in this area.

Health technology assessment is the systematic evaluation of the properties, effects, and impacts of a health technology. CADTH provides comprehensive evaluations of the clinical effectiveness, cost-effectiveness, and the ethical, legal, and social implications of drugs and health technologies on patient health and the health care system.

Health technology assessments, or HTAs, offer a valuable tool to policy-makers to support more rational, evidence-based decisions on the adoption of new drugs and other health technologies. CADTH's mandate is to deliver timely, evidence-based information to health care decision-makers across Canada about the effectiveness and efficiency of pharmaceuticals, medical devices, diagnostics, and procedures.

CADTH has helped Canada become a world leader in the field of health technology assessment. CADTH is a great example of provincial, territorial, and federal co-operation in health care. It is an independent, not-for-profit corporation. The agency is owned by, and reports directly to, the 13 provincial and territorial deputy ministers of health and the federal deputy minister of health. It is jointly funded by federal, provincial, and territorial governments, with the federal government providing approximately 70% of CADTH's $27 million budget, and the provinces and territories providing the remaining 30%. Canadian taxpayers get an excellent return for the investment of this money.

One of CADTH's most important programs is the common drug review, or CDR. The CDR is a process for carefully reviewing the clinical cost-effectiveness and patient evidence for drugs. Federal, provincial, and territorial governments across our country use the information to make decisions on which drugs should be listed on formularies and covered by their public drug plans. The pan-Canadian oncology drug review, also managed by CADTH, performs a similar role for cancer drugs. Both of these programs help ensure that patients have access to effective treatments and that taxpayer dollars are spent wisely. Some new drugs do not offer real health improvements and are significantly more expensive than existing treatments. Should these drugs be paid for by public drug insurance plans? CADTH helps us make these important choices.

CADTH's recommendations have also contributed to greater consistency in new drug listings across public drug plans. Additionally, as a signatory to the opioid action plan, CADTH is a part of the joint task force created to address this Canada-wide crisis.

CADTH provides a variety of other important services. For example, CADTH does HTAs on new and existing health technologies. These HTAs provide a full analysis of the clinical and economic aspects of health technology and sometimes include other factors that examine the broader impact of the technology on patient health and the health care system. These assessments cover topics ranging from the effectiveness of drugs for the management of rheumatoid arthritis to the best ways to quit smoking.

Other roles CADTH plays in our health care system include conducting environmental and horizon scans. These scans inform decision-makers about the use of health technologies in other jurisdictions and help guide important decisions within Canada's health care system. For example, environmental scans examine health care practices, processes, and protocols inside and outside of Canada. They help decision-makers better understand the national and international landscape. Horizon scans conducted by CADTH help alert decision-makers to new and emerging health technologies that are likely to have an impact on the delivery of health care in Canada. This early information supports effective planning for the introduction of new technologies in our health care system.

As illustrated by the foregoing, we know that CADTH currently plays an important role in our health care system, but there is more to be done. In addition to exploring the need for a national formulary, our government intends to invest millions of dollars in CADTH. This money will allow the organization to better align its cost-effectiveness reviews with Health Canada's regulatory reviews and to expand the scope of its activities, including conducting evidence reviews at all phase of the therapeutic life cycle and working with the provinces and territories to develop a needs identification and prioritization process. This will better support effective and evidence-based management and prescribing and use of therapeutic products across Canada's health care system.

Right now, Health Canada approves a drug after it reviews its safety, quality, and efficacy. Does the evidence show that the drug does what the manufacture claims? Is it safe, and does the manufacturer meet quality standards? In most instances, drug sponsors begin the process of applying for their drug product to get listed on provincial and territorial formularies by submitting information to CADTH for review only after the Health Canada approval. That could mean a delay of six months or more as CADTH works up a recommendation to public drug plans about whether a drug should be covered, in part on the basis of its cost-effectiveness and in part on clinical and patient evidence.

These two processes should be aligned; if possible, they should be run at the same time so Canadians can get faster access to new, worthwhile treatments.

We are presently pilot-testing the alignment of these processes. This improved coordination would better support effective and evidence-based management, prescribing, and use of therapeutic products across Canada's health care system. Additionally, we will—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I am sorry, but time has expired. The member may be able to finish her speech during questions and comments.

Questions and comments, the hon. member for New Westminster—Burnaby.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Madam Speaker, the member represents the region of Brampton in the House of Commons and, as she knows, as we all know, the new national leader of the NDP, Jagmeet Singh, comes from the Brampton area. I myself have travelled to Brampton a number of times, including a few months ago, and when I was speaking with people in the Brampton area, they raised concerns around the lack of a national drug plan.

The PBO said it is absolutely cost effective to put in place a national pharmacare plan. In fact, Canadians and governments would save money if national pharmacare were put in place. There are hundreds of thousands of Canadians, including thousands in the Brampton area, who do not have access to pharmaceutical products that would keep them healthy and alive. For the life of me, I cannot understand why members in the House of Commons from Brampton are opposing the idea of putting into place a national pharmacare plan. It just does not make sense. It does not make sense because their constituents also desperately need this plan, and the suffering is as acute in Brampton as it is anywhere else in the country.

My question to the member is very simple. Given that we know it is cost effective, given that we know of the need, why are representatives like the member from Brampton and Liberals opposed to putting national pharmacare in place?

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I am a member of the health committee, and the committee is working hard on a national pharmacare plan. This is the first topic the committee looked at, and members know that. The PBO's report is due next week, and our government is also working hard on that issue. We know that Canadians pay too much for prescription drugs, and our government is taking bold steps to save Canadians money and improve the affordability of access to prescription drugs, while exploring the need for a national formulary. We know we need to make Canada's existing prescription drug system more efficient and responsive to the needs of Canadians, and that is exactly what we are doing.

The committee heard 89 witnesses over 20 meetings, and the PBO's report is coming next week. This is a very important issue. That is why we are working on it. Next week, when the PBO's report comes, we will dig into it. We all know we have to work on that important issue. That is why we are working on it. We are making a plan to make it better for all Canadians. That is what we are doing. We want to deliver the best results for all Canadians.

[Bill Blair, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I first want to thank the member for Brampton South not only for her remarks but also for her very hard work on the health committee. I want to commend all members of the committee for their work in examining this area and the careful, thoughtful way in which they have approached it. I want to give the member opposite an opportunity to clarify.

Contrary to the remarks made by my friend from New Westminster—Burnaby, it has been amply demonstrated that the health committee has approached this with great seriousness. It has listened to countless witnesses and actually sought the report from the parliamentary budget officer. I want to give the member for Brampton South the opportunity to clarify the commitment that the health committee made to serve all Canadians and address this very legitimate concern about the affordability and accessibility of pharmacare.

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, the study of universal pharmacare by the Standing Committee on Health is ongoing. It heard from dozens of witnesses—patient advocates and experts in medicine, social policy, constitutional law, pharmaceutical manufacturing, insurance—and the committee asked the PBO to prepare a report, giving certain parameters to guide the committee in the evaluation of policy options. It is premature to call upon the government to do anything. We want to give Canadians a better plan and cost it. The committee is working hard and knows this is essential. We all know Canadians need better pharmacare. That is why we are working hard on that.

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Madam Speaker, I will be sharing my time with my colleague from South Okanagan—West Kootenay.

Last Saturday, I attended the Forever Young Seniors Expo in Cranbrook, in my riding of Kootenay—Columbia. It was a wonderful event organized by Kootenay CARP in celebration of National Seniors Day. I spoke to many seniors at the event and to many advocates on seniors issues. There certainly are many issues facing retired people today. CARP, which is the Canadian Association of Retired Persons, has a list of 10 advisory items that it wants the members of the House to address. Let me go over them briefly.

The first is retirement income security. Pensions and the guaranteed income supplement, or GIS, must increase. As members heard in a question I asked earlier this week, it is essential the government consider how critical it is for payments like GIS to be made consistently, every month. Many Canadians do not have enough savings to carry them beyond one month if they miss a cheque. However, every time the Canada Revenue Agency decides to review a case or make a change to a file, it stops the monthly payments that many of our seniors depend on, including for buying prescription drugs. This leaves seniors and other pensioners forced to choose between their rent, groceries, and prescription medications. Consistency is important, and so is the amount of income pensioners receive.

CARP's second item is the transformation of our health care system. It recognizes that reductions in federal health transfers to the provinces are putting undue pressure on the entire system. At the same time, private clinics are working through the courts to overturn our cherished universal health care. This is extremely worrisome to today's seniors.

Improved home care is another program that would save Canadians money. CARP points out that we need to do everything we can to keep seniors in their homes by supporting everything from Meals on Wheels to the United Way's better at home program. Improved home care would keep many seniors out of hospital, freeing up expensive hospital beds. It would provide better services for seniors, while reducing wait times and health care costs.

Prescription medication also impacts hospital times. I will get to that a bit more a little later.

Linked to home care, CARP wants to see better support for caregivers, which is why the NDP's push for a $15 an hour minimum wage is so important. It would help ensure caregivers earn better pay.

CARP's sixth point is better opportunities for older workers—other than running for political office, of course.

The seventh on the list is to make our cities more age-friendly by improving accessibility for people who use wheelchairs and walkers.

Investor protection is also on CARP's list. It gives an example of a 93-year-old woman who was able to negotiate a mortgage, but the bank refused life insurance protection. That is simply not acceptable.

The NDP has spoken often of the need for improved end-of-life care. We support a national palliative care strategy to accompany the current physician-assisted suicide laws. We are pleased to see that CARP has made end-of-life care a priority.

Similarly, and as part of a national mental health strategy, CARP asks for a national dementia care strategy. As Canada's senior population grows larger, the incidence of dementia grows larger as well. Now is the time to respond better to this health care crisis.

I skipped over one of CARP's top priorities, but it is the issue that brings us here today, which is the need for a universal pharmacare program.

Let me take a quick moment to read our motion again for those who may have just tuned in at home. It states:

That, given that millions of Canadians lack prescription drug coverage, and given that overwhelming evidence, including from the Parliamentary Budget Officer, has concluded that every Canadian could be covered by a universal pharmacare program while saving billions of dollars every year, the House call on the government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program.

Many of my NDP colleagues have already covered the basic issues: we are the only nation that has universal health care that does not include universal pharmacare, and a pharmacare program would save money. The parliamentary budget officer made that very clear this week with a groundbreaking report that said Canadians can have a universal pharmacare system for billions of dollars less than we now pay for prescriptions. In fact, the PBO estimates conservatively that Canadians would save $4.2 billion a year with a national pharmacare system.

Here is the kicker. I think the PBO got it wrong. When I read the PBO's report, I see it missed an important reason why pharmacare would save money. Let me explain.

We know that many doctors will keep patients in hospitals longer, including seniors, because they need to take prescription medications and patients in hospitals get their medications for free. They are covered under health care in every province. However, the moment patients are released, they have to buy their own medications. Doctors know that many patients do not have private insurance to pay for medications and that even programs that provide medications to seniors do not bear the full cost. Therefore, patients who are released from the hospital may or may not keep taking the life-saving medications they need. As a result, doctors often keep these patients in the hospital longer than they would otherwise need to be there. There is a cost to this.

According to the Canadian Institute for Health Information, hospital care in Canada costs about $63 billion a year. On average, the cost of a hospital stay is about $6,000 per day. This is a significant cost, and it could be a significant saving. Introducing a national pharmacare program would lower the health care costs for taxpayers while at the same time freeing up hospital beds and reducing wait times for patients. That is a win-win-win situation. The PBO's excellent report did not include these savings. Therefore, we can assume that the $4.2 billion each year that it estimates Canadians would save would be higher.

The PBO's report was not the first to state the benefits Canada would receive if we adopt a universal pharmacare program. Speaking lightly, I might suggest that the PBO got it wrong. However, the report was incredibly well thought out and extremely important. It tells us that pharmacare would have significant savings for Canadians because of the increased spending power it would offer. A single buyer for all medications in Canada would be able to negotiate with the drug companies to push the costs of medications down. The report estimates that Canadians can negotiate savings of 25% over what we are now paying for drugs. However, in Quebec, the province just negotiated a 40% savings. Therefore, the cost savings to Canadians may prove to be much more than the PBO estimated.

There is an urgent need for pharmacare. Yesterday, I met with some of my constituents from Cranbrook and Nelson here in Centre Block. Some of them are nurses. One of them is on multiple medications. They all said how important this was to them.

Canada currently has the second highest rate of skipped prescriptions due to cost among comparable countries. One in five Canadians report that either they or a family member neglect to fill prescriptions due to cost. In the past, my home province of B.C. has had the highest levels of problems accessing prescription drugs, with 29% of citizens, mostly the young, the elderly, and the poor, unable to afford necessary prescriptions. Of course, we pay some of the highest prescription drug prices in the industrialized world. Therefore, we know the problem, we know the solution, and we just need the political will.

The Angus Reid Institute recently completed a poll that found 91% of Canadians support the introduction of a universal pharmacare program. There are many supporters of pharmacare, including Canadian Doctors for Medicare, the Canadian Diabetes Association, and the Heart and Stroke Foundation. All of them have said that having a national pharmacare system is important to the health of Canadians.

Nationally, highly respected organizations that work for better care in Canada support pharmacare, doctors support pharmacare, and 91% of Canadians support pharmacare. Today I ask my colleagues on all sides of this chamber when they will join them and support pharmacare as well. This is an excellent time for you to do that.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I am certainly not going to do it. I do want to remind the member that he is to address his questions to the Chair.

Questions and comments, the hon. parliamentary secretary to the government House leader.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, it comes as no surprise that members on all sides of the House have a great deal of concern and compassion with respect to our health care system.

Well over a year ago, shortly after we came into government, the Standing Committee on Health recognized how important this issue was and it commenced a study. A part of that study involved asking the PBO to provide the committee with some actual numbers and some thoughts on our health care system. That standing committee is still dealing with the issue.

I did not participate on committee, but my colleague from Brampton and others did. They put a lot of effort into providing possible options for the House to look at. One party is now trying to capitalize on one idea to which all committee members are trying to contribute.

Does the member not believe that the standing committee should have, at the very least, received the report on which the NDP has based its opposition day motion, as opposed to taking credit for a report that is not due to a political party? Credit is due to members on the standing committee and their efforts. One of the members on committee is a member of the New Democratic Party.

Canadians are looking for some guidance on this issue. Why not allow the standing committee to continue to do the fine work it started?

[Wayne Stetski, NDP, Kootenay—Columbia, BC]

Madam Speaker, we have had an interesting discussion today with my colleagues across the floor and down the way. They seem to be looking for reasons why they should not support the motion. They say that they are not really sure the parliamentary budget officer has it right. They claim to be already looking at this in committee. Nothing has been put on the floor by any other party that would provide a reason not to support the motion.

The committee is heading in this direction anyway, yet you talk about taking a collegial approach to a resolution. A collegial approach would be supporting the motion. It really is quite simple.