Health committee  It's interesting. One thing that government can do...I certainly don't think it's the role of government to make the individual decisions. I would rather have the government get out of the business of making decisions, because we've seen there can be influences on those decisions that can go either way.

Health committee  We have a system in place where among our private plans pretty much anything that is prescribed is covered. That's the open formulary plan. If you think about what the incentives are for a private insurance plan—the more I prescribe, the more prescriptions churn through the industry, the more money gets made—it's the reverse incentive of the incentive one would want or hope for.

Health committee  We haven't estimated the specific administrative costs of ramping up, in part because Canada, probably to the surprise of this committee, has dozens of public drug plans across the country in each province, territory, and at the federal level. All of them manage their own formularies; all of them make their own decisions, and all of them, should they participate with the pCPA, have to sign their own contracts.

Health committee  Yes. Overwhelmingly, there's—

Health committee  Two things hinder the provincial negotiation power. One is that it's a minority payer. The other thing is that no does not necessarily mean no, and yes does not necessarily mean yes. When a province actually says yes to a drug, then that's great; it's signed a deal if it's taken up the manufacturer's offer.

Health committee  Thank you for the question. A have a couple of observations. The first is that you're absolutely right. It's not government that's writing prescriptions for patients primarily in our country; it's doctors. As I'm sure the committee can appreciate, the decision to pick up one's pen and write that prescription is the culmination of a whole lot of complex factors.

Health committee  Very quickly, I'll add that there are several things we can learn from several high-performing systems around the world. The key ingredient is that your drug plan has to have a budget. In fact, some of the best performing drug plans in the world are in every Canadian hospital that Canadians use on a regular basis.

Health committee  Maybe I'll start from a clinical perspective. Of course, I can't speak to the specifics of that individual's case. One important thing that we always have to ask ourselves is whether the prescribing that's going on is actually based on the best available evidence and whether the formularies are based on the best available evidence.

Health committee  I really appreciate the question. Not only can a pharmacare system give Canadians the best health possible, but a pharmacare system could give them much better health care than they currently get. To me it's incredibly important that this message come across clearly in this afternoon's discussion, that giving everybody access to every drug all the time is not good health care.

Health committee  Thank you for that question. It is important for committee members and other people to get the full manuscript from the Canadian Medical Association Journal, including the technical appendices that provide detailed sensitivity analyses to show you what kind of parameters have the biggest impact on the cost to government.

Health committee  Good afternoon and thank you so much for inviting me to join you. My name is Danielle Martin. I am a practising family physician and I'm also a hospital administrator. I'm the vice-president of medical affairs and health systems solutions at Women's College Hospital in Toronto.

Health committee  Good afternoon. Thank you for having me here today. By way of introduction, I am Steve Morgan. I am a tenured full professor at the University of British Columbia. Over the past 20 years, I have published 105 peer-reviewed pharmaceutical policy research studies and 43 reports on pharmaceutical policy for governments, research centres, and think tanks in Canada and abroad.