Health committee  Thank you. Good afternoon. Thank you for the opportunity to appear in front of you on this important issue. I want to begin by acknowledging that the land we are meeting on today is the traditional and unceded territory of the Algonquin nation. I, like everyone else, have been very concerned about the reports we've all heard of indigenous women being coerced into undergoing sterilization procedures.

Health committee  I think that it's fair to say, though, that at the end of the day it may be the employers who are actually paying the premium to the insurance companies, but this is all part of the calculation of the pay packet for employees. I think the benefit to employers and to insurers is that drug coverage costs are escalating, and in these—I'll call them, for lack of a better term, non-managed—privately financed drug benefit systems, this is getting to be an increasingly heavy cost burden for employers.

Health committee  Yes, but not necessarily.... Again, just to hark back to those two theoretical models that I put on the table, and I think it's worth looking—

Health committee  Yes. In some of these other countries where we use the term “universal coverage” rather loosely, it does mean that everyone has coverage, but it does not mean that public authorities pay the full cost. Public authorities have oversight of the parameters for drug coverage, and it is useful for the committee to look at the range of these models that are out there that all have, at the end of the day, universal coverage.

Health committee  Again, across most of the country, seniors have coverage through public drug plans. As for seniors who have been in the workforce for a long time, this is not the entire seniors population, obviously, but a significant portion may still have access to the health benefits program in their place of employment even after they retire.

Health committee  As a matter of fact I don't actually have data specifically on the use of medical marijuana in the various federal programs, or among the so-called federal populations. I think it would be information held by the responsible departments. If you wish we could commit to getting that information and providing it to you.

Health committee  Maybe I can start answering that one. On the second part, the cost as a consequence of people not filling prescriptions, there is not to my knowledge any good data that explains what those costs are. We do know that individuals who forgo medications, particularly for chronic diseases, and others, but particularly chronic diseases, do run the risk that their condition will deteriorate and that they will make demands as a consequence on other aspects of the health care system, be it emergency room services, surgeries, and so on.

Health committee  It is a reality now, as you've mentioned, that individuals on social assistance do have coverage in most provinces and it's generally pretty good coverage. Certainly in the case where seniors are covered, which is also the case in the majority of provinces and territories, there is some degree of income testing, but for reasons you can all imagine it's not that easy from a political standpoint to introduce a really progressive kind of regime where the beneficiaries are actually paying some portion of the cost in accordance with their income.

Health committee  I'm not aware of specific studies on that, but I think as a general point—and this is not speaking specifically to the use of prescription drugs or prescribing practices in ERs—certain initiatives, such as the choosing wisely initiative, have demonstrated with the over-prescribing of just about every health care intervention, those prescriptions aren't filled.

Health committee  I actually think that's a bit of an improbable scenario because we have to take into account the current unmet need. There's certainly a cost. What we would see is that in all likelihood the expenditure per capita might go down. As you've already heard, our spending per capita is pretty high, as well as drug prices being high.

Health committee  Yes, some analysis has been done. There's a large number of people, not the least of whom are in the generics industry, who are attempting to estimate what incremental costs will be. The maximum amount of extended protection that brand drugs could get in the Canadian marketplace would be two years.

Health committee  That's correct.

Health committee  Yes, that was what I was alluding to when I said there are two broad paths based in a way on the same principle: that resources are pooled to share risk across the entire population. The question is: what is the source of that funding? Is it all public sector dollars, in which case federal, provincial, and territorial governments assume all the costs that are currently contributed by employers, employees, and individuals?

Health committee  Mr. Chair, and Mr. Ayoub, I'm happy to make a couple of initial comments. I think it's clear, and all of us in one form or another in our remarks have indicated, that there are clearly gaps in drug coverage for Canadians. There are, as I mentioned in my remarks, individuals who have no coverage and individuals who have inadequate coverage.

Health committee  Thank you, Mr. Chairman. Good afternoon, and thank you for the invitation to speak to the committee. With me are Health Canada colleagues Frances Hall, the acting executive director of the office of pharmaceuticals management strategies; and Scott Doidge, who is director general of the non-insured health benefits directorate in the first nations and Inuit health branch at Health Canada.