Health committee  Very briefly, I just want to add that both in the “Pharmacare 2020” report and in another report by our national research network called “A Better Prescription”, just published last year, we articulate how the appropriate use of medicines is one of the key pillars of a national pharmacare system.

Health committee  I'm aware of a couple of surveys of employers that say they are very interested in a national public drug plan of some kind because they are finding themselves under great pressure. I think you heard testimony from representatives of the employers in Canada who basically argue that the cost of medicines is out of control in the private sector and they don't have the capacity to manage it, nor do they have the moral authority to decide who gets coverage and who doesn't, based on the nature of the disease and which drug comes to market.

Health committee  Roughly speaking, yes, in the sense that the World Health Organization manages what it calls the model essential medicines list for the world. That's the list it believes constitutes the drugs that every human being on earth has a fundamental right to access. That's the starting point.

Health committee  Based on the paper published earlier this year—and I would have to look at the precise figures—we estimated the incremental cost to government to develop a national plan to essentially provide all of these drugs was about $1 billion more than we're currently paying through public drug plans at present.

Health committee  Yes, it used an extraordinarily open formulary in the context of Canadian public drug plans. It had conservative assumptions about price savings, when even our analysis vis-à-vis the U.S. veterans administration right here in North America, right south of the border, shows that they save about 50% relative to Canada on generic drugs and about 40% relative to Canada on brands.

Health committee  Yes. Almost without doubt, the provinces will either have to cede authority in some way—and some lawyers and health lawyers have looked into this—or we're going to need to sit down and negotiate. This is consistent with Canada's framework for national health and social programs, through which we need to meet fundamental human rights.

Health committee  Yes.

Health committee  I think we already have the institutional capacity to do an excellent job of running a drug plan. Let's face it: our provinces already do a lot of work on this, and we have world-renowned experts and agencies like CADTH. We now have really good capacity within the pCPA to do price negotiations.

Health committee  Yes. I guess the PBO report is only the latest.

Health committee  I think one of the flaws of the Quebec model was that it was based on an insurance industry's model of what prescription benefits are, rather than an integrated model of a health benefit that includes prescription drugs. Systems around the world that integrate medicines into their equivalent of our medicare system make sure that preventative medicines are free of charge to as many people as possible, so that at least the stuff that keeps people out of hospitals is actually getting filled when prescribed appropriately.

Health committee  You have to find it. You can't necessarily immediately grab it, for instance, out of the extended health insurance from which public sector employees currently benefit. Eventually, that will become a savings both to those employees and their employers, but in the short run, to incentivize the program you need to find a revenue tool to bring money into the system.

Health committee  I can quickly answer that. I'm not entirely sure about going into the Canada Health Act, which is what Roy Romanow recommended for prescription drugs as a long-term goal. There are certain principles of the Canada Health Act that might not be consistent with the way you manage a pharmacare program, such as having no user charges to patients for any of the eligible drugs covered.

Health committee  It is fair to say that all the countries with effective systems for managing cost and access so that there's equity of access with cost control use some form of a national formulary.

Health committee  To answer your question, the logic of the way Canadian medicare was supposed to work, the way our system was supposed to be built in stages, including prescription drugs and eventually things like home care and long-term care, was that it would be provincially and territorially administered with cost-sharing at the federal level.

Health committee  Thank you very much for the invitation to speak before this committee again. Rather than provide a full introduction, I'll simply mention that since I last spoke before this committee in April 2016, I've published a further 22 peer-reviewed research papers on issues concerning the accessibility, affordability, and appropriateness of prescription drugs used in Canada and comparable countries.