Health committee  The idea of appropriate use in the simplest terms is the right medication for the right patient at the right time. Typically, for example, even now, physicians will often look at practice guidelines to decide which would be the best treatment. There is certainly the discussion—and the patient and physician relationship—but the statistics are fairly consistent that in fact a good deal of over-prescribing occurs.

Health committee  I'm sorry for the pause. I'm just trying to find the exact spot.

Health committee  Yes, thank you.

Health committee  You're quite right to point out, as you just did, that it is one of the principles the minister would be required to consider when moving forward on national universal pharmacare. With regard to the others—proposed paragraphs (a), (b), (c) and (d)—and then speaking specifically about appropriate use, one of the reasons that this wording is there is that there are numerous studies to show that in fact there are issues with improper prescribing or over-prescribing, and you're probably aware of a lot of efforts around de-prescribing, in particular with older patients.

Health committee  I may not have been clear. In the way CADTH functioned before moving towards becoming the CDA, it was quite limited to what we call “health technology assessment”. The functions and activities that would be added are what's set out in the legislation. There will be more happening within the context of the new CDA than what is currently done by CADTH.

Health committee  I would come back again to the functions that the CDA will undertake that go beyond what CADTH does now: data analyses and a lot of work around appropriate use. All of these things will inform how the strategy can come together. None of these activities are currently done by the pCPA.

Health committee  In fact, CDA is being built from CADTH. CADTH continues to exist in the sense of the people who work there and its structure, etc. With the activities that are being added to CADTH, which are set out in the legislation in clause 7, as you noted, CADTH is growing into, if I can put it that way, the nucleus of the CDA.

Health committee  We have been able to do that. I will ask my colleague to do it, simply because he wrote down all the numbers before we came. My recollection from my response was about the amount of time we had spent working on some of the policy work, and then about when we started the actual drafting.

Health committee  Again, just to return to my earlier comment, the term “indigenous peoples” is used as an inclusive term here, and it's also a term that is used in other legislation. When we are looking at bringing forward legislation, we look at consistency and do that due diligence. What I would add as well is that, in the sense that it's inclusive, it does not limit the interpretation that's being suggested—i.e., it is inclusive of exactly the wording that's being put forward, so there's a redundancy there.

Health committee  Thank you, Mr. Chair. The broader term, “indigenous peoples”, is in fact inclusive. That would be our view. Of course, in preparing the legislation, we would have done this due diligence as well, so I would agree with the earlier comments.

Health committee  The minister referred to the list in his remarks as well. There is a list that was put forward when the bill was first introduced on February 29, and as the minister noted, this is the starting point of those discussions with provinces and territories, so yes, there is a list available.

Health committee  There is some similarity around, for example, accessibility and also universality. There are also some differences, though. For example, under the Canada Health Act, we speak of portability, which is not a type of term that you would use when you're speaking of drug coverage. The principles that are reflected here are more closely aligned with the principles that would be more appropriate in speaking of drug coverage.

Health committee  Portability would relate to what many of us would experience if we needed to go to a hospital or see a doctor when we're perhaps visiting family in a different province. It's a bit different with a drug plan, because if you're covered under a drug plan, it tends to be the plan that is reimbursed by that province, so you wouldn't necessarily be able to receive the same coverage in another province.

Health committee  I'd have to go back and look, to be honest, because it has been a long path for us, but it's certainly been a number of months. Also, before leading to the legislation, you do all the policy work as well.

Health committee  The legislation sets up a framework for that consultation. If you look at the preamble, you see that a couple of things are important. One is that it's very clear on the jurisdictional work and the role of the provinces and territories. That is set out very clearly in the preamble.