Health committee  I haven't considered it exactly in that form. In some ways, we have a sort of two-tier system, even with patients who have private plans and patients on pharmacare. If their medication isn't covered on the plan, they always have the option of purchasing it by themselves. In some ways those decisions are being made when formularies say they don't think a particular drug works but that patients can buy it if they want to.

Health committee  I actually can't answer that question. I've not seen any analysis that we've done on the Quebec plan.

Health committee  First of all, I don't think it's quite that simple. Many patients who have private drug plans don't have open formularies. As a matter of fact, within some of the insurance companies, there are 10 different plans that your company could purchase. Some of them are much more restrictive than others.

Health committee  It's possible. There are other ways to do it, and I think it is happening across Canada right now; more and more systems are being developed within the provinces so that we can see all of the prescriptions that might be coming from multiple drugstores. But there's still a potential advantage to having one system.

Health committee  Right. I guess it really depends on its administration. If I were going to come up with something, it would be that it not be administratively burdensome. That would be an obvious one for me, and that it be more seamless. The upside would be perhaps better information, more guidance in more evidence-based formularies.

Health committee  Absolutely not. As I mentioned, the model we put forward, for a shared...could easily still be incorporated with private plans as well, so absolutely not.

Health committee  Thank you for that. I think I addressed that somewhat in an earlier question but our intention really—especially with the pre-budget consultations—was to look at measures that were able to be easily implemented in a short time frame. We really see that recommendation as a step towards national pharmacare if that's where we're headed, so we felt that this was a reasonable approach.

Health committee  Would you like to comment on that? Owen is very familiar with what's happened historically and over time. There have been a lot of attempts in the past.

Health committee  I'm not sure if we're talking about workarounds in the same sense. The workarounds I'm familiar with are usually me filling out special authorization forms or special requests for things that aren't covered, which is paperwork.

Health committee  Yes, that counts. There's definitely an administrative burden, and a burden on physician time, in dealing with the exceptions, which sometimes seem to be the rule. I would hope that the vision of a national pharmacare program would not be based around increasing the administrative burden on physicians, because that would not be a success, to my mind.

Health committee  It's nice to see you.

Health committee  I am going to defer to Mr. Adams.

Health committee  I think the answer is that we don't have that information. I think that would be very useful information. I'm not sure whether it's even possible to gather all that information. I know from my own experience that patients don't often reveal that they're not taking their medications.

Health committee  I think it could. When we talk about getting the provinces and territories together with stakeholders, along with the federal government, to look at a pharmaceutical strategy, determining how it could best occur would be part of that. I believe that it definitely could help with that on many different levels.

Health committee  I think certainly it can be very beneficial. I'm familiar with the situation in Nova Scotia, where I work. The formulary is determined by a committee that looks at evidence. They look at cost and they look at value. The fact that the formulary has been developed with these in mind gives us confidence that those things have been considered and provides a template for physicians to understand which prescriptions provide the best value for their patients.