44th Parl. 1st Sess.
May 6, 2024 11:00AM
- May/6/24 1:30:01 p.m.
- Watch
Madam Speaker, I am curious as to the member's thoughts on the pharmacare proposal that is within. I think that seniors, no matter what area of the country they are in, particularly those with diabetes, would recognize that having national pharmacare is a very strong, positive thing, just on that point alone.
Does the Bloc support Canada providing pharmacare coverage and recognize that at least we are moving in the right direction?
73 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 3:44:19 p.m.
- Watch
Mr. Speaker, this is a concrete proposal to move pharmacare forward in this country. The drugs are two classes of drugs. They represent more than 80 different medical drugs that deal specifically with diabetes and contraceptives. It is part of a broader suite of actions that we are taking, such as, for example, drugs for rare diseases. I am currently having conversations with every province and territory about how we can take action on drugs for rare diseases so that folks with rare diseases can get access to the medications they need.
It is part of what we have done on bulk purchasing to realize $300 million in savings for Canadians across the country. It also builds on the work that we are doing with a pilot in P.E.I., where we have been able to get copays down to five dollars there, saving seniors hundreds and hundreds of dollars in P.E.I.
Action is taken one step at a time by demonstrating in evidence exactly what is going to be saved and exactly how this should function. As an example, in British Columbia, when it comes to contraceptives, it already shows that the province is saving more than it costs to run the program. I suspect we will also see that in diabetes. Canadians, rightfully, want to see this in evidence. They want to see these things live out there, demonstrate how they work in each example and then build on that successively.
Our health care system was based on an iterative process by making sure that the steps we take are prudent, smart and fiscally responsible, and that is the way that we need to proceed with pharmacare as well.
284 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 5:00:57 p.m.
- Watch
Mr. Speaker, there are three million people across our country living with diabetes, and they pay about $18,000 a year out-of-pocket. This is going to make a big difference for those folks, especially knowing that they are going to have the devices as well.
This is the first step in a model that I really believe in, which would result in collective purchasing. Any Canadian would know that, when we buy collectively, prices usually go down. Of course, that is why Canada pays the second- or third-highest medication rates on the planet.
Does the member have any thoughts on the hopefulness of the people who will finally get medication they can afford?
116 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, I am thankful for the opportunity to speak to Bill C-64, an act respecting pharmacare. I am extremely excited to talk about this, because this is a very important program, another transformative initiative for Canadians. We are again supporting Canadians. We can think back to 1968, when we brought in medicare. We knew the Conservatives were against it then, and the Liberals brought it in; today, no one wants to get rid of medicare, because of its importance.
In this speech, I will be talking about the framework on pharmacare and also talking about diabetes and the three million people with diabetes, and how difficult it is for them. Also I will share some information about the pilot project we have been running in P.E.I., which has given us some information, as well as where we sit in the G20 when it comes to health care and drug care. Finally, I will talk about all those initiatives the Liberals have brought in, which are helping Canadians today and in the many years forward. It was the Liberal Party that brought those.
Let me start off by saying that this act is focused on certain drugs that we would bring forward, and related products.
Of course, my colleague will be joining me afterwards. I will be sharing my time with the member for Dorval—Lachine—LaSalle.
To continue, we are talking about certain drugs, such as contraceptives and diabetes medication. Again, as I said, there are over three million people with diabetes in Canada. Back in December 2023, we created the Canadian drug agency, and its focus is on three major areas. One is a formulary, which is putting up a list of all the drugs that would be included in this pharmacare program. Another is bulk purchasing. As some have mentioned already, we have already saved millions of dollars, and there are billions to be saved through that process, which will continue. Third, we will be publishing, of course, appropriate use of medication in Canada.
I also want to say that once this legislation is passed and receives royal assent, within 30 days the minister will appoint a committee of experts to make recommendations within a year, so that we can move on this as quickly as possible.
When I go to get some medication at the drug store, my pharmacist often tells me, “You have to do something for people with diabetes. The cost is unbelievable. Many Canadians are facing a cost they cannot afford to pay. You need to come forward with some type of initiative.” I am so pleased to be here today to talk about that.
In the last decade, we have seen a doubling of the number of people facing challenges with diabetes, which is extremely important. Today, 3.7 million people are living with this. If we do not do something to help them, 25% of those people have indicated that they cannot afford to pay for that medication. If we do not treat that disease, we know what some of the end products would be, and they are not very good. We are talking about blindness. We are talking about amputation. There are all kinds of challenges that come with that.
Just for insulin, for type 1 or type 2 diabetes, the cost can range anywhere between $900 and $3,000 or $4,000 a year, which is extremely high. The good news is that we are going to work with the provinces and territories and have a deal, so that they can have frontline services for these individuals.
Diabetes Canada said, “We are very pleased with the government's commitment to prioritize improved access to diabetes medications and devices. This monumental step demonstrates a genuine dedication from our political leaders to enhance the well-being of the over four million individuals living with diabetes in Canada.”
For example, last year in June we started a pilot project in P.E.I., and from that pilot project we have seen the medication costs drop by over 60%, helping the residents of P.E.I. In a very small province, they have already saved up to $2 million, out of pocket. That is extremely important, and when we talk about affordability, this is another step forward that our government is bringing to the table.
Where do we sit in the G20? Well, it is important. People ask why we are bringing this in. We are bringing this in because we probably should have brought it in before, but the time is now. We are the only country in the G20 that has health care insurance but yet does not include drugs. The U.K. has included some prescription drugs. Australia has a mixed formula of private and public. France has, of course, a health care system and is now paying significant portions toward drugs. There are other countries in the G20 that have some type of pharmacare, including Germany, Italy, Japan, South Korea, Argentina, Brazil, etc.
According to a CBC article, “the federal Advisory Council on the Implementation of National Pharmacare, led by Dr. Eric Hoskins, stressed how people's lives can suffer if they skip needed prescription drugs, and noted a Canada-wide program could eventually lead to system-wide savings of nearly $5 billion annually.” When they talk about how much it would cost, we could actually save up to $5 billion. I think that is also a very easy answer as to why we should move forward.
When I talk about our government, the values and ideology of the Liberal Party have always been to tighten up the gap, help the most vulnerable and make sure that all Canadians have opportunities to be successful. Let us look at some of the things that we brought forward: 1968, medicare; 1969, the Official Languages Act, making both languages the official languages of Canada; 1982, the Charter of Rights and Freedoms, which all Canadians should be very proud of. Some of the opposition members are hesitant today on some pieces of the charter and we will see where they go with that piece.
There is the new and improved universal child benefit. When the Conservatives had it, it was 30% to 40% less and it was taxable; now it is not. There is the new and improved CPP, in 2019, which went from $11,400 a year to almost $20,000 a year. Those are programs that are helping every Canadian. These are opportunities. This is what makes Canada great. This is why people want to move to Canada.
Let me speak about some more initiatives that we are bringing to the table. The national school food program would help over 400,000 young people. The new disability program would help over 600,000 people with disabilities, who we know comprise most of the individuals living in poverty. Those are major initiatives to help. We are also building the dental care program. Nine million Canadians would have access to the dental care program. These are big numbers. There are many Canadians who have challenges, and our government has been focused on how to support the individuals facing those challenges.
I am going to end with something that Canadians must listen carefully to. If the Conservatives ever came to power, what would they cut? They do not want to tell us. They say “a dollar for a dollar”, so if there is a deficit of $40 billion today, we know they are going to cut $40 billion tomorrow. That we already know; we just do not know which programs. Therefore, I am going to ask the Conservatives. Would they cut pharmacare? Would they cut dental? Would they cut the disability benefit for people with disabilities? Would they cut the school food program that we have been talking about for 20 years? Would they cut the CCB, which is helping young families? Would they cut the early learning and child care program? I do not know. I am sure the Conservatives do, and I would love for them to share that with Canadians.
1362 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, I am grateful for the opportunity today to speak to Bill C‑64, an act respecting pharmacare.
This bill represents the next phase of our government's commitment to a national universal pharmacare program. It proposes the foundational principles of national universal pharmacare and our intent to work with provinces and territories to provide universal single-payer coverage for many contraceptives as well as diabetes medications.
This is an important step forward in improving health equity, affordability and outcomes, and it could save the health care system money in the long term.
Public health care in Canada was built on the promise that no matter where one lives or what one earns, one will always be able to get the medical care one needs. Despite this promise, Canada is the only country in the world with universal health care that does not provide universal coverage for prescription drugs.
When medicare was first introduced, prescription drugs outside of hospitals cost less and played a smaller role in health care. Today, prescription drugs are an essential part of our health, helping to control chronic conditions, treat temporary ones, and aid in overall health and well-being.
One area that has seen significant changes is diabetes treatment. Over 100 years ago, thanks to a Canadian team of researchers, Frederick Banting, Charles Herbert Best, John J. R. Macleod and James Bertram Collip, insulin was discovered.
Since this monumental scientific discovery, there have been several advancements in diabetes treatment, from the introduction of fully synthetic human insulin to glucose monitors and insulin pumps. These breakthroughs have immensely improved the quality of life for people who have to live with diabetes, enhancing self-esteem, increasing social participation and improving the overall health and well-being of these individuals.
They have also come with higher costs, creating affordability challenges for Canadians affected by diabetes.
Outside of hospital, prescription drug coverage comes from a mix of private insurance, out-of-pocket cash payments and various provincial programs. While the majority of Canadians have access to some form of public or private insurance, about 2.8%, or 1.1 million Canadians, do not have access to private or public drug coverage.
Although most Canadians have some form of drug coverage, this does not mean that those with insurance have equal access to the prescription drugs they need. The existing patchwork system of private and public drug plans leaves millions of Canadians under-insured, and that means their out-of-pocket prescription drug costs create a financial burden that leaves them struggling to afford an essential part of health care.
In 2021, Statistics Canada found that more than one in five adults in Canada reported not having the insurance they needed to cover their prescription drug costs. Being under-insured can take many forms, for example, Canadians may have high deductibles, resulting in significant out-of-pocket costs before their insurance coverage even kicks in. They may reach the maximum annual or lifetime coverage limits for their insurance and have to pay out-of-pocket, or they may have to make co-payments, which are often 20% of the drug's cost on private plans and sometimes more on public plans.
All provinces have drug coverage to protect Canadians from catastrophic drug costs, but deductibles under these plans can range from 0% to 20% of net family income. In many cases, Canadians will never reach the deductible, leaving them without any support for their drug costs. This variability across the country creates a postal code lottery.
Let us consider the advancements in diabetes treatments. For a working-age Canadian with no private insurance, out-of-pocket costs vary widely. In some parts of the country, out-of-pocket costs for people living with type 1 diabetes can be higher than $18,000 per year out-of-pocket; for type 2 diabetes, they can be higher than $10,000 per year in out-of-pocket expenses. Even those with private insurance can face high co-pays or exceed annual plan maximums, resulting in high out-of-pocket costs.
Even for cases in which an individual is not accessing devices that cost thousands of dollars, they can face significant out-of-pocket costs. For example, we can consider a woman in her mid-twenties who is working a minimum wage job. An IUD, one of the most effective forms of birth control, can cost up to $500 with no insurance. Even with private insurance, a co-pay of 20% would be $100. While IUDs can last from three to 12 years and save money over the long term, the high upfront cost can make them inaccessible.
Under-insurance can be a particular concern for young adults who age out of their parents' private insurance but who do not have their own form of private coverage. Lower-income Canadians also make up a disproportionate share of the under-insured. While most provinces have put in place drug coverage for those accessing social assistance benefits, a gap still exists. Many lower-income households that do not qualify for social assistance continue to struggle with out-of-pocket prescription drug costs.
Employment factors contribute to differences in insurance coverage. People with low-paying jobs, such as entry-level, contract and part-time positions, often report less adequate drug insurance coverage. This may even discourage people from accessing social assistance benefits or from applying for jobs, because once hired, they may lose their public drug insurance coverage. However, many entry-level and part-time jobs do not offer drug benefits. One study found that only 27% of part-time employees reported receiving medical benefit coverage.
Under-insurance can have serious consequences. Many Canadians with high out-of-pocket costs report foregoing essential needs, such as food and heat, or not adhering to their prescription due to drug costs. Statistics Canada found that, in 2021, close to one in five Canadians spent $500 or more out-of-pocket for their prescription medication, and almost one in 10 reported not adhering to their prescription medication because of costs. This includes delaying filling prescriptions or skipping doses to contain costs.
When people do not take their prescription drugs the way they are supposed to, their health can suffer. This results in serious consequences for the individual and their household, and unnecessary costs to the health care system in the long run, as patients are more likely to visit an emergency room or to be admitted to hospital when they do not receive consistent treatment. For example, the full cost of diabetes to the health care system in 2018 was estimated to be around $27 billion and could exceed $39 billion by 2028.
I think we can all agree that no Canadian should be put in a position where they must choose between the prescription drugs they need for their health and well-being and putting food on the table. This is unacceptable, and it is why we are continuing our work to improve accessibility, affordability and appropriate use of prescription drugs as we move forward with national universal pharmacare.
1183 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 5:30:37 p.m.
- Watch
Madam Speaker, indeed, I am a proud Quebecker.
Our program is going to help millions of women, people from various backgrounds and people with diabetes. It is going to help everyone, all Canadians and all Quebeckers.
36 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 6:20:09 p.m.
- Watch
Madam Speaker, as I mentioned in my speech, pointing out the shortcomings of health care programs is an argument to make them stronger, not to gut them and to get rid of them altogether.
However, I will ask my colleague this question: Looking forward a year from now, when her constituents in Kawartha are looking west to British Columbia and are seeing that their fellow Canadians are getting their diabetes medication, their diabetes devices and their contraception provided for free under universal pharmacare, how is she going to explain to her constituents that they are not part of that program because her province did not get on board because she did not support it?
114 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 8:07:44 p.m.
- Watch
Uqaqtittiji, this is such an important bill, because it would help individuals who need it most, whether it is women who may need medicines for their reproductive health or people who suffer from diabetes. These are two areas of pharmaceutical care that are desperately needed throughout Canada, in the territories and in all the provinces.
Could the member better explain how this bill is not supporting those people, specifically women who may need access to abortion because of an unplanned pregnancy that they may have experienced?
86 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 8:24:02 p.m.
- Watch
Mr. Speaker, I listened with great interest to my colleague's speech.
I would like to ask the member about how something as simple as monitoring diabetes and testing sugar levels, which can prevent hospitalization and the additional costs that can occur due to hospitalization when people do not have this equipment to be able to take care of themselves at home. I would also like to ask, if he has a few moments, if he could talk about oral contraceptives for women.
83 words
- Hear!
- Rabble!
- add
- star_border
- share
Mr. Speaker, we know that almost four million Canadians have a form of diabetes, and we want to prevent their condition from deteriorating and their ending up in the hospital, which costs our hospital system even more. We want to prevent that, which is a big piece in Bill C-64.
Obviously, with contraceptives, we know that there are women out there who may not be able to afford the cost. We would be there to assist those individuals, especially the most vulnerable, in our country.
86 words
- Hear!
- Rabble!
- add
- star_border
- share
Cost has consistently been identified as the single most important barrier to accessing contraception and the cost is unevenly borne by women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions and often lack access to private coverage. Studies have demonstrated that publicly funded, no-cost universal access to contraception can lead to public cost savings. The University of British Columbia estimates that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Having safe, reliable birth control represents freedom and safety. However, these costs continue to be a barrier. With Bill C-64, we are taking action to remove the barrier.
The same cost reduction principle applies to diabetes medication. Diabetes is a complex disease that can be treated and managed with safe, effective medication.
However, one in four Canadians with diabetes have reported not following their treatment plan due to cost. Improving access to diabetes medications will help improve the health of 3.7 million Canadians living with diabetes and reduce the risk of serious, life-changing health complications, such as blindness or amputations.
Beyond helping people with managing their diabetes and living healthier lives, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs to the health care system due to diabetes and its complications, including heart attack, stroke and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028.
Independent of the legislation, we have announced that we will work with provinces and territories on a diabetes devices fund. This fund would ensure that people with diabetes have access to the medical devices and supplies they need, such as syringes, test strips, glucose monitoring devices and insulin pumps. This, combined with the framework outlined in Bill C-64 for universal single-payer coverage for first-line diabetes medications, will help ensure that no person with diabetes in Canada is forced to ration their medication or compromise their treatment.
I previously mentioned our excellent work with P.E.I. and how this $35-million investment is focused on improving affordable access to prescription drugs while at the same time informing the advancement of a national universal pharmacare. The work accomplished by Prince Edward Island has been outstanding. Since last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis and cancer, and is saving millions of dollars in out-of-pocket costs for P.E.I. residents.
On a national level, we launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years.
As part of the overall investment of $1.5 billion, we are making up to $1.4 billion available to the provinces and territories over three years through bilateral agreements.
This funding will help to improve access to new and emerging drugs for Canadians with rare diseases as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases. This will help ensure patients with rare diseases have access to treatment as early as possible for a better quality of life.
I want to quickly mention that, in December of last year, we announced the creation of the Canadian drug agency, which will provide the dedicated leadership and coordination needed to help make Canada's drug system more sustainable and better prepared for the future.
This is an incredible opportunity for Canadians coast to coast to coast, working alongside provinces and territories, to allow for pharmacare, especially when it comes to contraception and diabetes. This is the beginning of building a more robust health care system that will work for all Canadians. I am excited to support this bill, and I encourage all my colleagues to do the same.
665 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 9:19:25 p.m.
- Watch
Mr. Speaker, I think I heard the member opposite say that the people in his riding do not want this pharmacare plan. They do not want their diabetes medication or pharmacare for reproductive health to be covered.
It sounds to me as though he is more concerned about the insurance companies and how well they are going to make out after the legislation goes through. Is that the case?
69 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 9:23:29 p.m.
- Watch
Mr. Speaker, the member for Mission—Matsqui—Fraser Canyon began his speech by outlining how widely covered medical care is for both diabetes and the pill. They are already widely covered in that they cover so many voters.
Would the bill not be more aptly called “farm a vote”?
53 words
- Hear!
- Rabble!
- add
- star_border
- share
- May/6/24 9:24:43 p.m.
- Watch
Mr. Speaker, I really appreciate this opportunity and all opportunities to speak in the House on behalf of the residents of Hamilton Mountain, particularly with respect to this very important piece of legislation, which is necessary to help millions of Canadians who are struggling to pay for their prescription medications.
We have heard lots about access to and the affordability of prescription drugs in Canada. Statistics Canada data from 2021 indicates that one in five Canadians reported not having insurance to cover the cost of prescription medication in the previous 12 months. The same Statistics Canada data also found that a higher proportion of new Canadians reported not having prescription drug insurance coverage. Having no prescription insurance coverage was associated with higher out-of-pocket spending and higher non-adherence to prescriptions because of cost. This results in some Canadians' having to choose between paying for these medications and paying for other basic necessities such as food and housing. We likely all know someone who is struggling with this issue. Members may know someone, or maybe have heard stories about a person with diabetes who does not have insurance coverage through work and has to pay for their insulin, syringes and test strips out of pocket; a student who had insurance coverage up to a certain age through their parents and then lost that coverage; or a cancer patient who does have insurance but is still not covered under their plan for the type of medication they need to treat their cancer.
That is why we have introduced legislation based on the principles of accessibility, affordability, appropriateness and universality. These principles will help guide ongoing efforts to advance the implementation of national pharmacare. We need pharmacare that helps make prescription drugs more accessible. This includes improving the consistency of access to drug coverage and needed medications across the country. We also need pharmacare that helps make prescription drugs affordable. This includes reducing financial barriers for Canadians, such as deductibles and copays. Additionally, we need pharmacare that helps ensure that the prescription drugs that people are taking are appropriate. This includes getting the right drug to the right patient at the right time to support their physical and mental well-being. Finally, we need pharmacare that is universal. This means we need to work to ensure that the principles of accessibility, affordability, and the appropriate use of prescription drugs are applicable to all Canadians, regardless of where they live.
These pharmacare principles align with the work that is already being done on national pharmacare. This work includes our partnership with Prince Edward Island with respect to the improving affordable access to prescription drugs initiative, our implementation of the first-ever national strategy for drugs for rare diseases and the recent announcement of the creation of a Canadian drug agency. Going forward, these principles would be reflected in the upcoming bilateral agreements for universal coverage of contraception and diabetes medications.
Let me spend a moment to explain how those principles are already being put into action. On August 11, 2021, the Government of Canada announced it would work with the Government of P.E.I. to improve affordable access to prescription drugs and inform the advancement of national universal pharmacare by providing $35 million over four years to add new drugs to its list of covered drugs and lower out-of-pocket expenses for drugs covered under existing public plans for island residents.
As of December 2023, P.E.I. has expanded access to over 100 new medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to $5 for almost 60% of medications regularly used by island residents. I am pleased to share that, through this initiative, within the first three months, P.E.I. residents have saved over $2 million in out-of-pocket costs on more than 200,000 prescriptions.
As of July 1, 2023, P.E.I. also made adjustments to the catastrophic drug program, lowering the cap on the amount of money a household needs to spend out of pocket on eligible medications. As a result, no eligible P.E.I. household will have to spend more than 6.5% of their household income on eligible medications. Once that 6.5% cap has been reached, eligible medication costs for the remainder of the year will be paid by the program. As members can see, this collaboration is already creating more affordable access to needed medications for island residents.
On a national level, we have launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years. Most of this investment will be going to provinces and territories through bilateral agreements to improve access to new and emerging drugs for Canadians with rare diseases, as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases.
Similarly, we are providing $33 million over three years to support first nations and Inuit patients with rare diseases, and $68 million is being invested in various initiatives to support collaborative governance, data infrastructure and research for drugs for rare diseases.
Through this, the government will help increase access to and affordability of effective drugs for rare diseases to improve the health of patients across Canada. These principles will be further demonstrated and reflected in the next step of national pharmacare outlined in this bill, which describes our intent to work with provinces and territories to provide universal, single-payer coverage for a number of contraception and diabetes medications.
In addition, and separately from the bill, we will also create a fund for diabetes devices and supplies. This fund will be rolled out to support access to diabetes devices such as continuous glucose monitors, insulin pumps, syringes and test strips. This new coverage, to be delivered by provinces and territories that enter into a bilateral agreement, provides an excellent opportunity to see the principles of affordability, accessibility, appropriateness and universality at work. Canadians, no matter where they live or how much they earn, will be able to receive the contraception and diabetes medications they need. In turn, Canadians will be healthier, empowered to make important life decisions and will not have to skip doses due to the cost of these two types of essential medications.
In closing, we will continue to work on national pharmacare initiatives that include the principles of accessibility, affordability, appropriateness and universality laid out in this bill, because Canadians need national pharmacare that embodies these principles. We look forward to working with all parliamentarians to pass the pharmacare act so that these principles will continue to guide our ongoing efforts to advance the implementation of national pharmacare.
1136 words
- Hear!
- Rabble!
- add
- star_border
- share
- menumenu
- notificationsnotifications
- home
- mailmail
- searchsearch
