44th Parl. 1st Sess.
May 30, 2024 10:00AM
Madam Speaker, I am thankful for the opportunity to speak to a very important piece of legislation, Bill C-64, which deals with pharmacare and develops a framework for it. This bill, along with other investments made by our government, would help millions of Canadians who are struggling to pay for their prescription drugs. We had a very healthy process at HESA, the Standing Committee on Health. I want to thank all witnesses who appeared before the committee and those who sent written testimony because it really helped us understand the positive impact of this legislation.
This bill is a priority for our government. It establishes the fundamental principles for implementing a national pharmacare program in Canada. It also sets out our plan to work with the provinces and territories who so desire to propose universal single-payer coverage for a certain number of contraceptives and diabetes medications.
Since this bill was introduced, we have heard many facts about access to and affordability of prescription drugs within Canada. Statistics Canada's data from 2021 indicates that one in five Canadians has reported not having enough insurance to cover the cost of prescription medication in the previous 12 months. We know that having no prescription insurance coverage is associated with higher non-adherence to prescriptions because of cost. We also know that this results in some Canadians having to choose between paying for these medications and paying for other basic necessities, like food and housing.
This is why our government has consistently made commitments toward national pharmacare. Bill C-64 recognizes the critical importance of working with provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal single-payer coverage for a number of contraception and diabetes medications.
This legislation is an important step forward to improve health equity, affordability and outcomes and has the potential of long-term savings for the health care system. In budget 2024, we announced $1.5 billion over five years to support the launch of national pharmacare and coverage for contraception and diabetes medications. I would like to highlight the potential impact that these two drug classes, for which we are seeking to provide coverage under this legislation, would have on Canadians.
We have heard stories of people, or know someone, in our constituencies struggling to access diabetes medication or supplies due to a lack of insurance coverage through their work, or of an individual who has limited insurance coverage so they cannot choose the form of contraception that is best suited for them. For example, for a part-time uninsured worker who has type 1 diabetes and is also of reproductive age to manage her diabetes, it would cost up to $18,000 per year, leaving her unable to afford the $500 upfront cost of her preferred method of contraception, a hormonal IUD. With the introduction of this legislation, this individual would save money on costs associated with managing her diabetes and would be able to access a hormonal IUD at no cost, with no out-of-pocket expenses, once the legislation is implemented in her province.
Studies have demonstrated that publicly funded, no-cost universal contraception can result in public cost savings. Evidence from the University of British Columbia has estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Since April 1, 2023, British Columbia is the only province in Canada to provide universal free contraceptives to all residents under the B.C. pharmacare program. In the first eight months of this program, more than 188,000 people received free contraceptives.
The same cost-cutting principle applies to diabetes medication.
Diabetes is one of the most widespread chronic diseases in Canada. Although there is no cure for diabetes, there are treatments to manage the disease.
One in four Canadians with diabetes has reported not following a treatment plan due to cost. Improving access to diabetes medications would help improve the health of some of the 3.7 million Canadians living with diabetes and would reduce the risk of serious life-changing health complications such as blindness and 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 on the health care system due to its complications, including heart attacks, strokes and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028, as estimated by Diabetes Canada.
The bill demonstrates the Government of Canada's commitment to consulting widely on the way forward and working with provinces, territories, indigenous peoples and other partners and stakeholders, including other political parties, to improve the accessibility, affordability and appropriate use of pharmaceutical products by reducing financial barriers and contributing to physical and mental health and well-being.
Beyond our recent work on Bill C-64, I would like to highlight some of the ongoing initiatives that this government has put in place to support our efforts toward national pharmacare.
On a national level, our government 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 $1.5-billion investment, our government will make available up to $1.4 billion over three years to willing provinces and territories through bilateral agreements.
The strategy marks the beginning of a national approach to meeting the need for drugs used to treat rare diseases.
This funding would help provinces and territories improve access to new and emerging drugs for Canadians with rare diseases and would support enhanced access to existing drugs, early diagnosis and screening for rare diseases.
I would also like to highlight another initiative under way, which involves the excellent work by Prince Edward Island through a $35-million federal investment. Under this initiative, P.E.I. is working to improve affordable access to prescription drugs, while at the same time informing the advancement of national universal pharmacare. The work accomplished by P.E.I. has been remarkable. Since December of 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, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to five dollars for almost 60% of medications regularly used by island residents. I am pleased to share that through this initiative, P.E.I. residents have saved over $2.8 million in out-of-pocket costs as of March of this year.
Finally, on December 18, 2023, the Government of Canada announced the creation of Canada's drug agency, the CDA, with an investment of over $89.5 million over five years, starting in 2024-25. The CDA will provide the dedicated leadership and coordination needed to make Canada's drug system more sustainable and better prepared for the future, helping Canadians achieve better health outcomes. I am pleased to share that as of May 1, Canada's drug agency has officially launched.
In closing, members can see the extraordinary amount of hard work that has been dedicated to national pharmacare.
Bill C‑64 is a major step forward in our commitment to guaranteeing affordable, quality drugs for all Canadians. Our universal coverage plan for contraceptives and diabetes drugs will change the lives of individuals, families, society and our health care system.
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- May/30/24 10:22:58 p.m.
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Mr. Speaker, I am pleased to rise to speak to this issue and this bill, finally.
As others have already pointed out, Canada is the only country with a universal health care system that does not provide some sort of universal drug coverage. Under the British, Australian, New Zealand, French and Belgian systems, basically to some degree or another, people's medications are paid for by the government and they do not have to pay for them. Having said that, admittedly, in some countries there is copay.
This is an important bill. It is the first step in creating a national pharmacare system, and this I truly support. However, I did not always feel this way. As somebody who has long-practised in the health care system, I was a bit worried, because with the health care system as it presently is, we are struggling to pay for it. It occurred to me that what the government ought to be doing in health care is making sure that this sucker stays on the road. Certainly, I had a bit of trepidation with the idea that we were going to add another cost like pharmacare. However, having thought about it and having sat through committee meetings where we talked to experts, I have changed my mind because I think that a national pharmacare system would save the health care system money, not increase costs.
The current system, as we have it, which is a patchwork of private and public plans, is really inefficient. Multiple studies and recommendations since the 1960s have all basically said that. In fact, one study from the Canadian Medical Association Journal in 2017 concluded that we in Canada pay 50% more for our drugs than people do in 10 other wealthy countries that have national pharmacare programs. In addition, the inefficiency of our pharmaceutical system is demonstrated by the fact that we in Canada pay the second most for drugs of any people in the world. The Americans pay more, but other than that, we pay more for drugs than anyone else.
The inefficiency of our system comes from the fact that we provide pharmacare in Canada like the United States does. We, like the United States, have a patchwork system of private and public providers, and the private providers are often set up through employers. At times, these are non-profits, but for the most part they are for-profit companies. Similarly, there are public systems and public plans, and there are multiple public plans. For example, in Ontario, there is the Ontario drug benefit plan for those over 65, there is a Trillium plan for higher-cost medications and there is OHIP+.
Basically, we pay for our medications in Canada like Americans pay for all parts of their health care system, but our system for paying for medications, like the U.S. health care system, is really inefficient. Americans pay twice as much for health care as Canadians do. On average, Americans pay $12,000 per person for health care, and in Canada we pay $6,000 for health care per person, and they have worse outcomes than we do. For example, they have a lower life expectancy than we do in Canada.
I studied health law and policy both in Boston and at Georgetown University in Washington, D.C., and learned a bit about the health care system. I was certainly impressed by the inefficiency of the American health care system. They have private hospitals, private health care providers and private insurance companies, and each of these organizations has administrators who basically spend half of their time scheming on how they can decrease costs and increase profits. They have to pay for these administrators. Similarly, they have to pay the CEOs and the higher-up executives, who all bring in the big bucks, for working in those positions. On top of that, and most of all, a lot of money goes to the shareholders of corporations, which are legally obliged to financially benefit shareholders. All this money comes out of the health care system, money that ought to be going toward trying to improve the health care of Americans.
Similarly, in Canada, we currently have 1,100 private and public plans according to a Lancet 2024 study, although according to the Hoskins report, we have 100,000 private plans. If instead of having all these plans, we just had one plan, then surely there would be tremendous savings coming from economies of scale. We would not need 1,100 organizations with 1,100 sets of administrators administering their own plans. We would not need hundreds of CEOs siphoning money that would otherwise go to health care, and there would be no profits going to shareholders rather than going to health care.
There would be all sorts of savings from economies of scale and increased bargaining power. For example, if someone went to a provider or manufacturer of drugs and bought 10 million pills rather than 10,000 pills, I am sure they would get those pills at a cheaper cost, so there are savings there. Also, shipping costs are lower when buying in bulk, and there are fewer inspections needed.
When we add up all these savings, how much do they add up to? Well, according to the 2019 Hoskins report, with national pharmacare by 2027, which is when it would come into effect, total spending on prescription drugs would be $5 billion lower than it would be without national pharmacare. That is money we could use in the health care system for other things. That means more money to afford expensive cancer therapies, more money to address the long waiting times for either surgeries or diagnostic tests and more money to do research and try to find new cures for things like cancer, ALS, etc.
However, it is not just about saving money in the system. It is also about helping Canadians who struggle to meet the high costs of medications. According to the Hoskins report, between 5% and 20% of Canadians are either uninsured or under-insured, which amounts to two million to eight million people. Furthermore, one in five households reported that a family member in the past year had not taken a prescribed medicine due to its high costs, another three million Canadians said they were not able to afford one or more of their prescription drugs in the past year and almost one million Canadians borrowed money in order to pay for prescription drugs.
For all these reasons, I support this legislation and moving to the next step toward a national pharmacare system. I also welcome that we will be able to provide diabetic medications and contraception to people as one of the next steps in getting to a national pharmacare system.
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- May/30/24 11:16:59 p.m.
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Mr. Speaker, one thing I learned through her colleagues who were at committee was about the importance placed on the great health care program the Province of Quebec provides. It is a tremendous program and is one of the best in the country. It is a plan and a program available because the province provides it. Health care is a provincial issue, and every province is in a position to provide health care. Instead of the government putting the $1.5 billion in the budget toward this, it should put that money toward those who are uninsured and help those who are uninsured.
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