SoVote

Context: House Hansard - 321 - May/30/24

Ms. Heather McPherson (Edmonton Strathcona, NDP)

May/30/24 10:33:10 p.m.
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Mr. Speaker, I have worked with the member very closely on a number of files, and I know him to be a very honourable member of this place. He referenced the Hoskins report many times, and of course this is the report that was commissioned by the government to look at this. It found that $5 billion of savings would be available if we were to put in a national pharmacare program. Like the member, I recognize that this is not a full pharmacare program. This is a framework on which we could build a pharmacare program. Could the member comment on the medications or drugs that he thinks should be next in the pharmacare program now that we have dedicated this particular step to diabetes medication and devices and to contraceptives?

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Mr. Marcus Powlowski

May/30/24 10:34:00 p.m.
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Mr. Speaker, the member's question is very pertinent. I have some background in this. Once upon a time, years ago, I worked in a tiny country in the South Pacific, Vanuatu, on its essential drug list, which was its first essential drug list. The WHO is trying to do this with a lot of countries. Similarly in Canada, this act calls for the creation of an essential drug list. On that essential drug list, we would have the input of physicians and other specialists from across Canada to determine what the priority drugs are that a government finance system ought to supply its citizenry. That is an important question, and it is one of the next steps. I, like her, realize that this does not bring us to a national pharmacare system, but it is an important step on the way to that.

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Mr. Yasir Naqvi (Parliamentary Secretary to the Minister of Health, Lib.)

May/30/24 10:35:03 p.m.
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Mr. Speaker, I appreciate being recognized again. It is a great honour for me to work with the hon. member for Thunder Bay—Rainy River on the HESA committee. Given his medical and legal background, I find him quite beneficial to me for my understanding of a lot of health care issues. One of the things we heard a lot about at committee is the impact of this framework legislation on private health insurance. There was a lot of fearmongering on the Conservatives' part that somehow it would disappear. Could the hon. member for Thunder Bay—Rainy River comment and give us his views on what impact this bill would have on private health insurance?

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Insurance

Mr. Marcus Powlowski

May/30/24 10:35:50 p.m.
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Mr. Speaker, I welcome the very perceptive question by the member from Ottawa. This is a very important point. We heard from a lot of people, and there was a lot of concern about having a basic system. What if we needed more expensive medications for certain things? Would we be getting rid of private drug plans? That is not necessarily the case. There will be a public plan, but I think there would still be the option, if people wanted, to pay additional money for a private plan that would cover all the things that are not currently insured, as there is for other kinds of health care at the moment.

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The Speaker

May/30/24 10:36:25 p.m.
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Before I go to the member for Nunavut, who will be joining us virtually, I want to let members know that I have tried to provide members with about 40 seconds to ask and answer questions so that we can do the full rotation. It is really important that we all try to keep to that so that everybody can participate. I am also providing some flexibility, because questions are interesting and I want to hear as complete an answer as possible, as I am certain a person who asks a question would like that. The hon. member for Nunavut.

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Ms. Lori Idlout (Nunavut, NDP)

May/30/24 10:36:59 p.m.
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Re: Bill C-64

Uqaqtittiji, before I begin my speech, I will take this opportunity to congratulate Sharon DeSousa, who just became the first racialized national president at the Public Service Alliance of Canada. I first met her when the Iqaluit Housing Authority Inuit workers had their 136 days of striking to advance the rights of workers, not just for Iqalummiut, but also abroad. I am excited about Sharon's election. I will get to my speech. As the member of Parliament for Nunavut, Bill C-64, an act respecting pharmacare, put me in a bit of a personal dilemma. I wondered if I should support a bill that would do too little for the majority of my constituents. Through my speech this evening, I will share how I came to support the importance of this bill. As an Inuk from Nunavut, I continue to see the impacts of what happens when the federal government purposefully underinvests in indigenous peoples. The lack of investing in housing means that people live in overcrowded housing conditions. Many live in mouldy homes. These conditions create poorer health outcomes and deep-rooted social issues, such as increased violence, substance abuse and the continuation of intergenerational trauma being passed on to our children and our grandchildren. Having lived through these hurdles, I am always analyzing bills and debates with sensitivity to how all too common my experience is for indigenous peoples in Canada. I know all too well what it means to suffer. I hope when Canadians hear me, that they do their part to act on reconciliation with indigenous peoples. When I became the member of Parliament for Nunavut, I learned to act on solidarity. Before I was an MP, it was just a word. I wholeheartedly thank my colleague and friend, the member of Parliament for Hamilton Centre. This is what I am doing in supporting this bill. I am compelled to act knowing this bill, when it is passed, will help so many Canadians. It will help women and gender-diverse people access contraceptives. It will help many Canadians pay for diabetes medication. On another note, I must express my view regarding the Bloc's position on this bill. Its main concern seems to be that of jurisdiction and telling the government to stay out of its jurisdiction. I do hope its members reconsider their position because, regardless of jurisdiction, this bill can help more Canadians. This bill sets a foundation to create a universal single-payer system across Canada. This reminds me of Jordan's principle. I take this opportunity to honour the family of Jordan River Anderson, who this program is importantly named after. Jordan died a preventable death. He died while different jurisdictions were fighting over not having jurisdiction to cover his expenses and care. Because of Jordan's principle, care for first nations and Inuit has improved. While the Liberal government's responses take too long and it allows funding to lapse, Jordan's principle has made significant impacts for Inuit and first nations. Bill C-64 is an opportunity to model Jordan's principle so women and gender-diverse people have immediate access to contraceptives and people with diabetes can stop stressing about their finances knowing they can rely on this program for diabetes medication. I must share my criticism of the bill. I am dismayed to see that, once again, when it comes to indigenous peoples, we are forced to wait. While I appreciate that Bill C-64 would require the Minister of Health to initiate discussions based on essential medicines lists with provinces, territories and indigenous peoples, this work must start immediately. While first nations and Inuit have the non-insured health benefits program to have services such as dental care, eye care and mental health services paid for, much of the investments in Nunavut go toward medical travel because of the lack of health care in Nunavut. Children are flown thousands of kilometres to access basic care and dental care. This program funds millions of dollars to the airline industry. Ensuring pharmacare improves on the NIHB program will be very important in making sure that Nunavummiut, northerners and indigenous peoples see better care closer to home. The pharmacare bill must avoid the pitfalls that we have seen in NIHB. I remember, for example, my colleague and friend, the MP for Algoma—Manitoulin—Kapuskasing, bringing to me a witness when the indigenous and northern affairs committee studied the non-insured health benefits program. She brought forward a pharmacist, Rudy Malak, who struggled to get paid for providing eligible people the drugs covered under the non-insured health benefits program. The proposed act must ensure that pharmacists would be paid immediately without worrying about closing their doors because the federal government may take too long to pay its bills. I conclude by reminding everyone that, when it comes to helping Canadians, we must do so with a foundation of removing barriers for people. As much as I am conflicted about the bill, I must practise what the MP for Hamilton Centre taught me about acting in solidarity, knowing that the passage of the bill will help so many Canadians.

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

May/30/24 10:44:20 p.m.
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Mr. Speaker, I appreciate the member's general attitude in recognizing the importance of the legislation to the degree in which it would assist millions of Canadians in all regions of the country. I am wondering if she could expand on why it is so important that Liberals, New Democrats, Bloc members and Conservatives should be behind this bill to help so many of our constituents.

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Importance

Ms. Lori Idlout

May/30/24 10:44:53 p.m.
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Uqaqtittiji, as I said earlier, having empathy is really important, but acting on that empathy is even more important. When I hear about so many Canadians possibly having amputations because they cannot afford diabetes medication, I feel we all have to do our part to make sure that we act when we can, and it is our duty as parliamentarians to make sure that all Canadians get the drugs and the care that they need, so we can keep making sure that Canada is a better place to live in.

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Ms. Rachel Blaney (North Island—Powell River, NDP)

May/30/24 10:45:45 p.m.
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Mr. Speaker, when we are in this place, we have to wrestle with really hard pieces of legislation that benefit some but not all, and I am afraid that in this place, historically, up until today, indigenous people are left out of so much decision-making, and their needs are extensively not met, again and again. I am just wondering if the member could talk about what she sees as being needed right now to start including indigenous people in a more meaningful way so that we can start to repair the harm that has been done, specifically in this place.

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Ms. Lori Idlout

May/30/24 10:46:31 p.m.
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Uqaqtittiji, that is such an important question because one of the answers is what indigenous peoples have been saying all along, and we hear it in some responses, such as co-development, but we have to really make sure that, when it comes everything from laws to program development policies to decisions regarding lands and the health and education of indigenous peoples, we have to be at the table helping to make those decisions, not just because of a legal duty to consult, but demanding it because of reconciliation. We have to make sure that we have more indigenous peoples become parliamentarians, and we have to make sure that there is more participation that does not prevent us from helping to make decisions on these matters.

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Ms. Lindsay Mathyssen (London—Fanshawe, NDP)

May/30/24 10:47:37 p.m.
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Mr. Speaker, my hon. colleague talked about Jordan's principle, and I would really love for her to expand on the importance of that within her own community and on the dangers that we see with the government stepping back from the commitment to ensure that the needs of first nations, Inuit and Métis are placed in priority over money and squabbling between jurisdictions.

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Ms. Lori Idlout

May/30/24 10:48:12 p.m.
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Uqaqtittiji, Jordan's principle is such an important story to always remember because the implementation of it allows payments to be made up front and for the jurisdictions to discuss who ends up paying for it in the end. We have an opportunity with the pharmacare act for women and gender-diverse people to get their contraceptives immediately, without having to worry about whether it is going to be the provinces or the federal government who pays for it, as well as for people to get their diabetes medication. I know this kind of system can work because we see it in Jordan's principle, especially when we have discovered, through that program, the atrocities indigenous children are forced to experience and that treatment will happen immediately. We need that same kind of foundation through this pharmacare program.

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Ms. Julie Dzerowicz (Davenport, Lib.)

May/30/24 10:49:40 p.m.
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Re: Bill C-64

Mr. Speaker, it is a real pleasure for me to stand once again today to speak to this very important bill. Bill C-64 is an act respecting pharmacare. The bill contains three key sections. One, it would establish a framework toward a national universal pharmacare in Canada for certain prescription drugs and related products. Two, it provides that the Canadian drug agency work toward the development of a national formulary to develop a national bulk-purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications. The third section is that, within 30 days of hopefully this bill receiving royal assent, the minister would establish a committee of experts to make recommendations regarding the operation and financing of national, universal, single-payer pharmacare. The bill, along with other investments made by our government, would help millions of Canadians who are struggling to pay for their prescription drugs. Since this bill was introduced, we have heard many facts about access and affordability of prescription drugs within Canada. We know that Statistics Canada data from 2021 has indicated that one in five Canadians 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 was associated with higher out-of-pocket spending and higher non-adherence to prescriptions because of cost. We know that this results in some Canadians having to choose between paying for these medications or for other basic necessities, like food and housing. This is why we have consistently made commitments toward national pharmacare and have focused efforts on the key areas of accessibility, affordability and appropriate use of medications. Let me start with the pharmacare act, which references the foundational principles of access, affordability, appropriate use and universality. We have heard a lot about these four principles this evening, but it is important to continue this conversation. 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 to the health care system. In our most recent budget, budget 2024, we announced $1.5 billion over seven years to support the launch of national pharmacare and coverage for contraception and diabetes medications. I would like to highlight the potential impact the two drug classes for which we are seeking to provide coverage under this legislation would have on Canadians. We have heard of stories or know of someone in our constituency who is struggling to access diabetes medications or supplies due to 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 better suited for her. For example, let us talk about a part-time, uninsured worker who has type 1 diabetes and is also of reproductive age. For this individual to manage her diabetes, it would cost her up to $18,000 every year, leaving her potentially 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 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, B.C. 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. That is wonderful. With respect to diabetes, it is a complex disease that can be treated with safe and effective medications. One in four Canadians with diabetes has reported not following their treatment plan due to costs. Improving access to diabetes medications would help improve the health of some of the 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, we also know that, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs on 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, 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 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 under Bill C-64, I would like to highlight one or two initiatives, depending on my time, that the government has also put in place to support our efforts towards national pharmacare. On a national level, our government has 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. This funding would help provinces and territories 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. I would also like to highlight another initiative under way, which involves the excellent work by P.E.I. through a $35-million federal investment. Under this initiative, P.E.I. is working to improve the affordable access of 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 $5 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 expenses as of March of this year. Finally, on December 18, 2023, the Government of Canada announced the creation of Canada's drug agency, with an investment of $89.5 million over five years, beginning this year. Built from the existing Canadian Agency for Drugs and Technologies in Health, and in partnership with provinces and territories, 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, CADTH has been officially launched as Canada's drug agency. In closing, we can see the extraordinary amount of work that has been and will continue to be dedicated to our commitments related to national pharmacare that focuses on accessibility, affordability and appropriate use of medications. Bill C-64 represents the next phase of helping Canadians receive the medications they need, and we look forward to working with all parliamentarians to ensure its successful passing.

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Mr. Tom Kmiec (Calgary Shepard, CPC)

May/30/24 10:59:00 p.m.
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Mr. Speaker, the member did mention rare diseases, and I cannot pass up the opportunity to clarify a couple of things. It is only mentioned once, in clause 5 of the legislation. To all my constituents back home, and all the rare disease organizations and patients across the country, not a single person will have their rare disease drugs paid for by this legislation, not a single one. It is not in the legislation. The 2023 announcement that the government just made is a reannouncement of its 2019 announcement. Some hon. members: Oh, oh! Mr. Tom Kmiec: Mr. Speaker, the NDP caucus is heckling me once again. I know the New Democrats get really upset when I raise this. The government is the one that actually cancelled the original rare disease strategy in 2016, and at the time, the head of the organization called it “the kiss of death” for rare disease patients. Does that member agree?

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Ms. Julie Dzerowicz

May/30/24 10:59:52 p.m.
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Re: Bill C-64

Mr. Speaker, Bill C-64 would establish the framework of a national universal pharmacare program here in Canada. It is phase one of the proposed program, which would include prescription drugs and free coverage for contraceptives and diabetes medication, and we are hoping to expand the program. As well, there are additional elements that would complement the national pharmacare program, which is our national strategy for drugs for rare diseases. Again, it is starting with a $1.5-billion investment over three years. I believe our intention is that we will be expanding it in the years to come.

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Ms. Nathalie Sinclair-Desgagné (Terrebonne, BQ)

May/30/24 11:00:41 p.m.
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Mr. Speaker, my question is simple, but at the same time I think it is rather complex because I have never gotten a clear answer from the federal government. Why does the government think that it is better placed to understand the needs of Quebeckers than the Government of Quebec, which administers a pharmacare program that has been around for many years?

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Ms. Julie Dzerowicz

May/30/24 11:01:11 p.m.
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Mr. Speaker, this is a national pharmacare program. We know that there are a number of provinces that offer different levels of pharmacare support right now, but what we are trying to do is provide a national pharmacare program based on the four principles that we have been consistently talking about, which are accessibility, affordability, appropriate use and universality. We are trying move beyond the provinces of B.C., Quebec and P.E.I. to make sure that there is accessibility, affordability, appropriate use and universality for all Canadians.

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Mr. Gord Johns (Courtenay—Alberni, NDP)

May/30/24 11:02:08 p.m.
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Mr. Speaker, I find it pretty rich when Conservatives start talking about expanding pharmacare when they are doing everything they can to block it. Three years ago, they voted against pharmacare. They could have brought forward amendments to expand it to cover people with rare diseases. They did not do that. In fact, they are saying that people are already covered. Becky in my riding writes, “Our out-of-pocket costs for my son's insulin and devices come to just over $11,000 per year. It is so expensive sometimes that the pharmacy calls me to give me a heads-up about how much an order will be, as if we have an option. Without it, he will die. Something like national pharmacare would be a game-changer for us.” Maybe my colleague can talk about if she would would be willing to work with the NDP and the Conservatives, with everybody coming together, to include rare diseases. She knows that there is a willing partner right here.

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Ms. Julie Dzerowicz

May/30/24 11:03:03 p.m.
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Mr. Speaker, I want to thank the hon. member for his commitment and passion to the national pharmacare program. In my riding of Davenport, having a national pharmacare program is very popular. Constituents are very excited about phase one with the introduction of diabetes medication being covered, as well as contraceptives. I know that they are looking for an expansion of this program, which is something I am very interested in as well.

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Mr. Yasir Naqvi (Parliamentary Secretary to the Minister of Health, Lib.)

May/30/24 11:03:39 p.m.
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Mr. Speaker, I know that the member for Davenport has been a long-time supporter of pharmacare, and just like me, she has campaigned on this. Can she tell me the impact that this legislation would have on her community?

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