44th Parl. 1st Sess.
May 30, 2024 10:00AM
- May/30/24 9:33:31 p.m.
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Mr. Speaker, it is a historic day: We are going to be voting on the first steps toward universal pharmacare. The Liberals have been promising pharmacare to Canadians since 1997, and for decades Canadians have been waiting to have access to essential medication.
I want to start off by sharing a story. In 2021, I was out door knocking in a subsidized housing complex. When I knocked on one of the doors, the first person to come to the door was a little girl. She was holding two mermaid dolls and she was adorable. She might have been three or four years old, and she smiled up at me. Then her siblings came running out, and they called for their mom. When I talked to her mother, she had these bright eyes, and she was listening and staring up at us. Her mom said she had not a chance to think about policies or what needs to happen because she was so stressed about how much the devices for her little girl's diabetes cost and how much the medication costs.
This family had been struggling to afford essential medications, and the costs were so high that this mother was wondering how she was going to care for her little girl. I do not know how anyone could look that little girl in the eye and say that she does not deserve access to life-saving medication. I promised that mom that I would come here to Ottawa and fight for universal pharmacare so that her little girl would have her medication covered. I am so proud to be part of a team that is delivering on that promise.
For that family and their struggle, and for families across Canada that are in the same position, it is not inevitable. They are working hard. They are doing everything right. They are trying their best to provide a good life for their kids. However, with the choices of Liberal and Conservative governments for decades, they have decided to side with the biggest pharmaceutical companies instead of everyday Canadians, instead of that little girl.
Liberals have promised this for decades, but it is only now that New Democrats are in a position of power and are able to force the government to deliver on pharmacare. While the Conservatives try to do whatever they possibly can to stop people from getting access to life-saving medication, we are going to keep fighting to deliver on the promise to that mom, to that family and to families across Canada who deserve pharmacare.
I once shared a bit of that story and then asked the Leader of the Opposition how he could look that little girl in the eye and say that she does not deserve access to diabetes medication, that she does not deserve access to life-saving devices. His answer was to spew misinformation. He said that pharmacare will “roll back the rights that unions have fought so hard and so long to secure. Our labour movement fought too hard to secure private drug plans, and we will never let a big, centralizing, bureaucratic government in Ottawa take those rights away from workers.”
However, the major unions in Canada are calling for universal single-payer pharmacare: the United Steelworkers, CUPE, the Canadian Federation of Nurses Unions and Unifor. I could go on. Many of these unions have specific campaigns advocating for single-payer universal pharmacare. Unions across Canada came out celebrating the fact that the NDP was able to force the government to first provide contraception and diabetes medications and diabetes devices, but also to lay the legislative framework for universal pharmacare.
This is a huge step, and I think about some of those huge steps. Tommy Douglas had a vision of universal health care. It was New Democrats who fought alongside Tommy Douglas to get our country to a place where if a person broke their leg, they were not going to be turned away because they could not afford to fix it. I think about young kids, and we know that dental surgery is the most common surgery at pediatric hospitals. If people have essential dental costs or if they have tooth pain, then for the first time in our country's history, there would be people accessing dental care who could not afford it. We would have people like that family I talked about accessing diabetes medication and not worrying about whether they could afford it. They would not have to choose between putting food on the table or paying the rent and could access life-saving medication. This is a historic, huge step forward for our country. I am so proud to be part of the team that is making this happen.
I want to also take a moment to talk about providing contraception across Canada and what that means for women and for gender-diverse people. It is huge. I want to give a special shout-out to Devon Black and Teale Phelps Bondaroff, who are the co-founders of AccessBC, and who fought, pushed and advocated, and were successful in bringing this issue to the attention of the provincial government. I am proud that the B.C. NDP has already paved the way, offering British Columbians access to free contraception. We know that countries around the world have been doing this for decades, and finally, the federal government acknowledges that contraception is health care.
It is not surprising that the Conservatives are fighting tooth and nail to stop women from having control over their reproductive health. We know that their MPs have brought forward legislation that is trying to bring back the debate around a woman's right to choose or a woman's control over her own body. A Conservative MP went out and spoke at the rally that was calling to end abortion access in Canada. I would hope that we were past a point in Canada when a major political party is accepting of its members of Parliament calling to end abortion access. Abortion is health care. Contraception is health care.
Now, in Canada, we could start expanding our universal coverage to essential medication and to dental care. I would like to see it also expanded to mental health care. We could have a system in Canada that, if a person is sick and they need health care, they could access it.
I want to end by calling on all MPs in the House to take a moment and to think about the historic steps that we are taking. This would make a tangible difference in the lives of Canadians from coast to coast to coast. I think about that family, that little girl and what this would mean to her. I am so proud to be voting in favour of pharmacare tonight. I am grateful to be able to work alongside 24 other New Democrat MPs who have fought tooth and nail to get this piece of legislation to this point. We are going to take it over the finish line to ensure that every Canadian would be able to access the medication they need.
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- May/30/24 9:44:15 p.m.
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Mr. Speaker, the member stole my thunder a little.
We are talking about a universal, single-payer pharmacare program. The reason it is so effective, the reason experts and labour unions have been calling for this, and the reason civil society has been calling for it is that it would save Canadians money, and it would give access to essential drugs. It would also mean that when we buy as a single payer, we would get to negotiate prices as a single payer. It would mean that we would have so much more negotiating power.
That is why pharmaceutical companies are so opposed to it. They do not want to lower our drug costs and make less money. By ensuring that we have a single-payer system, it means those kinds of drugs are going to be more accessible to Canadians. It means that Canadians would be paying less, and it would save money over time.
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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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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. Speaker, I am very pleased to rise in the House to speak to Bill C‑64.
It is a great pleasure to join the debate today about the pharmacare legislation that is going to bring in the first steps of pharmacare in Canada, as well as to be the last person to give a speech before we actually vote on this important piece of legislation.
Quality health care, including access to prescription drugs, is vital to protecting and promoting the health and well-being of Canadians. Prescription medicines allow millions of Canadians to prevent and fight disease, manage chronic illness, ease pain and breathe better; in other words, they allow Canadians to live healthier and more productive lives. I must say, there are few issues that I hear more about than health care. It is a priority for my constituents.
With rising costs, some Canadians are facing difficult choices between paying for their prescriptions and covering essentials, such as food and heat. Nobody should be put in that circumstance. We need to ensure that prescription drugs are more accessible and affordable for Canadians, including those facing the greatest financial barriers to accessing medications. That is why our government has introduced the pharmacare act. The bill proposes foundational principles for national universal pharmacare and describes the government's intent to work with provinces and territories to provide Canadians with universal, single-payer, first-dollar coverage for a range of contraceptive and diabetes products.
When medicare was introduced in Canada in the 1960s, prescription drugs played a relatively limited role in health care. Most drugs outside of a hospital were inexpensive medicines for common conditions. However, in the intervening decades, the development of drugs has surged as pharmaceutical companies have pushed the science further in search of new treatments and cures. Prescription medicines are now an essential part of health care. As a share of overall health care costs, spending on prescribed drugs has risen from six per cent in 1975 to nearly 14% in 2022. This makes prescription drugs the second-largest area of health care spending in Canada, after hospital services.
Today, the landscape of prescription drugs available in Canada is robust and complex, with pharmaceutical companies launching dozens of new products every year. To support effective management, in government-run, public drug plans in Canada, as well as some privately run plans, a formulary is developed, which is a list of drugs and related products that are eligible for coverage under the drug plan. To develop the formularies, public plans consider both how well a drug works and whether these products offer good value for money relative to other treatment options. While there are over a hundred public plans in Canada, there is generally good alignment with regard to the list of drugs that are eligible for coverage across provinces and territories.
Many Canadians are only eligible for public drug coverage with high deductibles or premiums that provide little relief for more routine drug expenses, such as for prescribed contraception and diabetes medications. A national formulary would outline the scope of prescription drugs and related products that all Canadians should have affordable access to under national universal pharmacare.
In 2019, the advisory council on the implementation of national pharmacare, chaired by Dr. Eric Hoskins, recommended a national formulary service, one of the standards for national universal pharmacare. He proposed pharmacare coverage to be phased in, starting with a short list of essential medicines. In budget 2019, the government announced funding for a number of foundational steps towards national pharmacare, including the development of a national formulary. Back in 2022, the government announced continued progress towards this by introducing a pharmacare act and tasking the drug agency to develop a national formulary of essential medicines and a bulk purchasing plan. Preliminary work has already been completed, and a framework and process for developing a future national formulary was recommended.
The panel released its final report in 2022, including giving guiding principles for the formulary and a process for bringing it into place, as well as a sample list of commonly prescribed drugs and related products for three therapeutic areas with a high volume of drug use in Canada. These are cardiovascular disease, diabetes and mental illness. This list has been expanded by looking at equity-seeking groups to make sure that we are closing the gaps in access between different communities in Canada.
Actually, this foundational work is already having real-world impacts. In 2021, our government announced that it would work with the Province of Prince Edward Island on the improving affordable access to prescription drugs initiative. Under this initiative, P.E.I. is receiving funding to add new drugs to its list of publicly covered drugs and to lower the out-of-pocket costs for island residents.
I just want to say that, with the legislation, P.E.I. residents have already saved $2 million in out-of-pocket costs on more than 230,000 prescriptions, and the savings continue. Our government remains firmly committed to taking the next steps in pharmacare, and the legislation today is going to help us do that by providing coverage for contraception and diabetes medicine. This is part of our overall approach to support the provinces to improve health care in Canada, including with a new deal we signed with all the provinces last year to provide better care, as well as making it easier to get access to such things as a medical practitioner in rural areas, including where I live, by providing student loan forgiveness for people to operate there.
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