44th Parl. 1st Sess.
June 3, 2024 11:00AM
Mr. Speaker, it is my privilege today to begin the debate at third reading stage of Bill C-64, an act respecting pharmacare. The legislation, as people know, is a priority for the government. It would establish the fundamental principles for implementing a national pharmacare program in Canada. Additionally, it would outline our plan to work with participating provinces and territories to deliver universal single-payer coverage for various contraceptives and diabetes medications.
This is an important step toward a national universal pharmacare system, as well as a historic event in the evolution of health care in Canada.
The core principles outlined in the bill are accessibility, affordability, appropriateness and universality. Accessibility ensures that Canadians can access pharmaceuticals regardless of location or income, while affordability aims to minimize financial barriers.
Appropriate use prioritizes patient safety and health outcomes, while ensuring the sustainability of the health care system.
Last, the legislation would advocate for universal coverage across Canada. These principles would shape our collaborative efforts with provinces, territories and indigenous communities to establish national universal pharmacare.
Our government has repeatedly and consistently demonstrated our commitment to public health care. Budget 2023 announced $200 billion over 10 years to better support the health and well-being of Canadians with a strong and effective health care system. More recently, in budget 2024, we committed $1.5 billion over five years to launch the new national pharmacare plan. The plan would help provide support for Canadians seeking access to contraception and for those living with diabetes. Let me focus some of my time on contraception.
Canada has more than nine million women of child-bearing age, who account for nearly a quarter of our population. For many of them, access to safe and reliable contraception is essential.
It would grant them the autonomy to be intentional about their family planning and pursue their aspirations for the future. This may involve advancing their education or their careers, delaying starting a family until they feel prepared or choosing not to have children at all. Affordability has been recognized as the primary obstacle in accessing birth control. This can lead to individuals' not using it consistently and may discourage them from opting for the most reliable method available.
Consider oral contraceptives as an example. This type of birth control is priced at roughly $25 per month and carries a typical use failure rate of 9%. Compare this to IUDs, which cost up to $500 per year. Although IUDs are a higher initial investment, they provide coverage for five years and have a use failure rate as low as 0.2%. Women should be able to make the choice between different types of contraception, regardless of whether they can afford it.
Many Canadians are just simply not in a position to pay for these upfront investments. For example, a young, part-time worker who does not have drug coverage from their employer would struggle to pay for a $500 IUD. With limited income from sporadic employment, which is typical for many young adults, even the monthly prescription cost can present a significant financial burden. This is the reality for many Canadians, and it is a reality I have heard from some of my constituents in Ottawa Centre.
One study indicated that women and girls from lower-income families tend to use less-reliable contraceptive methods or opt out of using contraception altogether. This disparity emphasizes how socio-economic factors intersect with access to reproductive health care, identifying gaps in our health care system and perpetuating cycles of systemic inequality. Additional research has even shown us that providing contraception through public funding can actually result in public cost savings. The University of British Columbia estimates that implementing no-cost contraception has the possibility of saving the B.C. health care system around $27 million per year.
Recently, I had the opportunity to meet with Planned Parenthood Ottawa in my community of Ottawa Centre. Our conversation focused on a broad range of issues, but in particular we spoke of the impact Bill C-64 would have on the health of women here in our community. What became clear to me in that conversation was that contraception is not merely a matter of personal choice. It is an integral aspect of health care. It is a fundamental aspect of reproductive health, and it plays a pivotal role in advancing gender equality.
It was also made clear to me that, by ensuring affordable access to contraception, this legislation would advance gender equality. Preventing unintended pregnancies would enable more Canadians to participate in the economy, which would result in greater prosperity for all. This is crucial for building a more equitable society where everyone has the opportunity to thrive.
I want to thank Planned Parenthood Ottawa for the good work it does, day in and day out. I was really happy to speak to its representatives recently to let them know of a funding grant it is receiving to continue doing this important work in our community. I am thankful for them for meeting with me and for educating me further on the impact Bill C-64 would have on women here in our community and across the country.
Moving on to the impact on diabetes, we can apply the same cost-saving principle that I was speaking to in the case of contraception to medications that treat diabetes. Diabetes is one of the most prevalent chronic disease in Canada, impacting 3.7 million individuals at present. There are projections that this number will continue to grow.
Many of us know someone with diabetes and have seen the devastating effects it can have on a person's quality of life. While diabetes has no cure, treatments are available to control it.
These treatments are not always affordable or accessible to those who need them. We know that 25% of Canadians with diabetes have identified that the cost of their medications has impacted their ability to stick to their treatment plans. Neglecting proper management of this disease can result in devastating consequences.
When we made the announcement introducing Bill C-64, I was honoured to join the Minister of Health and many community advocates, who have been working in this area for some time, at the Centretown Community Health Centre, which is also located in my community of Ottawa Centre. Prior to the announcement, we met with some of the social workers, the primary health care practitioners and nurses who work at the Centretown Community Health Centre, which is a fabulous institution in my community. In fact, I used to serve on the board of the Centretown Community Health Centre some time ago.
When we met, we talked about the impact of this legislation. With regard to diabetes, we spoke to a specialist there who told us countless stories of individuals who she meets, and treats, who ration their diabetes medication. They are unable to afford the cost of their medication due to their current circumstances. It was made clear that, when diabetes is not properly managed, it can result in severe complications, such as heart attacks, strokes, blindness and even amputation.
In 2018, the total cost incurred by the health care system due to diabetes was estimated to be around $27 billion, a figure that we can expect to increase to $39 billion by 2028. These figures emphasize the urgent need for effective measures to mitigate the impact of diabetes and its associated costs on both individuals and the health care system as a whole. Independent of the legislation, the Government of Canada revealed its plan to collaborate with the provinces and territories to establish a diabetes devices fund. This initiative aims to guarantee that individuals with diabetes will have access to the essential medical devices and supplies they need to manage their treatment, including syringes, glucose-monitoring devices and insulin pumps.
This, along with the framework outlined in Bill C-64 for universal single-payer coverage for first line diabetes medications, would prevent any person living with diabetes in Canada from having to ration their medication or compromise their treatment. These actions will benefit all Canadians by helping diabetics control their disease, making it less costly to treat over time.
I want to address the concerns that pharmacare might affect private drug coverage, something that came up in the conversation when we were considering this bill at committee. Bill C-64 does not mention private drug insurance or regulate any of its activities. I want to be really clear about that. Our work with provinces and territories to offer universal single-payer coverage for contraception and diabetes medications would benefit all Canadians needing those drugs, regardless of their insurance status. Since the initiative is focused, benefits provided by private insurance are expected to remain unchanged. That choice remains in place.
As the two examples just mentioned show, the high cost of medication has become a pressing concern for too many people in Canada. For them, access to affordable medication is still a major challenge.
When medicare was first introduced in the 1960s, prescription medicines played a smaller role in the overall health care system. They were primarily administered in hospital settings, and those distributed beyond hospital confines were generally low in cost, but that is not the reality today.
Today, medicines are a vital and regular part of maintaining one's health. We know that roughly 1.1 million Canadians lack access to private or public drug insurance. That is approximately 2.8% of our population. In 2021, Statistics Canada found that one in five adults in Canada did not have the insurance they needed to cover the cost of the medication. In other words, 21% of adults in Canada face out-of-pocket drug costs that create a financial burden. This can lead people to forego their basic needs, such as food or heat, or even lead people to ration their medications or choose not to fill their prescriptions at all. Canadians should not have to choose between buying groceries and paying for medication. Being forced to make choices like these has serious consequences. Whether they are skipping meals or doses of medication, or opting to go without, sets off a chain reaction of adverse effects on the health of individuals and can heighten the strain on our health care and social support systems.
We can do better and we must do better. While it entails a financial commitment, the alternative, which is not investing in our pharmacare, would result in far more severe health and financial repercussions, as we can see with the two examples I presented earlier.
It is worth also noting that Canada has one of the highest per capita rates of prescription drug usage globally. Despite recent improvements, the elevated drug costs and the fragmented nature of drug coverage pose significant barriers for many individuals in Canada when it comes to accessing the prescription medications they need. In acknowledgement of these concerns, in December 2023, our government announced plans to advance the establishment of a Canadian drug agency, in short the CDA, with an investment of $89.5 million over five years, starting in 2024-25. The CDA will be built from the existing Canadian Agency for Drugs and Technologies in Health in partnership with provinces and territories. The Canadian Agency for Drugs and Technologies in Health publicly announced its transition to the CDA on May 1.
Canada's drug agency, or CDA, will play a central role in leading and coordinating initiatives designed to improve the sustainability and readiness of Canada's drug system for the future. Bill C‑64 sets out three main tasks for the CDA.
Initially, the agency would prepare a preliminary list of prescription drugs and related products to guide the establishment of a national formulary. This formulary would outline the range of prescription medications and associated products that Canadians should be able to access under the universal, national pharmacare.
Additionally, Bill C-64 would entrust the agency with formulating a national bulk purchasing strategy for prescription drugs and related products in co-operation with partners and stakeholders, including provinces and territories. This plan would explore methods to lower the cost of prescription drugs, which could help alleviate financial pressures for both individuals and the health care system. The agency would be required to finalize both the preliminary list and the strategy no later than the first anniversary of the day on which this act receives royal assent.
Last, the agency would aid in the publication of a pan-Canadian strategy concerning the appropriate utilization of prescription drugs and related products. This report would be released within one year of the bill receiving royal assent. Canada's drug agency would also be obligated to provide updates on the progress of implementing the strategy every three years.
As we know, national universal pharmacare cannot be accomplished without the contributions of the provinces, territories and indigenous peoples.
Given Canada's size and diversity, each province and territory has unique needs and specific challenges.
To establish a national pharmacare program that is both effective and fair, it is crucial to foster strong collaboration between the Government of Canada and all partners. Each stride toward national universal pharmacare will be made hand-in-hand with these partners. Future funding to support pharmacare will be allocated to provincial and territorial governments by way of bilateral agreements. This funding would supplement, rather than replace, existing provincial and territorial investments on public drug benefit programs.
In the immediate future, we will draw insights from ongoing initiatives as we persist in our efforts to enhance accessibility and affordability for all Canadians through a national pharmacare program.
Since August 2021, for example, our government has been working with the Government of Prince Edward Island to reduce drug costs for patients through the improving affordable access to prescription drugs initiative. Since then, P.E.I. has expanded access to over 100 additional medications on its roster of covered drugs, including treatments for cancer, heart disease, migraine and multiple sclerosis, just to name a few.
As of June 1, 2023, P.E.I. lowered copayment costs to $5 for nearly 60% of commonly prescribed medications for its residents. As a result of this initiative, within the first nine months alone, P.E.I. residents have saved over $2.8 million in out-of-pocket costs for over 330,000 prescriptions.
In addition to the progress being made on a regional level, I am happy to also share some of the work being done on a national level to support our pharmacare efforts. Bill C-64 builds on the work we have done to make drugs for rare diseases more accessible.
In March 2023, we launched Canada's first-ever national strategy for drugs for rare diseases. Supported by federal funding of up to $1.5 billion over three years, this strategy aims to enhance accessibility and affordability for medications for rare diseases, ensuring they are in reach for those who need them.
It marks the beginning of a national approach seeking to meet the need for drugs used in the treatment of rare diseases.
As my time is winding down, I want to say in conclusion that, in Canada, it is our belief that everyone should receive prompt access to the health care they need, when they need it, irrespective of financial needs. This principle is a core Canadian belief, and we are dedicated to defending it.
Bill C‑64 is a major step forward in our commitment to guaranteeing all Canadians access to affordable, high-quality drugs.
Our plan for universal coverage of contraception and diabetes medications would be life-changing for individuals, families, society and our health care system. While there is a lot of work ahead, we have already made substantial progress, from regulatory modernization to enhancing access to drugs for rare diseases, establishing Canada's drug agency and collaborating with the provinces and territories.
Passing this legislation would allow us to build on this momentum. We stand at the threshold of a new era in Canadian health care. We should seize this opportunity to invest in a stronger Canada.
I thank members for their attention.
I encourage all members of the House to vote in favour of Bill C-64.
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Madam Speaker, Liberals like to wrap themselves in the Canadian flag and proclaim themselves the great deliverers of health care in our country. It gets better. Allow me to read from former Liberal prime minister Paul Martin's 2004 election platform, which he infamously called a “fix for a generation”: “The priorities of a Liberal government begin with publicly funded, universally available health care. There is simply no other issue of such vital significance to Canadians. Liberals are proud of their founding role in making medicare a national priority.”
That sounded pretty good. It continues on, stating, “The objective of a Liberal government will be to agree with provinces and territories on a national pharmaceuticals strategy by 2006.” I would say that was a fail. That was former Liberal prime minister Paul Martin's 2004 election platform: a “fix for a generation”. Needless to say, national pharmacare did not happen in 2006. In fact, it is a full 20 years, a full generation, later, and we have a health care system that has fallen apart under the current NDP-Liberal government in Ottawa. Having broken our publicly accessible universal primary care system, we now have a Liberal Prime Minister who is setting his eyes on taking a wrecking ball to yet another part of our health care system. Why? In this backward town we call Ottawa, where common sense goes to die, Liberal logic says that if it is not broken, they need to break it.
What are the NDP-Liberals breaking today? It is the systematic dismantling of Canadians' access to their prescription drugs and treatments that are vital to their health. Just like 20 years ago, when that former Liberal prime minister brought disaster after disaster to primary health care, breaking it for a generation, if we follow our current NDP-Liberal Prime Minister down this path, our prescription drug system will forever be broken for generations to come. Rather than calling this a “fix for a generation”, I would say the fix is in.
It is against this backdrop of our broken primary health care system that Canadians need to take a good, hard look at this legislation. Bill C-64, the so-called pharmacare bill in front of us today, is not what the NDP or the Liberals are advertising. It is neither the implementation of universal prescription drug coverage, nor will it improve the options for the two items it promises to cover: contraception and diabetes medications. Instead, it goes out of its way to destroy Canadians' already pre-existing insurance coverage, provincial drug plans and freedom of choice in medication when pursuing treatments.
First, let us talk about federal-provincial relations. It is interventionist NDP-Liberal governments that use their control over the purse strings to force provinces into impossible decisions on patient care. Every time a premier tries to improve health care in their jurisdiction, the Liberal Prime Minister of the day will threaten to cut off health care funding to the province. Let us say a province wants to establish a few clinics offering MRIs outside of a hospital. To the Liberals, this is a mortal sin, and it cannot be allowed.
Earlier this year, the federal Liberal Minister of Health fined my home province of Saskatchewan $1 million for allowing MRI clinics to operate in 2021. This was an innovative idea that increased the number of MRIs performed at a lower cost. It was brilliant, but not so fast. The NDP-Liberal government saw that as a mortal threat and fined the province. As these clinics are still functioning because they are common sense, we can expect the fines to continue. How ridiculous is that? The answer is as simple as it is sad. They actually do not want the system to get better. They do not want better outcomes for people. The NDP and the Liberals learned long ago that as long as the health care system is broken, they can campaign in elections as the great protectors and saviours of the system. Canadians are not going to fall for that again. Remember, this whole thing depends on the federal government convincing the provinces to go along with this scheme, something we already know the Liberals are not good at doing.
Is this bill not doing something good? There is a second important thing to understand. This so-called pharmacare legislation will not bring universal prescription drug coverage to Canadians. Subsection 8(2) of the legislation, Bill C-64, under the heading “Discussions” says:
The Minister must...initiate discussions...with the aim of continuing to work toward the implementation of national universal pharmacare.
Let us break that down. What does the legislation require the minister to do? He must initiate discussions. That is fair enough. What do those discussions do? They have the aim of continuing to work towards a goal. Is that the big reveal? The minister is required to talk to some people to work towards an ideal. That sounds like every scam artist running a Ponzi scheme. Schmooze as many people as possible, and sell them on an idea that is nothing more than smoke and mirrors. This legislation is literally that: smoke and mirrors, conning Canadians into thinking there is a pot of prescription drug gold at the end of the rainbow.
It is not prescription drug gold at the end of this legislation. In fact, every single Canadian would be just that much poorer if and when this gets implemented because it is a direct attack on Canadians' private health insurance and drug coverage. Did members know that, according to The Globe and Mail, there are 102 government drug programs operating today, along with 113,000 private insurance programs? Statistics Canada reports that 79% of Canadians currently have health insurance that includes drug coverage.
The completely independent Parliamentary Budget Officer analyzed how much it would cost Canadian taxpayers if universal pharmacare were implemented. Their analysis is that pharmacare would cost about $40 billion every year. More importantly, that would be about $13 billion more than is being spent today. Let us keep in mind that pharmacare would replace existing public and private drug plans. Generally, private health care plans have better coverage than public ones. That would leave most people worse off. Therefore, overnight, four out of five Canadians would lose the prescription drug coverage they have through their employer, union, school, spouse, parent or provincial government plan.
The federal government is paying for it, which means we are paying for it through increased taxes. Either way we look at this, it would result in a multi-billion dollar spending increase paid for by us. Those who would really benefit from this are private companies who provide insurance to their employees because today the companies are paying for private drug insurance. Once this program kicks in, they could cancel those programs because the government would be paying for it. That would save those companies significant dollars. Essentially, it would be a transfer of dollars from the federal government directly to those companies, which is paid for by us.
Of course, the NDP-Liberals always love increasing taxes on unsuspecting Canadians. The other thing they love doing is limiting our choices to fit their narrow world view. There are two classes of drugs that the NDP-Liberals choose to cover in this so-called pharmacare bill: contraception and diabetes medications.
Let us talk about diabetes. Most people know that insulin is a shot given to diabetics to control their blood sugar levels, as needed. However, do people know that metformin is a prescription diabetes pill that is taken once or twice daily to help the body control its blood sugar properly, reducing the need for insulin? Do people know that metformin is prescribed commonly as a treatment for people before they have diabetes? With a daily treatment of metformin, that person may never develop diabetes, and that daily metformin is a dirt-cheap alternative to very expensive insulin. It keeps pre-diabetics from developing the disease, and it costs pennies, compared to insulin. Metformin is not covered.
What about Ozempic? We have all heard of Ozempic as the wonder weight-loss drug, but that is simply a side effect of being a diabetes drug that acts on the pancreas to control blood sugar. We also know that the best way to avoid type 2 diabetes is to be a healthy weight and to not be obese. Ozempic does that, but Ozempic is among the most expensive drugs on the market at about $75 a dose. Ozempic and metformin are used to prevent the disease of diabetes. Does that mean the NDP-Liberals are purposely going to deny treatment to those folks to prevent them from developing diabetes and are going to wait until they get the full-blown disease? How is that fair? Should that not be a decision for the patient and the doctor, and not for some bureaucrat in Ottawa?
Innovative Medicines did a comparison of the access of drugs covered by private insurance versus those in public plans. The results are as shocking as they are sad. In Canada, private insurance covers twice as many drugs as provincial plans do. The bottom line is that this bill, Bill C-64, proposes to take away people's private drug plan. That is what single-payer means. The result is that private companies and anyone else currently providing drug coverage in a benefit plan would cancel those plans and would force Canadians onto the government plan. Canadians would be stuck with a slimmed-down plan and would be forced to pay out-of-pocket for the rest.
After nine years, it is clear that this NDP-Liberal government simply is not worth the cost to Canadians' health. It has broken our primary health care system, and now with this so-called pharmacare legislation, it is setting out to break prescription drug coverage for 80% of Canadians who already have private insurance.
Conservatives will not stand idly by while the NDP-Liberals systematically break our country. If we form government, we would undertake the task to fix the immense damage this costly coalition has done. We would axe the tax. We would build the homes. We would fix the budget, and we would stop the crime. Let us bring it home.
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