Hon. Rosemary Moodie: Honourable senators, I rise to speak to Bill C-64, An Act respecting pharmacare.

I want to thank Senator Pate for her work as sponsor of this bill and for the valuable overview of the topic and the bill she has given us.

My goal today will be to provide insights that I hope will be helpful as we continue to study this bill, especially when it comes to the Standing Committee on Social Affairs, Science and Technology.

Honourable colleagues, you will know that Canada is the only country in the world with universal health care that does not include coverage for prescription drugs. Senator Pate highlighted the ways in which pharmaceutical products have become a necessary part of health care. Yet, we have not evolved medicare to respond to the need to ensure that Canadians have the drugs they need.

Access to drugs that are effective is not a “nice-to-have.” Colleagues, let’s be clear: We should consider this a human right.

In Canada, a patchwork system has evolved through hundreds of thousands of private insurance plans and public plans over the past many decades. Insurance companies, industry and others will tell you that 97% of Canadians are covered by insurance plans. I would urge you, colleagues, to view those numbers with much skepticism.

The truth is that one in five Canadians is effectively uninsured, and there are a number of reasons why. Although some may have some insurance, the copays they are required to pay limit their access; the coverage they have is insufficient for a full year of prescriptions; or, as we heard is the case with contraceptives, drug coverage is impacted by a parent or other family member. This leads to cost-related non-adherence — or, to put it differently, the inability to take the drugs you need because you can’t afford to do so.

No Canadian should be faced with this challenge. No Canadian should have to choose between taking medicine for their heart disease and buying groceries for their family. The fact that millions of Canadians do face this challenge tells us that our large patchwork of private and public schemes is failing us.

Not only does this patchwork fail to provide access to drugs for many Canadians, it also provides inadequate access for those who do have some form of coverage. For example, someone in a management position will have better coverage than someone on the factory floor because, in our current setting, prescription drug coverage is sometimes treated as an employee benefit, rather than the provision of access to vital drugs.

Frankly, colleagues, the system that we have today is not meeting the needs of Canadians. All Canadians should have access to the drugs they need.

This patchwork system is not only failing to provide access to some and providing unequal access for others; it has also resulted in Canada spending far more on drugs than we should have to.

Colleagues, it may surprise you to learn that we spend more on drugs than countries like Australia, the United Kingdom and the Netherlands. In fact, according to the Canadian Institute for Health Information, or CIHI, drugs are the second most expensive part of our health care system, after hospitals. In 2023, almost 14% of health spending in Canada was on drugs. Public drug systems spent a total of $17.2 billion in 2022.

Why is this? A primary reason is that public-private mixed systems like those we see in the United States, Germany and Switzerland cost more.

Another reason is that insurance companies negotiate confidential reimbursements with manufacturers to recuperate funds when drugs are expensive, effectively de-incentivizing them from negotiating lower prices. Whatever the reason, it is clear that we are spending too much on the drugs that we can access, while many Canadians continue to have little or uneven access to the drugs they need.

Colleagues, the reality as I have described it has been the status quo in Canada for many years. How do we move forward from these issues and build a system where every Canadian can access the drugs they need?

I would refer to the first recommendation of the Hoskins report, which states:

The council recommends the federal government work with provincial and territorial governments to establish a universal, single-payer, public system of prescription drug coverage in Canada.

The council proposes the five fundamental principles of medicare, embodied in the Canada Health Act, be applied to national pharmacare

Honourable senators, with Bill C-64, Canada is taking a step toward what the Hoskins report proposed. Nevertheless, I want to be clear that we should not proceed down the road of strengthening the patchwork model, as some have proposed. This would only lead to poorer and more uneven access at higher costs for Canadians. In fact, public systems stepping in to cover the cracks and pay for more expensive drugs amounts to expecting the public to take on a greater financial burden while private insurers continue to draw profits. Why should Canadians accept this approach?

I wish to draw from the example of the U.K. There, outpatient prescriptions come with a copay of about US$13, while hospital prescriptions are entirely free. There are also mechanisms to keep costs low for those who have a heavy burden of prescription, and many don’t have to pay at all, such as children, seniors and those with disabilities.

This system is a strong example of a universal, single-payer, publicly administered system and provides much greater overall value. In fact, in 2021, the U.K. system spent US$517 per capita, while the Canadian system spent US$865 per capita. This example demonstrates that including national pharmacare as part of our health care system can provide access to medicines while lowering overall costs.

Colleagues, this brings us to Bill C-64. In some senses, it is an underwhelming bill that leaves us with questions.

I would describe Bill C-64 as effectively doing several things. First, it provides the guidelines to build a national pharmacare system. This includes, for example, important conditions such as working with provinces, territories and Indigenous peoples; and considering principles such as accessibility, affordability and appropriate use. It also gives the minister authority to enter into agreements for “. . . related products intended for contraception or the treatment of diabetes . . .” and the responsibility to consult with the Canadian Drug Agency.

The minister is given many responsibilities in this bill, but it should be noted that the minister does not have to wait for the mandate given to him by Bill C-64 to begin discussions with key parties.

Second, Bill C-64 lays out certain key principles for pharmacare — namely, that it should be a universal, single-payer, first-dollar program.

Finally, Bill C-64 puts forward contraceptives and diabetes-related medication as the pilot project for pharmacare, the first items of what should become an expanding formulary.

Colleagues, this is promising in some respects, but I have many hesitations about whether this bill truly puts us on the road toward universal pharmacare.

The first is the significant ambiguity in the bill. It is not immediately clear whether Bill C-64 will lead to a truly single-payer, publicly administered system or simply fill in the gaps so that “universal access” becomes an umbrella term incorporating both public and private plans.

The Parliamentary Budget Officer, in his March review of the bill, stated that:

The new program will cover 100% of the expense on diabetes and contraception medication for those who currently do not have public or private drug plan coverage and for those who currently do not fill their prescriptions due to cost related reasons. The latter group is assumed to be 14% of total prescriptions. The program will also cover the out-of-pocket portion of prescription costs for those who have public or private drug plan coverage.

Is this the case? Is the plan to fill in gaps or to provide universal coverage to all, regardless of whether they have an existing private plan?

The technical briefing held last week with government officials raised even more questions for me. It is not clear whether or not the government plans to bring in the needed overhaul, versus simply expanding what the provinces are already doing. The briefing has led me to question whether the government is, in fact, committed to a specific direction or whether it may choose to change course and apply different principles sometime down the road. This, for me, is very concerning. I look forward to asking the minister and his officials more questions at committee.

Building on this ambiguity, I would question the government’s commitment to public administration of pharmacare. Colleagues, I cannot overemphasize that public administration of pharmacare is an essential principle and is key to ensuring access to drugs for all Canadians.

Private insurers are not incentivized to work toward lower costs, minimize administrative fees or challenge manufacturers on the cost-effectiveness of drugs in the same way that public plans do.

To be clear, this is not to demonize private insurers by any means, but it is to highlight that as businesses, their interests are markedly different than the public’s interests.

Having said this, I strongly urge us to ensure public administration is and remains a keystone of pharmacare.

Honourable colleagues, I support universal pharmacare and the intentions of Bill C-64. I believe this bill should become law, but we have important work to do to make sure that the bill is as strong and as clear as it can be so that universal pharmacare can become reality.

I look forward to seeing this bill before the Social Affairs Committee, and I welcome senators interested in this bill who are not on the committee to join us so that together we can strengthen this bill for all Canadians. Thank you, meegwetch.