Don Davies NDP Vancouver Kingsway, BC

moved:

That, given that millions of Canadians lack prescription drug coverage, and given that overwhelming evidence, including from the Parliamentary Budget Officer, has concluded that every Canadian could be covered by a universal pharmacare program while saving billions of dollars every year, the House call on the government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program.

Mr. Speaker, I am honoured to be splitting my time today with the member for Salaberry—Suroît.

Canada is a country that prides itself on our universal health care system. It is no exaggeration to say that our public single-payer system of physician and hospital coverage is one of the features of our nation of which Canadians are most proud. I believe it defines us as a country.

However, our health care system is neither perfect nor comprehensive. Indeed, it has a number of glaring coverage gaps. These include services such as outpatient, dental, mental health, rehabilitation, and home care. The motion the New Democrats are proud to introduce today calls on the government to take action to address one of the most pressing and solvable of these gaps: pharmaceutical drugs.

Currently, this gap consists of a patchwork of private and public coverage that varies widely across Canada. Outside of Quebec, every province and territory provides public drug coverage for people only in very limited circumstances, sometimes for those on social assistance, sometimes for seniors, and sometimes for people with specific conditions such as cancer, transplants, and infectious diseases. For those outside these groups, folks have to pay the cost of the medication out of their own pockets.

Quebec is the only province with a mandatory program, requiring that every citizen obtain insurance. However, it is a mixed private-public scheme where the most expensive and difficult-to-insure citizens are foisted onto the public plan, making it extremely costly. The situation is problematic even for those who have extended benefit plans through work. These plans often have annual limits or copayments that leave claimants exposed for out-of-pocket costs. Employers across Canada report difficulty paying for these benefits and increasingly are dropping coverage for their employees.

The consequences of this omission are present in every community and every demographic. They are real. They are pressing. They are serious.

Here is a typical example, recently described in an article written by two physicians from Alberta. They describe the real case of a 60-year-old Calgary woman with high blood sugars and very high blood pressure. She paid for medications out of her own pocket each month, she had no employer insurance, and she could not afford the premium for Blue Cross. One month, however, when facing extra expenses, she did not have enough money to pay for her expensive diabetes and blood pressure medications. She ended up in the hospital. This woman would likely have avoided the emergency room altogether if she had stayed on her medications. Ironically, by having to access hospital care, she ended up costing our health care system much more than the cost of her medication.

Unfortunately, stories like hers are all too common. A number of studies have established that 10% to 20% of Canadians have no pharmaceutical coverage whatsoever. This means that four million to seven and a half million Canadians are living every day without the medicine their own doctors prescribe for them and which they need to stay healthy and sometimes even alive. One in five Canadians reports that he or she or a family member neglects to fill prescriptions due to cost. In fact, Canada has the second-highest rate of skipped prescriptions among comparable countries. This particularly hurts seniors and the poor. One in 12 Canadians over 55 skips prescriptions due to cost. Low-income Canadians are three times more likely to experience financial barriers to accessing essential medication.

Shamefully, Canada stands virtually alone among developed countries in this regard. We have been identified as the only developed country in the world with a universal health care system that does not provide some sort of universal prescription coverage. Canada is one of only five OECD nations whose public health system does not provide publicly funded drug insurance to all citizens. Even as millions go without coverage, Canadians pay among the highest prescription drug prices in the industrial world, second only to the U.S., and these costs are growing at an alarming rate.

Here is the absurdity. If someone cuts a finger, he or she goes to the doctor who stitches it up, and the individual leaves and never sees a bill. However, if people go to a doctor and their ailment needs to be treated by medication, they are at the mercy of their ability to pay. This is irrational, it is unfair, it is not consistent with a modern universal health care system, and it is also unnecessarily expensive.

However, there is a solution. In fact, it is a solution so clear, so established, and so patently feasible that there is no reason why we should not begin to implement it at once. That is what this motion and the New Democrats are urging the government to do; to begin to implement a universal pharmacare system in Canada.

By implementing a universal public pharmacare system, we can cover every single Canadian, every man, woman, and child, and save anywhere between $4 billion and $13 billion a year. Let me repeat that, just as with universal health care, we can make sure that all Canadians can get the necessary medicine they need when they need it and we can collectively save billions of dollars as a nation. Here is how and why.

A universal public system would save money in myriad ways. It would establish a national, independently monitored, evidence-based formulary that covers drugs that are the most effective and cost sensitive. It is estimated that more than $5 billion a year is wasted because private drug plans pay for unnecessarily expensive drugs and dispensing fees. By reimbursing drugs only when they represent value for money, public plans are much better equipped to rein in such costs.

Second, it would allow for the effective national bulk purchasing of drugs, a proven method that reduces drug costs by an average of 40% for brand-name drugs, as has been the experience in New Zealand, the U.S. veterans administration, and countries throughout Europe. A year's supply of atorvastatin, a widely used cholesterol drug, costs about $143 in Canada, but only $27 in Sweden and $15 in New Zealand.

It would allow for the negotiation of exclusive licensing agreements with pharmaceutical companies to achieve the best prices for widely used medications. It would streamline administration costs, reducing thousands of duplicative administrative systems, perhaps to one per province and territory. The administration costs of for-profit private plans average 15%, while administration costs for public plans are less than 2%.

It would avoid cost-related non-adherence, the technical term for the increased costs that come when folks do not take their medicine and become more seriously ill. The health committee heard evidence that one diabetic patient who ends up in intensive care because that individual could not afford to take insulin costs more money than providing free medication for life.

However, members do not have to take my word for it. The parliamentary budget officer's report on the federal costs of a national pharmacare program, released September 28, confirms what health policy experts have been saying for years, that Canadians could have a pharmacare system that covers everyone for billions of dollars less than they now pay for prescriptions. The PBO found that, in 2015, Canadians spent $24.6 billion on pharmaceuticals that would have been eligible for coverage under a national pharmacare plan. Accounting for pricing and consumption changes, the PBO estimated that Canada would have, instead, spent $20.4 billion in 2015 under national pharmacare. Using the most conservative assumptions, leaving out certain cost savings entirely, and applying the Quebec formulary, one of the broadest in Canada, he found that Canada would have saved $4.2 billion that year.

Other studies, including by renowned Canadian researchers, estimate the annual savings to be even higher, perhaps between $9 billion and $13 billion. That is why so many voices in Canada are advocating for a national pharmacare program. This includes many organizations—retirees, physicians, nurses and other health professionals, business and employer associations, the Canadian Labour Congress, health care researchers, and patient advocates of all kinds—and we know that the public broadly supports national pharmacare. A 2015 poll found that an astonishing nine out of 10 Canadians support the concept of national pharmacare.

The details of what kind of system we create are yet to be determined. A pan-Canadian pharmacare program could be a stand-alone federal program, or we could fold it into the Canada Health Act and add prescription coverage as an insured service, just as we do with any other medically necessary service.

Ultimately, of course, we have to pay for our medicine, but it is always Canadian citizens who pay, in any event, whether they pay through public or private sources. The question is whether we want to pay $24.6 billion a year, with millions of Canadians left uninsured, or instead, pay $20 billion overall, with coverage for every single Canadian. To ask that question is to answer it.

Our most important goal should be to ensure that no Canadians go without the medicine necessary to their health. New Democrats in the House, therefore, call on the Liberal government to agree to this goal. We ask Liberals to vote for this reasonable and necessary motion and meet with the provinces within one year to begin the discussions to make it a reality.

It took New Democrats and courage to bring medicare to Canadians. We will continue to work to do the same thing for pharmacare.