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Minutes of Proceedings

42nd Parliament, 1st Session
Meeting No. 20
Tuesday, September 27, 2016, 8:46 a.m. to 10:51 a.m.
Bill Casey, Chair (Liberal)

Library of Parliament
• Karin Phillips, Analyst
• Marlisa Tiedemann, Analyst
C.D. Howe Institute
• Ake Blomqvist, Health Policy Scholar
Canadian Union of Public Employees
• Victor Elkins, Regional Vice President for British Columbia
• Chandra Pasma, Senior Research Officer
As an individual
• Mélanie Bourassa Forcier, Professor and Director, Health Law and Policy Programs, Université de Sherbrooke-CIRANO
• Colleen Flood, Professor and University Research Chair, Director of the Centre for Health Law, Policy and Ethics, University of Ottawa
Pursuant to Standing Order 108(2) and the motion adopted by the Committee on March 7, 2016, the Committee resumed its study of the Development of a National Pharmacare Program.

Ake Blomqvist, Colleen Flood, Mélanie Bourassa Forcier and Victor Elkins made statements and, with Chandra Pasma, answered questions.

At 10:17 a.m., the sitting was suspended.

At 10:25 a.m., the sitting resumed.

The Committee proceeded to the consideration of matters related to Committee business.

It was agreed, — That a proposed budget in the amount of $ 8,400.00, for the study of Bill C-224, be adopted.

On motion of Darshan Singh Kang, it was agreed, — That the Committee request the Parliamentary Budget Officer to provide it with an analysis of the following items:

 a. The percentage of Canadians:

i. who are ineligible for public prescription pharmaceutical coverage (under current provincial and federal programs), excluding catastrophic coverage, and who do not have private or employer sponsored coverage; and
ii. whose private or employer-sponsored coverage has been reduced or eliminated in the past 10 years; and where possible, broken down by region (West, North, Prairies, Ontario- Quebec, Atlantic), by urban/rural, by age quintile and by annual household income quintile.

b. Estimate the current annual total of:

i. employer contributions to employer-sponsored private insurance benefit plans in respect of prescription pharmaceutical coverage;
ii. employee contributions to employer-sponsored private insurance benefit plans in respect of prescription pharmaceutical coverage;
iii. total out-of-pocket payments by patients for prescription pharmaceuticals; and
iv. tax subsidy to employer-sponsored private insurance benefit plans.

c. Estimate the cost of (1) creating and (2) administering:

i. a single-payer universal first-dollar prescription drug coverage; and
ii. a single-purchaser and national distribution system for prescription drugs, possibly modeled on the Canadian Blood Services and/or other relevant models in Canada or other jurisdictions.

d. Assume that there is a single national formulary for prescription drugs with at least three tiers: necessary medicines (Tier 1); equivalent-to-necessary/alternative therapies (Tier 2); and all others (Tier 3). In terms of the financing of a single-payer prescription drug coverage program, analyze the efficiency of an:

i. introduction of a payroll tax;
ii. increase in sales tax;
iii. increase in corporate and/or personal income tax; and
iv. introduction of a $5 co-pay on Tier 2 and a moderate co-pay on Tier 3.

e. Discuss the implications of and the tools available for raising an additional $10bn in revenue to finance such a program.

f. To the extent possible:

i. estimate of the savings to the health care system from eliminating cost-related non-adherence to pharmaceutical prescriptions in Canada; and
ii. estimate of the savings achievable by a single-payer, as opposed to the present multiplicity of public and private payers, acting as the sole original purchaser of prescription pharmaceuticals in Canada.

In carrying out this analysis, the PBO will work with Canadian Institutes for Health Information, Statistics Canada, Canadian Agency for Drugs and Technology in Health, IMS Brogan and other sources to obtain appropriate data and will not rely on analyses prepared by or for a third party. The PBO’s report will disclose in detail the sources of data, the quality of the data and the methods of analysis used.

By unanimous consent, it was agreed, — That, notwithstanding the Committee routine motion on the distribution of documents, adopted on Monday, February 3, 2016, the Clerk be authorized to distribute a draft workplan on the study of the opioid crisis in Canada in English only.

It was agreed, — That the meetings of Tuesday, October 4, and Thursday, October 6, 2016, be dedicated to the study of the opioid crisis in Canada; and that the Committee approve the proposed schedule of the first two (2) meetings.

At 10:51 a.m., the Committee adjourned to the call of the Chair.

David Gagnon
Clerk of the Committee