Interventions in Committee
 
 
 
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View Ben Lobb Profile
CPC (ON)
View Ben Lobb Profile
2018-11-29 9:45
That's good to hear.
I think Ms. Boudreau made a comment about having pharmaceuticals behind the shelf, perhaps.
I was at a Shoppers Drug Mart the other day, and the Aleve, etc., and any of the things for sinus infections that would be included in the making of these drugs were all there.
One thing I was surprised by—and maybe I have never paid attention—was the self-checkout method. Just while we're sitting here, you could load your grocery bag right full of it, take it right through the wicket and no one would even know. Should we be asking pharmacies to...?
Maybe they want self-checkout to cut costs, but maybe, in order to get a box, you're going to have to talk to the pharmacist. Is that something we should be asking pharmacies to do?
Michelle Boudreau
View Michelle Boudreau Profile
Michelle Boudreau
2018-11-29 9:46
We do work with the National Association of Pharmacy Regulatory Authorities, NAPRA, which you may be familiar with. It gives some guidance to the pharmacy colleges from province to province about things like where to keep products—behind the shelf or in front—and it is left to each individual province in the pharmacy college to make those determinations.
View Peter Fragiskatos Profile
Lib. (ON)
Thank you, Chair.
I want to begin with the pharmacists.
Southwestern Ontario has been plagued by an opioid crisis. Certainly, British Columbia is very correctly mentioned at the top of the list when it comes to this issue, but southwestern Ontario has not been immune to the problems.
I thank you very much for putting the whole issue of medication return programs on the table here today. I don't know much about them, except what I've read. You're an expert in this area. They seem to have had some success. I was reading about the case in Manitoba. A program there was recently renewed for five years. In 2017, according to a report in the Winnipeg Free Press, 16,000 kilograms of unused or expired medications were returned by citizens. That's medications in general, but it sounds very good.
I have two questions for you. Manitoba is participating. Is this program in place in all provinces? You said that 90% of pharmacies are offering this. I'm going to guess that provinces across the country offer this.
Joelle Walker
View Joelle Walker Profile
Joelle Walker
2018-09-20 11:01
The programs will vary province by province. There's an association called the Health Products Stewardship Association, and it operates in about half of the provinces. It helps fund some of these programs.
Unfortunately, because health care is so disparate across the country, the reality is that some provinces don't have those programs. New Brunswick is one example where pharmacists pay out of pocket themselves for the destruction of the returns.
Health Canada continues to put in place certain parameters by which this can be done, to limit diversion, so pharmacists have to have bins and special bags in their pharmacies. They have to be able to dispose of drugs in a safe way, especially when you think about needles, sharps, as well as other potentially dangerous substances. Just about all pharmacies accept them, but the amount which they do....
I think the statistics you were referring to have more of a national perspective. I think the total approximate number of medication returns is about 400 million tonnes annually.
When you consider this in the context of the other issue we talked about with pharmacare, there's a lot of wastage in our system. Those are areas that we think should be tackled with both the opioid crisis that's happening, as well as—
Joelle Walker
View Joelle Walker Profile
Joelle Walker
2018-09-20 11:03
They're being returned to pharmacies annually.
View Sonia Sidhu Profile
Lib. (ON)
View Sonia Sidhu Profile
2017-06-15 11:33
Thank you, Chair.
Thank you, all the presenters. It was great testimony.
My first question is to Ms. Dattani. A 2015 publication of “The Translator”, your organization's health policy publication, said, “ The overall goal of antibiotic stewardship is to maximize patient outcomes while minimizing the unintended consequences of antibiotic use.” It is also noted that pharmacists can be an important partner in preventing the spread of AMR.
Can you explain a little more the role of pharmacists in this process? How can the role be more effective on AMR?
Shelita Dattani
View Shelita Dattani Profile
Shelita Dattani
2017-06-15 11:33
Thanks for your question.
As I alluded to in my comments, pharmacists are currently engaging in lots of different opportunities, whether it's counselling patients, public health and health promotion, or discussions during immunizations. Pharmacists can definitely have a more impactful role if they're able to actually intervene in patients' therapy, adapt prescriptions, adapt durations of therapy, and prescribe for simple, uncomplicated types of infections.
This is happening in a couple of provinces, but is not consistent throughout the country. It doesn't completely make sense to me, when I have the same knowledge, skills, and judgment as my colleagues in New Brunswick or Alberta, that they are able to exercise this and act as antimicrobial stewards while I can't. Consideration of that—harmonizing practices across the country to enable pharmacists to practise to that expanded scope—is a key solution.
Anna Romano
View Anna Romano Profile
Anna Romano
2017-01-31 11:26
Thank you, Mr. Chair.
I appreciate the opportunity to address this committee on behalf of the Public Health Agency of Canada.
Let me begin my remarks with some important definitions that I think will illustrate the public health imperative of supporting and improving mental health. Mental health is defined by the World Health Organization as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
Mental illness, on the other hand, refers to mental health problems that are typically diagnosed and treated by mental health professionals. They include depression and anxiety as the two most common mental illnesses, as well as other less common ones, such as schizophrenia.
We know that mental illness is a significant contributor to poverty. In turn, the experience of poverty can negatively affect mental health. The World Health Organization has recently highlighted that the experience of poverty, inadequate housing, and problems finding work or getting an education are risks for poor mental health.
Understanding the impact of social and economic factors on mental health is key to developing effective public health programs. At the Public Health Agency we work upstream to help strengthen protective factors that promote positive mental health by helping Canadians build resilience and coping skills and prevent mental illness. Alongside other poverty reduction strategies, strong mental health can help break cycles of poverty.
The agency's work to promote mental health includes surveillance, testing programs—also known as “intervention research”—and support to community-based programs for vulnerable populations such as children, youth, survivors of violence, and seniors.
I would like to spend the next few minutes telling you about some of the investments the agency is making in these areas.
Given our focus on prevention and promotion, supporting vulnerable children and youth is a public health priority. Our suite of prenatal and parenting support programs reaches 278,000 at-risk children and parents in over 3,000 communities across the country each year.
We invest about $112 million dollars annually in three programs: the Canada prenatal nutrition program, the community action program for children, and the aboriginal head start in urban and northern communities. Families using these programs are facing challenging life circumstances, such as low income, lone or young parenthood, social or geographic isolation, situations of violence or neglect, as well as substance abuse problems. These programs support positive parenting, parental involvement, attachment, resilience, and healthy relationships, all of which are protective factors associated with positive mental health.
We know from program evaluations and participant surveys that these programs have a significant positive impact on both parents and their children, including improving mental health.
The Public Health Agency is also evaluating mental health promotion interventions to understand what types of interventions work, for whom, and in which context. Specifically, we invest $1.5 million per year on projects focused on children, youth, and their families that increase protective factors for mental health such as social support for vulnerable parents, secure parent-child attachment, resilience, the ability to resolve conflicts, and the ability to create healthy relationships. For example, the fourth R is a school-based prevention program that promotes healthy relationships amongst youth. The program includes role modelling of relationship skills, peer mentoring, bullying prevention, sessions on safe use of social media, as well as lessons to address and prevent dating violence.
The agency also supports community-based projects that strengthen both the physical and mental health of survivors of family violence. Poverty, unemployment, and economic stress are among the many risk factors for family violence. Family violence can cause serious health and social problems throughout the lifespan of a victim, including increased risk of behavioural problems in children, drug and alcohol use and attempted suicide in teens, and mental illness.
The agency supports projects across the country that reach vulnerable populations including street involved youth, indigenous and northern populations, and parents and children affected by violence. These projects also test the effectiveness of innovative health promotion approaches by measuring changes in mental health outcomes such as anxiety, depression, and post-traumatic stress injuries.
Poor mental health can impact Canadians at every stage of life, and seniors are no exception. Seniors with low incomes are more likely to experience social isolation, loneliness, and depression as well as ill health and a shorter lifespan. As you have heard from other experts, poverty reduction is not just about income support. It is as much about strengthening the bonds of community and having the ability to access the social supports around you. This is why the Public Health Agency continues to work closely with provinces and territories as well as the World Health Organization on the age-friendly communities initiative. In Canada this initiative has strengthened social inclusion in over 1,000 communities by bringing together seniors, caregivers, governments, and other stakeholders to help seniors remain active, engaged, and healthy in their communities.
The agency also works with partners to raise awareness and develop resources on seniors' mental health. For example, the agency provided funding to the Canadian Coalition for Seniors' Mental Health in collaboration with Shoppers Drug Mart to develop resources for seniors and their families on a range of seniors' mental health issues and to provide continuing education to pharmacists to support the dissemination of this information.
I will conclude here by emphasizing that investing in mental health promotion can help contribute to the reduction of poverty, but breaking the cycle of poverty and poor health requires a multi-disciplinary approach, given the complexity of the challenge.
Thank you for your attention and the time and energy you're devoting to this topic. I'd be pleased to answer any questions.
Alistair Bursey
View Alistair Bursey Profile
Alistair Bursey
2016-10-18 8:54
Good morning, everyone. Thank you for the opportunity to be here today.
My name is Alistair Bursey. I am a pharmacist in Fredericton, New Brunswick.
I'm here to speak with you about the growing problem of opioid addiction in our communities from the perspective of a practitioner at the front line of an urgent public health crisis. I'm also the chair of the Canadian Pharmacists Association, the CPhA, which is the national voice of Canada's 40,000 pharmacists. I'm joined today by my colleague Phil Emberley who serves as CPhA's director of professional affairs and also works as a community pharmacist here in Ottawa.
I want to begin by thanking the members of this committee for convening this emergency study. There is no question that opioid abuse is fast becoming a Canadian epidemic, and we need strong leadership in this country to stem the tide. Phil and I can tell you that not only are pharmacists the experts when it comes to medication but that we serve on the front line in our communities. Every day in our practices we come face to face with the tragedy of opioid abuse. As a pharmacist my mission is to treat all patients in my community. Over the years the number of patients receiving addiction therapy in my practice has grown at an unsettling pace. Generation after generation are caught in the grips of addiction and often we see them years after the damage has already been done. We know this problem can't be solved overnight. But there are many things we can do to treat those affected, prevent inappropriate prescribing and dispensing, and protect youth from the grips of addiction.
Prevention is where I would like to begin my remarks today. In addition to tackling the existing crisis, we really have to look at some of the underlying causes that have led us to this point. All levels of government need to work together to take a proactive approach to help prevent opioid misuse early on before it becomes a problem. This must be done through a mix of policies and public awareness of the consequences of opioid misuse and inappropriate use of pain medications. A particular focus should be on educating Canadian youth as the evidence demonstrates that many young people are exposed to illegal narcotics before they graduate from high school.
A key to success lies in building effective partnerships with health care providers. Community pharmacists play an important role in educating patients about the harms associated with prescription opioids and other potentially harmful medications. For example, medication reviews allow pharmacists to review the patient's response to the medications. This service provides an opportunity to educate patients on how to take their pain medications safely. It can also flag drug-seeking behaviour. Medication reviews can also reveal patient misconceptions about how and when to take medication, flag medications that are not adequately controlling pain, and confer with their prescribed optimized pain therapy. This valuable interaction between pharmacists and the patient is vital to ensuring safe and optimal use of medications. That fact that we see each Canadian on average 14 times per year provides us a great opportunity to intervene with our expertise and to consult with family physicians to improve patient's pain control.
CPhA supports the government's recent announcement that it will proceed with regulatory change requiring opioids to carry warning stickers and come with patient information sheets describing addiction and overdose risks. It's a good start. But pamphlets and warning labels are no substitute for pharmacists' care. That's why CPhA recommends that all jurisdictions, including the federal government as a provider of health services, expand funding for pharmacists' services to include pharmacist pain medication reviews. Funding pharmacists' consultation and follow-up would go a long way to improving the outcomes of these patients. Education goes hand in hand with better prescribing practices. The government has acknowledged more must be done to support better prescribing of opioids but Canada has fallen behind. We know that outdated Canadian prescribing guidelines simply do not reflect the best available evidence, yet our standards have not caught up. While new guidelines are expected next year, prescribers may feel pressured to prescribe opioids to patients experiencing acute or chronic pain without trying non-drug approaches. In the United States, the Centers for Disease Control encourages prescribers to start patients with low doses while providing a limited supply. We must immediately adopt comparable standards here in Canada to ensure patients receive the best possible care.
Prescribing guidelines are not the only thing that must change for our profession to be more effective and decrease the inappropriate use of opioid medications. A pharmacy is the safest, and most effective and efficient and accountable delivery model for dispensing prescription drugs. But pharmacists can only be as effective as the tools at their disposal. The existing patchwork of prescription monitoring programs, also known as PMP, across Canada is no match for the problems of polypharmacy and double doctoring. PMPs are a stopgap solution.
Moving beyond prescription monitoring to implementing a fully integrated drug information system, DIS, and functional electronic health records, EHRs, in every province and territory would ensure that pharmacists and physicians have access to the information they need to work collaboratively to monitor inappropriate prescribing and address drug-seeking behaviour.
Greater accountability will result when prescribers are unable to claim that they were unaware that a patient was being treated by another physician. The progress of deploying EHRs and a DIS across the country needs to be accelerated to give us the tools we need to reduce opioid addiction.
Public drug plans can also help limit the supply of prescription opioids by limiting the number of opioid doses that can be reimbursed within a specific time period. In my home province of New Brunswick, for over 20 years opioids and other controlled drugs have been limited to a maximum 35-day supply, yet similar controls are not in place across the country. Limiting the maximum supply provides pharmacists with more frequent opportunities for monitoring and intervention, and a much tighter turnaround time to engage the prescriber if required.
From a public safety perspective, limiting the maximum supply results in a decreased inventory of narcotics in our communities. I know from my own experience that pain and chemotherapy patients have been violently targeted by criminals for their prescription opioids. Dispensing fewer capsules at a time can help reduce the risk of diversion.
However, limiting diversion of prescription opioids from pharmacies is a drop in the bucket in fighting this public health crisis. Counterfeit pharmaceuticals manufactured illegally in clandestine labs are feeding the overdose epidemic, plain and simple. These drugs are highly dangerous, putting users at a high risk of overdose since it's impossible to know what or how much of a given substance these drugs contain. Illicit manufacturing of synthetic opioids like fentanyl is increasingly common, and law enforcement needs tools at its disposal to curb the growing supply.
The government has made good progress through the restriction of precursor chemicals, but more can be done to limit production of these dangerous drugs. The Canadian Association of Chiefs of Police reports that criminals are importing commercial pill presses into Canada, but that border agents don't have the authority to seize them. To put this in perspective, these machines can be purchased online for less than $10,000, and they can make between 10,000 and 18,000 pills per hour.
As a pharmacist I can tell you that there is simply no reason for an individual to possess of one of these machines. The CPhA strongly urges the government to impose penalties for the illegal importation of pill presses and tablet machines, and to limit possession to pharmacists and others who hold an appropriate licence.
Finally, we can't forget the human face of opioid abuse, and we can't turn our backs on people who have already succumbed to opioid abuse. We need more programs to help those who are currently addicted to opioids. Pharmacists play a front-line role in assisting recovering addicts by dispensing drugs to treat addiction, such as methadone, suboxone, and naloxone, and by providing regular support, monitoring, and follow-up, sometimes on a daily basis.
These programs and the health providers who deliver them need more support. There is no magic bullet that will put an end to a crisis decades in the making, but we also want to be careful of unintended consequences. As we start to restrict legal access to these drugs, front-line health care workers can be put at risk. Pharmacists will be the first to experience intimidation, threats, and robberies.
Recently I had a discussion with a colleague from Newfoundland, where oil workers in the throes of addiction returned from Alberta to their rural community, and robbed a pharmacy with the aid of gallons of gasoline and a lighter.
Pharmacists are very concerned with the challenges that they're going to face as the supply tightens.
Lawmakers, regulators, and health care professionals must work co-operatively to find solutions to stem the tide of addiction. Pharmacists are committed to being a major part of the solution, and we ask for this committee's support in combatting opioid abuse in Canada.
View Darshan Singh Kang Profile
Ind. (AB)
Thank you, sir.
Mr. Bursey, what role can pharmacists play in identifying and treating individuals with substance use disorders?
Alistair Bursey
View Alistair Bursey Profile
Alistair Bursey
2016-10-18 10:17
Pharmacists often are the eyes and ears of physicians on the front lines. We see patients, especially addiction patients or patients who are receiving pain medications, many times throughout the year. In New Brunswick, the average number of visits by a New Brunswicker to a pharmacist is 16 times a year. It's a great opportunity for identifying and for collaborating with our physicians on our addiction programs to find solutions and make sure that these patients who are in the throes of addiction can get treatment. I think pharmacists play a key role in collaborating with other health professionals.
View John Oliver Profile
Lib. (ON)
View John Oliver Profile
2016-09-29 9:41
We heard from the Pharmacists Association. They're quite concerned that we as a nation would lose the full service that a pharmacist provides in terms of not just filling the prescription but also providing advice on drugs and complications and co-issues. Is it possible to make sure, if we were looking at a national pharmacare program, that there would be full coverage and full compensation models built into that for the people who administer the prescriptions along the route?
Peter Weltman
View Peter Weltman Profile
Peter Weltman
2016-09-29 9:42
Again, I see that as policy direction. If you come back to us and say we want a program managed on this basis, exactly the way it's delivered today, with this change and this change, and ask us to come back to you and cost it, we could do that, but we wouldn't come to you and say, “Well, if you did this, we could do this, or if you did this, we could do that.”
Mr. John Oliver: Thank you.
Walter Natynczyk
View Walter Natynczyk Profile
Walter Natynczyk
2016-06-09 8:53
Mr. Chair, members of the committee, Auditor General, ladies and gentlemen, I'm pleased to be here today on behalf of Veterans Affairs Canada. Joining me today is Michel Doiron, the assistant deputy minister for our service delivery branch, and Retired Captain Dr. Cyd Courchesne, our chief medical officer.
I wish to thank the Auditor General and his staff for their ongoing contribution to assist the department in achieving effectiveness, efficiency, and accountability as we support the well-being of our veterans and their families.
As the Veterans Affairs Minister, the Honourable Kent Hehr, indicated, immediately following the tabling of the Auditor General's report, we accept all of the report's recommendations. We are taking immediate action to ensure the health care benefits program is efficient, valued, and supports the needs of our veterans.
To give you an idea of its size, in fiscal year 2014-15 the Veterans Affairs drug benefits program supported the costs for drugs for approximately 51,000 veterans in the order of $80 million. While the report found that most of the 2004 Auditor General recommendations related to the program were implemented, it did highlight areas for improvement with corresponding recommendations.
The media coverage is concentrated on the cost of marijuana for the Government of Canada and on maximum doses, which risks diverting attention from the fact that the report discusses all drug benefits.
We find as well that sometimes the department's role in the payment of drug benefits could be misunderstood. To clarify, it is Health Canada that is responsible for the regulation of medications for all Canadians, including our veterans. Veterans Affairs Canada does not prescribe medication; rather, it pays for medical treatments authorized by the veteran's physician or health professional.
To review, the Auditor General's report found the following key four points.
First, we do not have an adequate process in place to make evidence-based decisions related to our drug benefits list. Second, we should review our cost-effectiveness and program efficiency strategies. Third, we need to contain the rising costs of marijuana for medical purposes. Finally, we have not analyzed the use of drugs that are not on our drug list but are accessible, on a case-by-case basis, to eligible veterans.
Implementing the Auditor General's recommendations will help us to better achieve our goal of supporting the health and well-being of our veterans in an efficient and effective manner.
I will now briefly discuss VAC's current or planned activity in relation to each of these priority areas.
First and foremost, we need to ensure that systematic evidence-based reviews support our decisions with regard to the drug benefit list. To determine which drug should be included on our list, we look to the expertise of the Canadian Agency for Drugs and Technology for Health. Once Health Canada has approved a drug for use in Canada, this independent agency relies on an advisory body to review clinical cost-effectiveness and patient evidence, and makes recommendations about listing it on provincially-based, publicly-funded drug plans.
A Veterans Affairs national pharmacist was hired last year and is working now with public health plan counterparts to identify best practices in formulary management. An enhanced drug benefit management team is now reviewing the program and developing a strengthened decision-making framework which will identify the types of evidence to be considered, when to consider them, and how they will be assessed to make formulary decisions.
We're also improving timely access to a pharmaceutical support program for those men and women being released from the Canadian Armed Forces. For example, last year in April we implemented changes to ensure that retiring sailors, soldiers, airmen and women continue to receive the same drug benefits from Veterans Affairs that they were receiving from the military based upon drug history and their eligibility for Veterans Affairs programming.
Veterans Affairs Canada will examine and assess the cost effectiveness of its drug list with its federal partners and the Pan-Canadian Pharmaceutical Alliance in order to improve cost effectiveness by May 2017.
The department will leverage its partnerships with Health Canada and other federal drug plans and jurisdictions, and consult with private industry to identify opportunities to implement cost-effective strategies for our program.
Further, Veterans Affairs Canada will regularly assess and review its drug benefits list and claims data. This analysis will inform program changes to help reduce the administrative burden for veterans and lower the costs for delivering the program.
With regard to marijuana for medical purposes, it would be worthwhile to review the context of providing access for marijuana for medical purposes to our veterans.
In 2001, Health Canada began providing controlled access to marijuana for medical purposes to Canadians. It controlled the adjudication of requests, product distribution and costs, as well as setting consumption limits. Supporting regulations outlined which health conditions marijuana could be approved for and which specialists could prescribe marijuana for medical use.
In the Canadian health care system, as I mentioned, the veteran's primary care physician is responsible to determine the appropriate health care treatments to meet his or her patient's needs.
In 2007, based on the approval of a senior manager, the department approved the payment for marijuana for medical purposes on an exceptional basis for one client for compassionate reasons. Starting in 2008, Veterans Affairs allowed for coverage of costs related to marijuana for medical purposes for eligible veterans who were approved by Health Canada. In fiscal year 2008-09, five clients were reimbursed, with expenditures in the order of $19,000. By 2013, these numbers rose to 112 approved clients with expenditures in the order of $400,000.
In 2014, Health Canada introduced regulatory changes that reduced its role to regulate and licence private producers. Restrictions were removed on the quantity of marijuana that could be authorized by physicians and the price was established by private producers licensed by Health Canada.
Based on these changes, Veterans Affairs Canada instituted a practice to approve requests from eligible veterans for up to 10 grams per day if authorized by their physician or health care practitioner, and if they are registered with a Health Canada licensed producer. The Veterans Affairs director general of health professionals, who is also Dr. Courchesne, reviews any requests that exceed the 10 grams per day. While six such requests were approved previously and now grandfathered, no amounts greater than 10 grams per day have been approved under the current guidelines.
Since 2014, the number of veterans using marijuana for medical purposes and the associated expenditures have increased significantly.
Earlier this year, the Minister of Veterans Affairs, the Hon. Kent Hehr, requested a departmental review to assess how we provide marijuana for medical purposes as a benefit to veterans.
This departmental review, including various consultations, was launched in order to assess the current approach to providing marijuana for medical purposes to veterans as a medication. We will be able to take stock of the review in the coming months.
Departmental representatives are consulting medical specialists, suppliers and veterans who have been prescribed medical marijuana in order to learn more about the issue. These consultations are intended to help devise an effective monitoring approach to ensure veterans' well-being.
With respect to monitoring drug utilization, I wish to assure veterans and their families that there are existing alerts in our drug benefits system, as well as at the pharmacy and provincial health care system levels. Nevertheless, we absolutely agree that we need a clearer approach to monitoring drug utilization and detecting trends.
We will ensure that our monitoring practices are systematically reviewed to ensure optimal efficiency, while taking advantage of the best practices of other departments and jurisdictions. Strengthened processes will include regular and documented reporting to our formulary review committee.
All changes to monitoring by VAC of medication use will respect the fact that veterans' health care is mainly the responsibility of their physicians or the accredited health professionals and the health care system.
Mr. Chairman, ladies and gentlemen, I want to assure you that the work is under way now to address our shortcomings, and we will have completely addressed each of the recommendations in the Auditor General's report by the spring of 2017.
Again, I wish to thank the Auditor General and his staff for their work and assistance in supporting the well-being of our veterans, and I thank you for your attention.
Merci.
View Brenda Shanahan Profile
Lib. (QC)
My question is for the deputy minister. I thank you for clarifying the role of Veterans Affairs in the administration of the drug benefits. Of course, our concern here is to assess not only the use of public funds, but also how those funds are used for the health and well-being of our citizens, particularly those who have served our country.
What I'm concerned about is how this problem came to blossom to this extent before the Auditor General made his report.
I would like to understand much more the role of the new hire you have, the pharmacist who has come in and whether this person is enough to do the job that he or she faces. I would also like to understand the development of the decision-making framework, and in particular why in your action plan the target dates are simply Q1, Q2, Q3. For a problem that has reached this degree of urgency, I want to know why those target dates are, frankly, loosey-goosey.
Walter Natynczyk
View Walter Natynczyk Profile
Walter Natynczyk
2016-06-09 9:04
Madame, thanks very much for the question.
I guess I would say that over time, in the effort to find efficiencies throughout the department and to structure.... There used to be a pharmaceutical team. That team was decentralized throughout the department and involved a reduction overall in the number of folks with expertise in pharmaceuticals within the department.
That's why last year we recreated this team and brought aboard the expertise to address and really create the leadership, the management, and the structure for us to put together a decision-making framework and move forward with a very deliberate plan, while also recognizing as we move forward that we're working in partnership with our key partners, the Canadian Armed Forces, the Department of National Defence, and Health Canada to make sure we are moving forward in lockstep with them.
I'll just ask whether Dr. Courchesne could expand on parts of your question.
Cyd Courchesne
View Cyd Courchesne Profile
Cyd Courchesne
2016-06-09 9:06
Thank you, sir.
As was mentioned, when I arrived at the department 18 months ago, there was no pharmacist. I saw that as a gap to the good functioning of the formulary review committee.
We hired a very experienced pharmacist from the Canadian Forces and started right away to put in some procedures to tighten the decision-making that was identified by the Auditor General. We had identified that even before the report came out. Ms. Vesterfelt sits on the Canadian drug review committee of the Canadian Agency for Drugs and Technology in Health. She also sits on several other committees that are all pan-provincial and federal. Her role mainly is to provide analysis and advice to the department, but also to the formulary review committee.
Everything that is presented now needs to be analyzed before it's presented for consideration, and we've established guiding principles. Before, I would say the decisions that were made at the formulary review committee were not made willy-nilly, but the process could have been more rigorous. One of the recommendations from the OAG noted that there was a lack of documentation. Now we have written analysis of items that are presented to the committee for consideration, and they are part now of the records of decisions of the committee so that we have a trail showing how we came to consider this. Among the guiding principles is the principle of cost-effectiveness, so an economic analysis is done for every new item that's brought to committee.
View Brenda Shanahan Profile
Lib. (QC)
Thank you very much, Doctor.
I don't see this as a problem with data collection, because the applications have to be made for the drugs and the payments have to be made, but indeed one of analysis.
I'll get back to the deadlines that you have in your action plan, and I think my colleagues will have further questions on that as well.
Why do we not have tighter deadlines in achieving that decision-making framework? It's at a decision-making point, and frankly it's too far out, I would venture to say.
Cyd Courchesne
View Cyd Courchesne Profile
Cyd Courchesne
2016-06-09 9:08
I think we gave those deadlines, because although we do have a new national pharmacist and we are hiring staff, implementing new procedures takes time.
I don't think we're going to wait until that date to get things done. Things are under way, and we've given ourselves until next May to complete them, knowing that implementing change can take time to organize, especially when I have just the one pharmacist working with new staff who have been hired to support the drug formulary.
Cyd Courchesne
View Cyd Courchesne Profile
Cyd Courchesne
2016-06-09 9:25
I want to say upfront, and I don't want this to sound like an excuse, but we are not a health care system. We don't prescribe. We don't provide the care directly. We manage a drug formulary. We make available and accessible the drugs that our population needs, and at the best price for the government.
There are alerts in the system. I don't want to leave the impression that everything is reimbursed and that there are no alerts. What was not happening in 2004 was that we were not asking for regular reports of Blue Cross Medavie, who administer the program for us, to give us those reports. But they do send us reports of people who are exceeding the limits, and we do scrutinize those send them back to their care providers. We send letters to their care providers saying, “Did you know that we've been asked for two prescriptions?”
But things have changed in Canada with pharmacy. Pharmacists and pharmacies in every province are all connected now. There used to be a time when you could go doctor shopping for prescriptions and to three different pharmacies and nobody would know. Well, now they know. Now these alerts for drug interactions and for shopping around are done at the point of service, so we don't need to monitor that because it happens right there. If a pharmacist sees that someone went around somewhere else, at another Shoppers Drug Mart, to ask for a prescription for benzodiazepines, they will contact that pharmacist and the prescriber and it will stop right there.
It's the same for drug interactions. Because we are not the care providers, we don't monitor those. The pharmacists will say right away, “This drug is not good to take with this drug. You're taking this for your hypertension and this drug should not be prescribed to you.” Then they contact the prescriber immediately.
There are redundancies in the system and we don't need to be monitoring that now.
View Paul Lefebvre Profile
Lib. (ON)
View Paul Lefebvre Profile
2016-06-09 10:09
I want to ask a few questions about the formulary review committee and who sits on it, because from the Auditor General's report they are responsible for reviewing, maintaining, and revising its drug benefits program, as well as making recommendations and providing guidance to its senior management.
Who sits on this committee, and now that we're talking about evidence-based decisions, how is that a change from what was being doing before? I know that you guys are reviewing it, so what was occurring on this committee before, and how has that changed now that you guys are doing your review?
Walter Natynczyk
View Walter Natynczyk Profile
Walter Natynczyk
2016-06-09 10:10
I will start and then I'll ask Dr. Courchesne to wade in.
The formulary review committee comprises health professionals from our own department. It includes Dr. Courchesne and our national pharmaceutical advisor, as well as the pharmacists and the medical consultants from Medavie Blue Cross. In addition, we have our service delivery specialists from Michel Doiron's team, and we also have members of the Canadian Armed Forces on that team.
View Paul Lefebvre Profile
Lib. (ON)
View Paul Lefebvre Profile
2016-06-09 10:10
Has that always been the case, because Madame Courchesne stated at the beginning that there were no pharmacists involved? Can you expand on that?
Walter Natynczyk
View Walter Natynczyk Profile
Walter Natynczyk
2016-06-09 10:11
Again, what we've done is to recreate leadership in pharmaceutical advice in the department that had been lacking for a few years. While we had pharmacists, they weren't Veterans Affairs pharmacists. They were from Blue Cross Medavie and others.
Now we actually have recreated the critical mass in the core of decision-making inside the department, so we now have some structure to develop a strategy, develop a plan, and capture it in a very rigorous way, so that we know how the decisions are made; when they are made; and again, going back to the Auditor General's point, when we're actually going to achieve these things to get it done in a timely fashion.
Cyd.
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 15:40
Thank you very much, Mr. Chair, and to the committee, thanks for inviting us to join you today.
My name is Perry Eisenschmid. I'm CEO of the Canadian Pharmacists Association. I am joined by my colleague Phil Emberley, CPhA's director of professional affairs, who is also a practising pharmacist here in Ottawa.
We're here today on behalf of Canada's 40,000 pharmacists. Every day pharmacists see the impact on patients when they can't afford their medications. Not only do they counsel patients to help them get the most from their prescriptions, but pharmacists are the ones who must deliver the devastating news that a patient isn't covered.
Pharmacists are, quite simply, the health care professionals closest to this issue. It's pharmacists' proximity to some patients' daily struggle with inadequate prescription drug coverage and the negative impact on patients that drives our efforts to inform the conversation on national pharmacare.
Our primary concern is ensuring that patients have access to medically necessary medications that are right for them. Above all, we must prioritize health outcomes and patient needs. Investing in the right drugs and services early on is not only good for patients, it is also necessary for the sustainability of our health care system.
From CPhA's perspective, the status quo is not acceptable. Let me be clear: CPhA absolutely supports a plan for pan-Canadian pharmacare in which the federal government has a role in ensuring that all Canadians have access to medically necessary medications, regardless of income.
CPhA believes any future pan-Canadian pharmacare plan must address four key priorities: first, ensuring all Canadians have access to the medications they need; second, protecting Canadians from undue financial hardship; third, ensuring patient access to a stable supply of clinically effective and cost-effective drugs; and fourth, providing access to the full range of pharmacy services.
We have two main messages here today to convey to the committee. The first is that the committee should consider both incremental and long-term solutions. The second is the importance of the word “care” as an element of pharmacare.
This committee has heard testimony from witnesses with different ideas about how best to help those Canadians who don't have coverage or whose insurance doesn't go far enough for them to make ends meet. We all agree that Canada can provide better access to prescription drugs. The real question is on how we get there.
Broadly speaking, the discussion has been framed around an assumption that there are only two ways we can approach this issue: create a brand new national pharmacare system, or build on our existing system to make it more equitable and efficient. It's our position that this need not be the case. These choices aren't mutually exclusive.
What we do know is that Canadians don't want their friends, their family, or their neighbours to have to choose between paying the rent and paying for medications. We also agree that moving towards a new national pharmacare system that could replace all public and private plans would take time to develop and implement. In the meantime, many Canadians would still have to go without the medication they need.
That's why we're recommending both immediate steps to improve Canadians' access to medication as well as considerations for a longer-term approach. Our research provides the committee with various practical and affordable options to enhance the current system that could immediately help those Canadians who are falling through the cracks.
In the long term it's important to recognize that all potential models have strengths and potential drawbacks. Regardless of the approach Canada pursues, we should be fully aware of the potential risks. This is especially important as they relate to access and achieving optimal health outcomes, and we should identify ways to mitigate those risks. At the end of the day, we have to ensure that pharmacists have access to medications to provide their patients with the optimal drug therapy to achieve the best health outcome.
That brings me to our second recommendation, which speaks to the care element of pharmacare. While managing costs is essential, it's only a piece of the puzzle. An effective pharmacare system must not only address gaps in patient coverage but also address gaps in access to services that support safe and effective drug therapy for patients. As medication experts, pharmacists know there are important considerations for the functioning of any future system, public or private, to ensure that Canadians are receiving the maximum health benefit from their prescription drugs.
No matter what your perspective is on this issue, the fact is that drugs represent only 15.7% of total health spending in Canada. The right prescription, taken appropriately, is a low-cost, high-value intervention that improves health outcomes, especially when compared with costly alternatives such as surgery and visits to the emergency room.
Prescriptions drugs are a powerful, sophisticated tool. They can save lives when used correctly, but improper use can lead to ill health or even death. Containing and controlling drug costs is a key piece of any pharmacare plan, but now is the time for bigger and bolder thinking. Wouldn't it be better to make an investment to ensure first that the right medication is available to all Canadians, and second, that our citizens have easy access to effective medication management and oversight?
A long-term plan for pharmacare has to focus on the health of Canadians over their entire life cycle, not only when they're at the counter paying for drugs. A holistic focus that recognizes the value of appropriate drug therapy can help us realize savings for the broader health system while delivering sustainable patient-centred care. That means ensuring that Canadians have access to the drugs that make them healthier, and that means that Canadians have access to the advice and oversight of the undisputed experts in medications. The 40,000 pharmacists who work in communities and hospitals across this country have spent many years at school and on the job focusing exclusively on understanding how and when medications work, and when they don't.
In recent years, pharmacists' scope of practice has grown by leaps and bounds, delivering value for patients and payers alike. Expanded pharmacy services extend beyond dispensing of prescription drugs and capitalize on pharmacists' accessibility and expertise in providing much-needed oversight to our system of pharmaceutical care.
Take, for example, the medication reviews that pharmacists provide. These services help ensure appropriate use and enhance adherence, two major drivers of optimal health outcomes and drug plan costs. In some cases we're talking about reducing the use of medications, and in other cases it means expanding someone's drug regimen.
Here's a practical example. Most seniors over 65 take at least five drugs. With those aged 85 plus, it's ten or more at once. Let me tell you, this is a challenge that the profession is tackling head-on. We know of one 77-year-old woman in Ottawa who was taking no less than 32 different drugs, but a pharmacist was able to help her get that number down safely to 17. With medication reviews, pharmacists can collaborate with patients and prescribers to identify optimal drug therapies to ensure Canadians are on the right medications.
Unfortunately, these services aren't available to all Canadians. It's a real challenge that pharmacist services are covered differently across the country, some more comprehensively than others. A pharmacare program that recognizes the role of pharmacist services, such as medication reviews, would address many of the concerns this committee has heard about the need to go beyond simply paying for drugs and instead address the care aspect of pharmacare.
It's not only medication reviews; there are benefits to expanding pharmacy services in other areas as well. A study in Ontario found that pharmacist care can deliver a meaningful reduction in blood pressure, one that lowers the risk of stroke by about 30%. As well, consider how pharmacists are assisting people in their efforts to stop smoking. Recent numbers from the pharmacy smoking cessation program in Ontario show that 29% of participants in the program were still cigarette-free after one year. Consider the flue shot, especially for those who are considered at high risk for influenza complications: a recent survey found that 28% of Canadians in this group would not have been immunized if not for the convenience of pharmacy-based vaccinations.
The final thought we would like to leave with the committee is that the goal of any pan-Canadian pharmacare model, both in the short term and the longer term, shouldn't only be about reducing costs. It should be about providing optimal care. Getting value for each health care dollar is a principle that should be adopted across the entire health care system, not just for drug costs. We need to acknowledge that spending on drugs is an investment in the health of Canadians. We also need to acknowledge that the rush to achieve short-term savings can sometimes lead to longer-term costs, both in terms of health care expenditure and quality of life.
We know the committee has a complex task before them. There are no simple answers or solutions. Nevertheless, we encourage the committee to consider both short-term and longer-term approaches. Equally important, we encourage the committee to ensure the care in pharmacare. Including pharmacist services is an essential element of any pan-Canadian plan.
Thank you very much. We would be pleased to answer any questions.
View Darshan Singh Kang Profile
Ind. (AB)
Thank you.
My second question is to the Canadian Pharmacists Association.
Do your members generally receive compensation from pharmaceutical manufacturers for prescribing brand name medicines when an equally effective generic drug is available?
Second, how would this practice be affected by a national pharmacare strategy?
Philip Emberley
View Philip Emberley Profile
Philip Emberley
2016-05-16 16:17
Thank you for the question.
No, pharmacists are not compensated by a pharma company for dispensing brand name medication. They're required to dispense the lowest-cost drug for a specific molecule. That's part of their code of ethics.
As to the second part of your question, this will not change with a national pharmacare plan.
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-16 16:19
Thank you, Mr. Chair. You're doing a fine job today.
One of the things I'm concerned about is that we are talking about increasing access to pharmaceuticals. I think we should be aware that without controls, it could be a dangerous and costly thing. In Canada we have challenges with over-prescription and with prescription drug abuse. I'd like your opinion on these questions.
We've heard from different witnesses that up to 40% of seniors are on inappropriate medication. Mr. Eisenschmid, I think you mentioned the role pharmacists could play in catching this. Mr. Emberley, I think you worked for the British Columbia government, and you are an expert on the optimal use of medication.
Have you guys ever run the numbers on how much money could be saved by the public system if medication were more properly prescribed to patients?
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:21
I've never seen an analysis of that. It's patient by patient, but I think there are significant potential savings.
That goes back to the theme of my presentation. Making sure that all Canadians have appropriate coverage and that their drugs are covered by public or private plans is a great thing. The end goal, however, is not to dispense more medications; rather, it's to manage medication by professionals to make sure the patient is getting the appropriate care. We think pharmacists, being in 10,000 locations that are often open 24/7, are the perfect first point of contact and are the experts required to make sure medication is being prescribed appropriately and not excessively.
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-16 16:21
I think that's important when you're looking at the scope of your practice, because 40% of the time we're getting it wrong with elderly people. How dangerous is that to the system?
I'm also concerned about the stats on opioid abuse. I think Canadians, per capita, are the number one users of opioids. You wonder why Canadians need more opioids than anybody else in the world.
What role could you perform as pharmacists, and how would that affect your relationship with medical doctors?
I had a neighbour in Oshawa who was a pharmacist, and he told me about catching medical contradictions in different medications. I can see how your role could be expanded. It could be very cost-effective. How would your relationship with the medical profession have to change?
Philip Emberley
View Philip Emberley Profile
Philip Emberley
2016-05-16 16:23
That's a great question, and I have to say this is not a problem that belongs to doctors. It's not a problem that belongs to nurses or to pharmacists. I think what it speaks to is that we need to have a team-based approach. It's an approach that leverages the knowledge and skills each professional brings.
I've been a pharmacist for 28 years, and I think in the last 10 years, as a profession, we have become much closer to prescribers and working with prescribers in order to optimize care. When we mention taking people off medication, it's not about that. It's about finding the optimal mix of medications that people need.
I will mention that I see seniors come in, and some of them are on so many medications they lose track of what's what and what this medication is for and what that medication is for. It becomes sometimes a toxic mix. I think there's a valuable role for pharmacists there in pulling things apart, making a recommendation where it's appropriate, and prescribing or saying, “Look, we think there's a problem here that could be addressed.” This is how we can move forward to optimize the care of the patient.
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-16 16:24
When you mention care versus cost, I remember that a few years ago Deb Matthews was concerned with the federal government because she wanted to see more opioids, the tamper-resistant type, brought in instead of the generic and easily diverted type of opioids. I believe she quoted 85% of the population of one of our first nations communities were addicted to opioids.
The concern, I think, is that it's kind of an easy thing to do, write a prescription. In some situations, how could a pharmacist work into a system to make it more appropriate, as you mentioned, with the right medication available for Canadians? How could we look at your role and your scope of practice and the importance of pharmacare with this study?
You mentioned that in some provinces you're not fully covered for giving out advice. How could we look at that to improve the entire system and the team that's involved in the entire system?
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:25
I can start, and then Phil can embellish.
One of the biggest impediments, and many people don't realize this, is that pharmacists' compensation for those kinds of expanded services is pooled, unfortunately, under the drug plan budgets of the provincial governments. With all of this focus on cost containment and more cost containment, the unintended consequence is that provincial coffers are less able to fund the important expanded services we're talking about here.
One of the things we would put on the table for consideration is if the federal government is getting more financially involved through a national pharmacare program or other means, we need to somehow start funding those services outside of the provincial drug plan budgets, which we know are continually constrained, to make sure the medications that are being prescribed are being managed effectively.
When there is over-prescription, pharmacists see this first-hand. They see the patients wandering in with the unintended consequences of inappropriate prescribing. They are there first-hand, and if they're empowered through regulation and compensated appropriately, they would be able to step in and make the appropriate intervention.
View Colin Carrie Profile
CPC (ON)
View Colin Carrie Profile
2016-05-16 16:26
It seems that Canadian professionals are well versed in prescribing, but it's the unprescribing.... Is this a role that pharmacists could be partnering with medical doctors on? With the opioid crisis and the huge numbers rolling through Canadians' blood systems every single year, is there any reason why we're number one in the world for this type of product? I think 25% of users, when they start on these prescribed opioids, turn to addiction.
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:26
I think some of these partnerships do exist today. They can and should be expanded. Your point is physicians typically prescribe a medication, and it's the pharmacists who see the patient on a regular basis as they refill those prescriptions. They are in the best position to make an appropriate intervention, I would argue.
Philip Emberley
View Philip Emberley Profile
Philip Emberley
2016-05-16 16:27
Yes, it's true, we do see patients getting into trouble, and you can't strictly just stop a medication. In a lot of cases you need a systematic way of helping them to reduce.
I think a big part of what pharmacists also do, because they see their patients so often, is get a sense of when patients are getting into trouble. There are visible cues with, for example, patients refilling their medications early. You get a sense that people may be getting into trouble. I think an important role pharmacists play is to let members of the team become aware of those situations so they can intervene and provide addiction management services.
View Ramez Ayoub Profile
Lib. (QC)
Thank you, Mr. Chair.
I also want to thank the witnesses for their insightful presentations and the extremely important information they are contributing to this study.
I have not yet had time to introduce myself. I am the member of Parliament for Thérèse-De Blainville, located north of Montreal, in Quebec.
I will first mostly address the Canadian Pharmacists Association representatives.
Mr. Eisenschmid, you mentioned several times that we shouldn't focus too much on the cost of medications. Whether we like it or not, the cost of research is reflected in the cost of medications. According to a cost estimate for a Canada-wide pharmacare system, the costs would be high.
I would like to hear your thoughts on the fact that retail pharmacies sometimes raise the prices of prescription drugs. I have here figures going back to 2012-2013. That profit margin accounted for 4.2% of the total costs paid by public insurance plans for prescription drugs, or about $323 million. So public insurance plans put a cap on the profit margin refund for prescription medications.
Why are retail pharmacies raising the price of prescription drugs? Do private plans also set a cap on profit margin refunds?
How do you think we should address the issue of caps in terms of profit margins for prescription drugs if a Canada-wide pharmacare system was instituted?
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:38
We represent the pharmacists, who are typically on hourly wages or are salaried employees. That question is probably more for the owners of the retail chains and what they're doing with their business operations.
View Ramez Ayoub Profile
Lib. (QC)
All right. I'm a little bit surprised, but it's okay.
Since the first provincial pharmacare plans were implemented in the 1970s, generic drug companies have given pharmacies discounts. Generic drugs have also become an important part of pharmacies' revenues. However, over the past few years, the lower refund rates for generic drugs through public plans have reduced the discounts generic drug makers give to pharmacists.
Are generic drug companies still giving pharmacies those kinds of discounts? If so, what percentage of their revenues do those discounts generally account for? How much of those discounts are passed on to clients by pharmacies?
Philip Emberley
View Philip Emberley Profile
Philip Emberley
2016-05-16 16:39
A number of provinces in Canada do still allow rebates to pharmacies. A number have put in controls. For example, Ontario does not allow rebates for generic companies.
With a number of the changes that have been made to generic drug pricing across Canada, these rebates have gone down considerably. We feel it's very important for a lot of the services we've described that pharmacists do to be adequately funded. I know these rebates have decreased in recent times.
View Ramez Ayoub Profile
Lib. (QC)
My second question was on whether those kinds of rebates are given back to the customer. Do they get a a percentage of rebates, or do all the rebates go to the pharmacists? Do you have that kind of information?
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:40
I think the undercurrent of your question is with regard to compensation models both for the business of pharmacy and for pharmacists themselves. I think you're bringing up a very good point, which is that right now the compensation for pharmacies and pharmacists is not aligned with the services and the value they are providing. There's no question that right now pharmacies rely a lot on either rebates or allowances in certain provinces to fund their overall operations, because, they would argue, they are not getting appropriately compensated for direct interventions like medication adherence.
We would all agree that we ultimately need a change in the compensation structure for pharmacies and pharmacists to ensure that there's appropriate payment for the appropriate service and that pharmacies don't have to rely on earning a margin on the drugs they dispense to cover other services. We would agree with that.
View Ramez Ayoub Profile
Lib. (QC)
Most of the time, pharmacists own or operate their own pharmacy. However, as you said, that's not always the case. Some pharmacists are paid an hourly wage. That's a different matter, if I understand correctly.
View Rachael Harder Profile
CPC (AB)
View Rachael Harder Profile
2016-05-16 16:42
Thank you.
My question is directed to you, Mr. Eisenschmid.
Here at committee we've heard from a number of groups of witnesses—academics and industry, individuals and representatives—and many of them have pointed a finger at pharmacists for higher drug prices. The Pharmacare 2020 academics even went so far as to question the credibility of your organization to conduct research and picked on some of the statistics you brought forward, indicating that your conclusions were motivated by profit margins rather than other alternatives.
I can imagine these allegations are familiar to you. I'm actually just looking for you to comment on those allegations today.
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:43
We were very disappointed by those allegations and that they struck at the credibility of the Canadian Pharmacists Association. We thought they were unfounded. In fact, we've had follow-up conversations with them to try to understand the rationale behind it.
The particular research study that I think they are critical of didn't have a particular perspective. It was an economic analysis conducted by an economic researcher who was trying to basically put some facts on the table and to update Professor Morgan's model with updated information, because he was using the exchange rates from 2013. We knew the world had changed a lot since he had first put his model together, and we commissioned a study to look not just at his model but at alternative models, including the Quebec model and the P.E.I. model, for example.
We just wanted to get some facts on the table. It wasn't a position piece. We didn't make a recommendation. We just wanted to make sure there was appropriate information to guide decision-makers.
View John Oliver Profile
Lib. (ON)
View John Oliver Profile
2016-05-16 16:49
My second question deals with the report “Pharmacare Costing in Canada”. In there, the statement was made that a national pharmacare program would result in a negative impact on the ability of pharmacists to serve patients. When I asked the author of the report what that was about, he explained that in other jurisdictions where the public systems don't pay pharmacists as well as the private systems, pharmacists hold their services back.
I have to ask you this question as the leader of your association. If we move to a national pharmacare program, does that really mean you'd be directing pharmacists across Canada to withhold their services, rather than negotiating with the government and coming to a fair and honest price payment for their services?
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:49
Of course not.
Again, I think we're mixing associations here. We represent the pharmacists who work typically on an hourly wage or on a salary basis in pharmacies. They're not negotiating with governments on their particular working conditions or compensation.
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:50
That was the researcher's perspective.
View John Oliver Profile
Lib. (ON)
View John Oliver Profile
2016-05-16 16:51
There are solutions, then, to pharmacists being kept well paid and continuing to provide services for Canadians. There are solutions to how we're going to pay for these services.
Generally you would support, then, the statement that a closed formulary model does not result in poorer health care outcomes for Canadians.
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:51
It doesn't have to.
Again, we're not for or against a fully public-paid program. We wanted to put some facts on the table. Any national pharmacare program can work effectively as long as it has the patient's interest in mind, ultimately, and not just cost savings.
View John Oliver Profile
Lib. (ON)
View John Oliver Profile
2016-05-16 16:52
I just want to say that your documents come across as being very negatively directed toward a national pharmacare system. Whether you've intended it or not, it looks as though you are against it, which is difficult for your association and your membership, in my view.
View Rachael Harder Profile
CPC (AB)
View Rachael Harder Profile
2016-05-16 16:56
Okay. Here we go.
What costs do you think would be associated with offering the full range of pharmacists' services that are offered right now through private care if we were to move that into public care? You said $6.6 billion. Do you think that's fully comprehensive?
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:57
It's not a matter of what I think. It was the consultant who is the expert in the field who thought that was the appropriate price, and we have no reason to question it.
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:57
That wasn't for pharmacists' services. There's a separate conversation around pharmacists' services, which I alluded to. They have not been costed. That's the medication management and the medication adherence.
View Rachael Harder Profile
CPC (AB)
View Rachael Harder Profile
2016-05-16 16:57
Right. We would have to account for that in a pharmacare program, would we not?
Perry Eisenschmid
View Perry Eisenschmid Profile
Perry Eisenschmid
2016-05-16 16:57
You don't have to. We highly recommend that you do. There's not much point in having a national pharmacare program if you're not ensuring that people are using medications appropriately.
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