Dr. Danielle Martin asks the Senate for National Pharmacare

April 10, 2014

On Thursday, Hon. James S. Cowan presented a question to the Canadian senate on behalf of Dr. Danielle Martin. Dr. Martin presented evidence, based on her experience as a healthcare provider, of the need for a national pharmaceutical strategy. This is the transcript of Dr. Martin's question and the subsequent discussion.

National Pharmacare

Hon. James S. Cowan (Leader of the Opposition): Honourable senators, my question today comes from Dr. Danielle Martin, a family physician in Toronto. Dr. Martin was the founding board chair of Canadian Doctors for Medicare and is currently Vice President, Medical Affairs and Health System Solutions at Women's College Hospital in Toronto. Colleagues will know that her recent presentation to the U.S. Senate has received enormous attention and support in Canada.

Dr. Martin's question is as follows:

As a family physician working in the trenches of Canadian health care, I often see patients who do not take their medications because they cannot afford them. One of my patients is a taxi driver whose South Asian heritage and sedentary job have predisposed him to his current medical problems of diabetes and high blood pressure. In spite of working long shifts and being careful in his spending, he cannot support his family and pay for his medically necessary medications. I worry, as he does, about the complications he may experience in the coming decades, some of which could be devastating such as heart attacks, strokes, and blindness, because he cannot both feed his family and buy his needed medicine.

Stories like this are all too common across Canada. A recent study by Law and colleagues found that 1 in 10 Canadians does not fill a prescription or take medication as prescribed because of concerns about costs. This turns out not only to be an issue that adversely affects self-employed and precariously employed Canadians, but also an issue of profound regional inequity that should be of deep interest to our federal government. A patient with congestive heart failure might face out-of-pocket costs for prescriptions varying between $74 and $1,332, depending on which province she calls home.

At the time that our cherished Medicare system was developed in the 1950s and 1960s, and even into the 1980s with the passage of the Canada Health Act, the bulk of health care was provided by physicians and in hospitals. Today our systems are rapidly transforming to meet the needs of an aging population that is living longer with chronic disease. Indeed, we know that 2/3 of Canadians over the age of 65 take 5 or more medications. The needs of Canada's aging population cannot possibly be met without appropriate access to life-saving medications in the community. By far the most administratively simple and equitable solution would be to expand our public insurance plans to include coverage of medically necessary medications alongside those things currently mandated under the Canada Health Act.

Furthermore, pharmaceutical costs are rapidly increasing across both public and private insurance plans in Canada. National Pharmacare, with a national formulary and bulk buying of medications, could reduce costs by between 10 and 42 per cent, saving up to $10.7 billion annually.

The 2003-2004 Health Accords called for a National Pharmaceutical Strategy that would represent baby steps toward this vision, but the NPS died on the vine and the Health Accord has not been renewed.

My question is: Will this government put National Pharmacare on the agenda?

Hon. Claude Carignan (Leader of the Government): I would like to thank the Honourable Senator Cowan for passing on Dr. Martin's question.

We are committed to offering a strong health care system that is funded by the government and based on the Canada Health Act. We are currently investing record amounts in the provincial and territorial health care systems. In fact, we will give the provinces and territories the highest health transfers in the history of Canada. This unprecedented funding will reach $40 billion by the end of the decade. It will make the system more stable and predictable.

We are committed to working with the provinces on innovative ideas and improving health care models. Our government will never balance the budget on the backs of the provinces and territories. Since we came to power, health transfers have increased by nearly 50 per cent.

To respond more specifically to Dr. Martin's question, here is a summary of the facts. It is important to work with the provinces. The federal government has allocated a great deal of money in the form of provincial transfers. When it comes to the delivery of health care programs, it is up to the provinces to set up programs that will meet the objectives of the Canada Health Act.

Senator Cowan: Thank you for the response, Senator Carignan, but I would remind you that Dr. Martin's question was specifically in relation to a national pharmaceutical strategy. If your government is not prepared to commit to the development of a national pharmaceutical strategy by itself, will it commit to working with the provinces to develop such a strategy?

Senator Carignan: As I mentioned, we are committed to working with the provinces on innovative ideas and improving health care models.

Hon. Art Eggleton: If I may, honourable senators, because the leader talked a lot about the expenses involved, it's worth noting what Dr. Martin says here and what we heard in testimony before the Social Affairs Committee dealing with the health accord. There could be substantial savings of taxpayers' dollars and money in the health care system by going to a national pharmacare program that would produce a national formulary instead of one for each of the provinces; and it would bring in more bulk buying of medication. This could mean a substantial saving in costs.

She particularly asked you about a national pharmacare program. I know you support that because one of the committee's recommendations was adopted unanimously in this chamber, with no dissenting voice whatsoever. Recommendation No. 28 states:

That the federal government work with the provinces and territories to develop a national pharmacare program based on the principles of universal and equitable access for all Canadians; improved safety and appropriate use; cost controls to ensure value for money and sustainability; including a national catastrophic drug-coverage program and a national formulary.

That was supported unanimously in the Senate, so I take it, senator, that you would be willing to now advance this idea to the government.

Senator Carignan: As I said, our government provides the provinces and territories with the tools they need to deliver health care services in their respective regions. We announced a long- term stable funding arrangement that will see transfers reach an historic level of $40 billion by 2020.

Our government has also expressed an interest in participating in the bulk buying of medication program that the provinces are working on. We will continue to work with the provinces and territories to find innovative ways to meet their needs with respect to the provision of health care services.

Senator Eggleton: Please bear in mind, Senator Carignan, that when it comes to the provision of health care services, you talk about the provinces, but the federal government is also a provider of health care services, for example, to Aboriginal communities, the Armed Forces, the RCMP, government employees, et cetera. In fact, when it comes to expenditures on health care service provisions, we rank in the middle of the provinces. We're the fifth largest in the country. Do we not have an obligation as a provider to be with the provinces in the development of these programs?

Senator Carignan: My answer is the same: we are committed to working with the provinces.


For more information:
Katie Raso, Canadian Doctors for Medicare
T: 416-351-3300
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