Debates of May 6th, 2024

Second reading

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, it is always a pleasure and an honour to rise in this most honourable of houses. This evening, I will be sharing my time with the hon. member for Milton.

Before beginning my formal remarks, I would say that, when I think of Bill C-64, an act respecting pharmacare, and the implementation of a piece of legislation that would obviously strengthen our health care system and the delivery of it, I would not be remiss to say that this is not only an excellent piece of legislation that would help Canadians, specifically those in need of contraceptives and the nearly 4 million Canadians dealing with diabetes, but also another sign of our government's strengthening of our social fabric and social system. It would build on other programs that we have implemented, including the Canada child benefit, which we know has lifted hundreds of thousands of children out of poverty and helps families every month. In my riding, nearly $80 million or $90 million a year arrives, tax-free and monthly. We know that the Canada workers benefit, which helps our working poor and those trying to make ends meet and get ahead, helps literally millions of Canadians. We introduced middle-income class tax cuts in 2015, raised the basic personal exemption amount and accelerated the pace. We know those are delivering $10 billion annually in tax relief to Canadians, as we speak.

More recently, the Canadian dental care program, which thousands of dentists have signed on for, is benefiting individuals in my riding of Vaughan—Woodbridge. In fact, in the heart of my riding at Weston Road and Rutherford Road, there is a big billboard, put up by one of the dentists in the community, stating that they welcome patients who are eligible and approved for the Canadian dental care program. This program is already helping thousands of residents in the riding of Vaughan—Woodbridge and in the city of Vaughan. The work that we are doing on Bill C-64 would continue to build on that work of helping Canadians to receive the services they need, which, in this case, is to improve health care.

With respect to health care, I was at the announcement with the Prime Minister and the Premier of Ontario, Doug Ford, when we announced a $3.1-billion bilateral agreement of health care funding for more nurses, more doctors and more health teams across the province of Ontario, a part of the $200 billion the federal government is committing to health care across this beautiful country.

I appreciate the opportunity to speak to the important work under way through Bill C-64 with regard to the Canadian drug agency, or CDA. The CDA is one of the key features contained in Bill C-64. On December 18, 2023, the Government of Canada announced the establishment of the CDA, which is to be built from the existing Canadian Agency for Drugs and Technologies in Health, in partnership with provinces and territories. The government committed $89.5 million over five years to establish the CDA, providing dedicated leadership and coordination to make Canada's drug system more sustainable and better prepared for the future. This investment would be in addition to the existing funding of $34 million per year to support CADTH's current work.

The CDA would build on CADTH's existing mandate and work, expanding to include new functions such as appropriate prescribing and use, data and analytics, and system coordination. Developing the CDA recognizes the organization's reputation of excellence, performance and results. It also ensures that we would be adding value to the system by building on what is already working with the CADTH.

Let me say a bit about how we got to this important milestone. Canada's pharmaceutical system evolves slowly over time, often responding to address new challenges as they developed. When medicare was first introduced in Canada in 1966, drugs used outside hospitals were primarily inexpensive medicines for common conditions. A growing number of specialized drugs are now helping to cure or manage a range of conditions, and rising rates of chronic disease have made prescription drugs a central part of our current health care system.

New pharmaceutical system organizations and functions have been created to manage the access and use of prescription drugs, but this has happened in an ad hoc and fragmented manner. Canada currently has over 100 public drug plans and 100,000 private drug plans, creating a patchwork of access and coverage for Canadians. Despite improvements in recent years, high prices and the patchwork of drug coverage leave many people in Canada facing barriers to access the prescription drugs they need when they need them.

Stakeholders in landmark reports have underscored the need for federal leadership in addressing these gaps. In recognition of concerns about the sustainability of the Canadian pharmaceutical system, budget 2019 provided $35 million over four years to establish the Canadian Drug Agency Transition Office, or CDATO, to provide dedicated capacity and leadership to work with provinces, territories and key partners on a vision, mandate and plan to establish the CDA. Since its establishment in 2021, the CDATO has conducted extensive engagement and analysis, holding over 400 meetings and round tables with a diverse range of stakeholders to understand the gaps and challenges in the pharmaceutical system and obtain advice on how to make improvements.

Extensive engagement has taken place with provinces, territories, patients, pan-Canadian health care organizations, health care professionals, industry insurers and international partners. Based on this engagement analysis, the CDA will build on CADTH's existing mandate and functions, expanding to include new work streams that better support patients and system sustainability, namely improving the appropriate prescribing and use of medications, increasing pan-Canadian data collection, expanding access to drug and treatment information, and reducing drug system duplication and lack of coordination.

Through our engagement, we learned that the appropriate prescribing and use of medications is a clear priority for many stakeholders. This is about ensuring that patients are prescribed the safest and most effective treatment for their outcomes and conditions. Each year, $419 million is spent on potentially harmful medications for seniors, and $1.4 billion is spent to treat harmful effects. However, there is no unified approach to guide and inform prescribers or patients on appropriate prescribing and use.

To date, we have launched an appropriate use of advisory committee involving patients, clinicians, experts and leading organizations in the field. The committee is advising on the development of a pan-Canadian appropriate prescribing and use strategy. Later this spring, the committee will issue its final report that will inform the work of the CDA to create and implement an appropriate prescribing and use program in collaboration with partners.

Stakeholders have also pointed to the need to improve pharmaceutical data and analytics to better understand the impact of drug treatments. However, there is limited ability to access, link or share drug data, which is siloed in different sources, such as hospitals, private drug plans, physicians' offices and jurisdictions. This fragmentation limits our ability to understand a drug or treatment's use pattern and effectiveness, including how it performs once it is being used by patients in the real world and how it compares to other available treatments.

We are working with several organizations in the health data field, such as CADTH, the Canadian Institute for Health Information, Canada Health Infoway, Health Data Research Network Canada and the pan-Canadian Pharmaceutical Alliance, to improve access to and use pharmaceutical data. Stakeholders also consistently emphasize the importance of incorporating patient equity and lived experience in the CDA's developments and operations. They noted that patient engagement in the pharmaceutical system is limited. Incorporating patient perspectives through engagement and governance were key recommendations for an organization that is transparent, accountable and meaningfully involves those who need it most, the patients.

We have also heard of significant challenges regarding system coordination. During the course of our engagements, most stakeholders highlighted at least one coordination-related issue that they face. Challenges include a lack of information sharing, confusion about roles or responsibilities or limitations to meaningful engagement. Our pharmaceutical ecosystem is managed by multiple organizations that have different purposes, priorities and areas of jurisdiction.

There is one organization mandated to convene players, focus the agenda, ensure efficiency and enhance collaboration. Because of this, there are both gaps and duplication in the system. Building from CADTH is a significant step in promoting system alignment. CADTH is a highly reputable organization with strong leadership and a shared federal, provincial, territorial governance model that works.

Through CDATO and CADTH's extensive partnerships and building on the work to date, we will build a CDA that is well positioned to convene key players and focus on promoting better outcomes for patients. We will develop an organization that has the capacity to adapt to the ever-changing pharmaceutical landscape. Our work to date reflects the significant input provided by stakeholders over the last three years. It also highlights a strong interest across the system to make meaningful improvements.

The CDA will support pharmaceutical system modernization in Canada and lay a strong foundation for future growth, including by providing the capacity to support the commitments outlined in Bill C-64, which is now before the House. The CDA will assume a leading role in the pharmaceutical system to ensure Canadians have better health outcomes and are well informed about the medications that they need now and into the future.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, by now, Canadians are used to broken promises from the Liberals. In 2015, members will remember that they were going to make housing affordable, and now housing prices, mortgages and rents have doubled. They also promised the last election under first-past-the-post, but maybe not.

However, on pharmacare, I think maybe Canadians need a history lesson because the Liberals have been promising to do pharmacare since 1992, and they have never done it. The bill before us is also not pharmacare. It is a plan to get a plan to maybe do pharmacare. It is not going to be national. Quebec has already said that it is not going to participate.

Could the member just admit that this is an attempt to pacify the NDP to make sure that it does not pull its support and trigger an election?

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, since 2015, when I was first elected to this most honourable House, my focus has been on helping and ensuring the success of the residents of my riding of Vaughan—Woodbridge and of all Canadians, and that is what we continue to do. We continue to implement policies that strengthen our social system, including what is contained in Bill C-64, specifically for folks with diabetes and individuals in need of contraceptives.

Obviously, the rare disease strategy is something near and dear to my heart as I have a nephew who suffers from a rare genetic disease. I understand the issues that my brother and sister-in-law go through in taking care of my nephew. The issue of expanding pharmacare, expanding our national system and strengthening our social safety net is very near and dear to my heart.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, we heard several times this evening from Conservatives talking about child care. If we look at how that legislation came about, which is something the NDP pushed for for years, it was eventually written into legislation and passed in a very similar format to pharmacare, and it required the participation of provinces. We heard all sorts of opposition from the Conservatives, but what we saw is that provinces, one by one, came on board. Now, we see the same thing with pharmacare.

I am just wondering if the member can project on whether we are going to see, over the coming months and the coming year, as agreements are signed with British Columbia and Manitoba, that other provinces are going to have a hard time explaining to their people why they do not get free contraception and free diabetes medication, and slowly they are all going to sign on to a national universal pharmacare plan. Is that how it is going to roll out?

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, leadership is about having the confidence to invest in Canadians and invest in Canada. We continue to work with all the provinces. We have signed all the agreements for the national early learning and child care agreements across the country with all the provinces, Conservative, New Democrats or Liberal. We have done the same on health care.

As I said in my speech, I was there with the Prime Minister and the Premier of Ontario, Doug Ford, the morning we signed the bilateral health care agreement of injecting $3.1 billion as part of the agreement with the Province of Ontario. That is real leadership. That is not hot air. That is real leadership, which is providing real solutions to individuals in the province of Ontario and across this country that we call home.

We will continue to introduce measures that I know make a real difference in the lives of everyday Canadians, including the ones who live in my riding of Vaughan—Woodbridge.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Mr. Speaker, I listened with great interest to my colleague's speech.

I would like to ask the member about how something as simple as monitoring diabetes and testing sugar levels, which can prevent hospitalization and the additional costs that can occur due to hospitalization when people do not have this equipment to be able to take care of themselves at home. I would also like to ask, if he has a few moments, if he could talk about oral contraceptives for women.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, we know that almost four million Canadians have a form of diabetes, and we want to prevent their condition from deteriorating and their ending up in the hospital, which costs our hospital system even more. We want to prevent that, which is a big piece in Bill C-64.

Obviously, with contraceptives, we know that there are women out there who may not be able to afford the cost. We would be there to assist those individuals, especially the most vulnerable, in our country.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Environment and Climate Change and to the Minister of Sport and Physical Activity]

Mr. Speaker, reproductive and sexual rights are human rights. Our government recognizes that, and we stand by it as a matter of principle. Members of the Conservative Party caucus can stand in the House and say they are not interested in pursuing anti-abortion legislation that would infringe upon women's reproductive rights; however, sadly, that conviction is far from a universally held one in the caucus. In fact, the entire caucus has been designated as anti-choice by the Abortion Rights Coalition of Canada.

I am proud to say that, on this side, we are walking the walk. We are leading by example and putting forward Bill C-64, an act representing pharmacare, which would provide universal access to prescribed contraceptives to Canadians. In collaboration with provinces and territories, we will support universal coverage of contraceptive medications and devices so that nine million Canadians of reproductive age will have access to the contraception that they need and deserve. This will ensure that Canadian women can choose whether they are going to have children. It will give them greater control over their bodies and their futures.

Currently, Canada is one of the only countries in the world where access to health care is universal but access to contraceptives is not. Women therefore have a more limited range of options, and are more likely to experience unwanted pregnancies, which can impact their lives.

Access to safe, reliable birth control is essential. It gives women the freedom to plan their families and pursue their long-term goals and dreams. Unintended pregnancies, on the other hand, can cause a great number of negative health and economic impacts on families. At present, coverage for contraceptives varies across the country. Most Canadians rely on private drug insurance through their employer for their medication needs, and some populations are disproportionately affected by the lack of coverage.

Women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions, often lack access to private coverage, and only a fraction of Canadians are eligible for prescription birth control at low or no cost through a public drug plan. When a person pays out-of-pocket for their contraceptive needs, regardless of whether they have coverage, cost has been identified as the single most important barrier to accessing contraceptive medications or devices that they require.

One study showed that women from low-income households are more likely to use less effective contraceptives, or no contraceptives at all. Cost is a significant obstacle to gaining access to more effective forms of contraception.

For example, oral contraceptives cost approximately $25 per unit, or $300 per year. In comparison, intrauterine devices, or IUDs, are often more effective and last up to five years, but they have an upfront cost of approximately $500 per unit. IUDs are a much more effective method of contraception, since they have a low failure rate of 0.2%, compared with that of oral contraceptive pills, which is 9%. Furthermore, they do not require daily doses to remain effective, which is a long-standing challenge with the pill.

At this time, I would also point out that women can have the choice, but sometimes, it is not so much a matter of choice; it is a matter of how a woman's body reacts to these various interventions. It really should be a matter of choosing not based on cost, but based on what works best for them. If someone is a young woman in their twenties, working at a part-time job that does not offer private coverage, accessing an IUD or other contraceptive method can be a big cost when trying to manage other basic life expenses, such as rent or grocery bills.

As colleagues can see, this is the reality that many Canadians are currently facing and trying to manage. We have decided to intervene and help. Bill C-64 would address the lack of access by working with provinces and territories to provide universal coverage of contraceptive medications and devices, so Canadians can access the contraceptives they need. Furthermore, some provinces are already paving the way; this is similar to how Saskatchewan led the way by implementing universal health care in the 1960s. Last year, British Columbia became the first province to provide universal access to contraceptives to their residents. Recently, Manitoba also announced a commitment to implementing universal contraceptive coverage in their province. I would join my colleague in clapping.

There is a certain trend I see, with certain provinces offering these services to Canadians. What is that common trend? I think we can leave it to our imagination, but it tends to be parties that are left of centre, that are more progressive and that are willing to step in and help where people need it most. Studies from the United Kingdom show that universal access to contraceptives provided a return on investment in health and social services of nine to one for every investment in universal contraceptive access.

In the Canadian context, evidence from the University of British Columbia estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year.

We commit to working with those provinces and the others in Canada to ensure that everyone in Canada has universal access to contraceptives.

This new coverage, to be delivered by provinces and territories that enter into a bilateral agreement with the Government of Canada, means that Canadians would be able to receive the contraceptives they choose, no matter where they live or how much they earn. In turn, Canadians will be healthier; they will be empowered to make important life decisions, and they will not have to opt for less-effective or less-desirable methods of contraception because of the cost of this essential medicine.

We will work with provinces and territories to provide Canadians with universal coverage for contraception. This is just the first phase of a national pharmacare plan, which can show how much of an impact universal coverage for contraception and, indeed, more than just contraception, will have on the lives of Canadians and further enshrine reproductive choice in Canada.

In closing, we look forward to working with all parliamentarians to pass the pharmacare act so that all Canadians can have reproductive choice and rights and get the contraception they need and deserve.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Mr. Speaker, the member opposite opened his speech by talking about the morning-after pill. Does he know that, in his province of Ontario, that is already covered? With respect to all the money that is going into protecting women from going full term in pregnancy, would the government instead, or in addition, at some point choose to direct the funding towards in vitro fertilization?

Our birth rate in Canada is lamentably low. Rather than focusing on wiping out or tapering off the population, would they consider helping women to have babies?

[Adam van Koeverden, Liberal, Milton, ON]

Mr. Speaker, that is a shameful display of the type of anti-choice rhetoric that happens in the House far too often with Conservatives. The facts remain: Women want the right to choose. They want the right to choose how to have their bodies, and—

[Some hon. members]

Oh, oh!

[Adam van Koeverden, Liberal, Milton, ON]

Mr. Speaker, as I am being heckled by a Conservative—

[The Deputy Speaker, Conservative, Chris d'Entremont]

Order. Ask questions, get answers and comments.

The hon. parliamentary secretary has the floor.

[Adam van Koeverden, Liberal, Milton, ON]

Mr. Speaker, the Conservatives can find all the excuses that they want to deny women access to free contraceptives, whether it has—

[An hon. member]

Oh, oh!

[Adam van Koeverden, Liberal, Milton, ON]

Mr. Speaker, I continue to be heckled by a caucus that has a perfect score with the Abortion Rights Coalition of Canada as being completely anti-choice. They can deal with that on their own time. We will stand with Canadians. We will stand with women, and we will stand for women's rights and reproductive rights.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Mr. Speaker, let us bring a little bit of cheer to all this by asking questions about the content.

I would like the member to tell me whether he thinks that the child care program is working well in Quebec and the rest of Canada. We know that the federal government recognized Quebec's jurisdiction and its right to opt out of that program with full compensation.

Does my colleague not believe that the pharmacare program could also work just as well if the federal government were to respect Quebec's expertise and jurisdiction by simply transferring the money?

[Adam van Koeverden, Liberal, Milton, ON]

Mr. Speaker, I thank my colleague for his question. It is true that Quebec is a leader in Canada in many areas, including women's rights and reproduction.

It is important to recognize when a province or territory is a leader or ahead of its time when it comes to important, progressive issues. The federal government must consider all of its options to create a level playing field.

To level the playing field, it is important that we find ways to ensure that great ideas in provinces such as Quebec, Manitoba or British Columbia are shared by all Canadians.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Mr. Speaker, as I have heard in the House tonight, I know the Conservatives think providing free contraception is communist, but I would like to say this to the hon. member across the way: They talk about reproductive rights, but in New Brunswick, one cannot even access a trauma-informed abortion at care. We have a Canada Health Act that they have to uphold, and I am glad that the member supports that, but his government actually does not support action. It is one thing to say that we support the right to a safe, trauma-informed abortion, but it is another thing to provide access to that right.

[Adam van Koeverden, Liberal, Milton, ON]

Mr. Speaker, I am grateful to the member opposite for her intervention tonight, because it underscores the importance of electing good provincial government and the necessity to look at provinces' leadership, read their platforms very carefully and consider who they are. They demonstrate exactly who they are, whether it is their approach in New Brunswick or, frankly, in Alberta, to how they support LGBTQS+ kids. The position on abortion in New Brunswick has been demonstrated very clearly. Canadians know what they get when they elect Conservative governments in Canada: a questioning of the enshrined rights of women.

[An hon. member]

Oh, oh!

[Adam van Koeverden, Liberal, Milton, ON]

Mr. Speaker, as I continue to be heckled by members of a caucus that has a perfect score with the Abortion Rights Coalition for being anti-choice, I think they are demonstrating exactly who they are.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Mr. Speaker, I am proud to rise today to support what the NDP has fought for. It is the beginning of a pharmacare plan that will start with one of the things the NDP has championed for years: the reproductive rights of women and people who menstruate. It is a significant step forward to promote reproductive rights for women and gender-diverse people in Canada; we know, for far too long, leaders have neglected calls to improve reproductive health services. In this room today, I have heard Conservatives saying such things as that we already pay for abortion; they know very well that even the Liberal government still does not provide access to safe, trauma-informed abortion care. We are talking about the gamut of reproductive rights; that includes the ability, if one so chooses, to access contraception.

I used to be a high school sex ed teacher. One thing we would talk to the kids about was choice and how to protect themselves and their reproductive rights should they want to avoid pregnancy. I know there are Conservatives smiling because the discussion around sex, abortion and contraception is a difficult one, but these are important open discussions that we have to have, especially as we change into a society that is becoming much more inclusive in our gender diversity. I support that. The bill would allow nine million people of reproductive age in Canada to access contraception, providing them with reproductive autonomy and reducing the risk of unintended pregnancies.

However, we know that bodily autonomy is currently under attack. We have heard in the House, in fact, petitions that have been put on the floor by the Conservative Party that attack the trans community. The March for Life is happening on Thursday, and I wonder which Conservative faces we will see again this year at the campaign. Just as the colleague across the way said, the Campaign Life Coalition has labelled the Conservatives anti-choice. This is not surprising, because in this very session of Parliament, Bill C-311 was named a backdoor anti-abortion legislation in the name of so-called violence, even though it was not supported by any women's groups working with women and gender-diverse people who are experiencing violence.

The bill is also a major win for promoting the rights of economic empowerment for women and gender-diverse people in Canada. We have a right to choose what we want to do with our own bodies. I find it disturbing that, in 2024, most of the people opposing the bill in the House on the Conservative side are not even impacted by it. I do not know many men in the House who have to run to the drugstore to get birth control pills or have to use diaphragms or IUDs. This is a gender-specific issue for women and gender-diverse people. It is really appalling, because the very Conservative opposition that is talking about freedom, with a leader who talks about freedom, does not believe in freedom when it comes to bodily autonomy. The member for Carleton does not believe in freedom of religion, with the kind of Islamophobic, visceral garbage I have to hear on that side. Now they are directly attacking women's right to choose.

[The Deputy Speaker, Conservative, Chris d'Entremont]

We have a point of order.

The hon. member for Sarnia—Lambton.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, you certainly have given lots of advice on people not impugning other members with motives. I think the member has gone quite far enough, and I would ask if you could return her to the theme of today.