44th Parl. 1st Sess.
May 6, 2024 11:00AM
Mr. Speaker, there have been discussions and I hope you will find unanimous consent for the following motion that, notwithstanding any standing order, special order or usual practice of the House, (a) the amendment to the motion at second reading for Bill C-64, an act respecting pharmacare, in the name of the MP for Cumberland—Colchester, be deemed withdrawn, and (b) Bill C-64, an act respecting pharmacare, be deemed read a second time and referred to the Standing Committee on Health.
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- May/6/24 1:30:01 p.m.
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Madam Speaker, I am curious as to the member's thoughts on the pharmacare proposal that is within. I think that seniors, no matter what area of the country they are in, particularly those with diabetes, would recognize that having national pharmacare is a very strong, positive thing, just on that point alone.
Does the Bloc support Canada providing pharmacare coverage and recognize that at least we are moving in the right direction?
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- May/6/24 1:30:36 p.m.
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Madam Speaker, I would like to lob that question back at the parliamentary secretary and ask him if the Liberals really intend to implement universal pharmacare across the country. It just does not make sense.
It is not that universal pharmacare does not make sense. It is that it does not fit into a context where Quebec already has a pharmacare program that covers thousands of drugs.
It makes no sense to impose such a program without the right to opt out with full compensation in an area that is under Quebec's jurisdiction. Quebec even questions why this program only covers diabetes and contraceptives. The government is not following through on its commitment.
I have a feeling these meddling federal policies will continue for a long time to come. They may suit the rest of Canada, but they in no way meet the needs and interests of Quebec, which already has its own system. Yes, it needs some improvements, but not with federal conditions.
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- May/6/24 1:31:51 p.m.
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Madam Speaker, I am going to talk about pharmacare too. It interests me because the Hoskins report made it very clear that the best way to control and reduce drug costs for everyone is to have universal public pharmacare.
The Quebec system is a hybrid system that was cutting-edge at the time. Today, however, even Dr. Rochon, the person who instituted the system, says that it is time to finish the job and adopt a universal public system.
Yes, Quebec must be given the right to opt out with compensation. We support that and agree on it. However, this universal pharmacare plan would be the best thing for Quebeckers, for patients, for businesses and for hospitals. It is something that the Fédération des travailleurs et travailleuses du Québec, the Confédération des syndicats nationaux, the Centrale des syndicats du Québec and the Union des consommateurs du Québec are all calling for.
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- May/6/24 1:32:35 p.m.
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Madam Speaker, it is no surprise to me that these major labour organizations are calling for this, because I used to work for them.
We fought for universal pharmacare for over 20 years. That struggle is what led to the system we currently have in Quebec. Our hybrid system is not perfect and could be improved. I believe that people want to continue with it.
I am very pleased to hear for the first time that the NDP agrees with us about the right to opt out with full compensation, because neither the bill we are studying nor the agreement to keep the government in power mentions this condition.
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moved:
That in relation to Bill C-64, An Act respecting pharmacare, not more than five further hours shall be allotted to the consideration at the second reading stage of the bill; and
That, at the expiry of the five hours provided for consideration at second reading stage of the said bill, any proceedings before the House shall be interrupted, if required for the purpose of this order, and, in turn, every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment.
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- May/6/24 3:34:32 p.m.
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Mr. Speaker, the member for Burnaby South, the leader of the NDP, was the leader in actually bringing the bill to bear, with pharmacare being so vitally important for so many Canadians. He basically said, last week, that the Conservatives had up until noon today to remove their blocking amendment.
The Conservatives put an amendment forward that would block pharmacare. What that means for each and every Conservative MP is that 17,000 people, on average, who depend on vital diabetes medication would still have to pay for it out of pocket, in many cases $1,000 a month. That is an unbelievable charge on their ability to put food on the table or keep a roof over their head, and the Conservatives did not care. The reality is that 25,000 women who are looking to take care of their reproductive health in terms of birth control or contraception are also being denied by the Conservatives' blocking this important legislation.
My question very simply—
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- May/6/24 3:36:00 p.m.
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Mr. Speaker, the Conservatives should have stood up and should have the guts to actually defend the unbelievably negative things that they have tried to do around pharmacare.
My question to my colleague is very simple. When 17,000 of their constituents need access to diabetes medication and 25,000 need access to their reproductive health prescriptions, which are part of this bill, why are Conservatives blocking the ability of Canadians to access these medications?
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Mr. Speaker, the debate right now is on time allocation on Bill C-64, and I would put it to the Minister of Health that I would love for us to be having a debate on an actual proposal for pharmacare.
It has been since June 2019 that the former Ontario health minister, Dr. Eric Hoskins, gave the government and this country clear direction that we need a national pharmacare program. We are the only country in the world with a national health care program that does not automatically include the provision of needed prescription drugs. We know from the Hoskins report that, properly implemented, a full national pharmacare program will save this country $5 billion a year at least.
However, the bill is picking out only two things, which is what is so strange about this bill and why I object to the debate being closed before we can actually discuss it. Why are we only talking about reproductive health care and diabetes medication? What that may end up doing is giving those opposed to pharmacare evidence that it costs more than it is worth, when we need to prove to everyone concerned that national pharmacare will save our health care system money and ensure Canadians get the health care they need.
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- May/6/24 3:44:19 p.m.
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Mr. Speaker, this is a concrete proposal to move pharmacare forward in this country. The drugs are two classes of drugs. They represent more than 80 different medical drugs that deal specifically with diabetes and contraceptives. It is part of a broader suite of actions that we are taking, such as, for example, drugs for rare diseases. I am currently having conversations with every province and territory about how we can take action on drugs for rare diseases so that folks with rare diseases can get access to the medications they need.
It is part of what we have done on bulk purchasing to realize $300 million in savings for Canadians across the country. It also builds on the work that we are doing with a pilot in P.E.I., where we have been able to get copays down to five dollars there, saving seniors hundreds and hundreds of dollars in P.E.I.
Action is taken one step at a time by demonstrating in evidence exactly what is going to be saved and exactly how this should function. As an example, in British Columbia, when it comes to contraceptives, it already shows that the province is saving more than it costs to run the program. I suspect we will also see that in diabetes. Canadians, rightfully, want to see this in evidence. They want to see these things live out there, demonstrate how they work in each example and then build on that successively.
Our health care system was based on an iterative process by making sure that the steps we take are prudent, smart and fiscally responsible, and that is the way that we need to proceed with pharmacare as well.
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- May/6/24 3:46:01 p.m.
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Mr. Speaker, I view this legislation not as a pharmacare plan but a spending plan and what will be another empty broken promise, just like the carbon tax was going to be revenue-neutral and just like housing was going to become more affordable under the current government. Frankly, I do not see enough trust from Canadians to see another project fail to be delivered properly.
I have been getting a lot of questions from constituents regarding the proposed plan. People are asking me if they should cancel their existing insurance plans because, like many others, the majority of Canadians are already covered. They are worried there is going to be a reduction in availability of coverage under the single-payer system that is being partially promised, partially proposed and, ultimately, I expect, poorly delivered.
Perhaps the minister could clarify, for the hundreds and thousands and millions of people across Canada who are wondering if they are in limbo, if they are going to lose the quality of the coverage they have through their private insurance and whether they should cancel it now and await further clarification from the government, what eventually may be covered under the pharmacare plan.
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- May/6/24 3:53:11 p.m.
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Mr. Speaker, I agree with the minister when he says that everyone who needs it should have drug coverage. The Bloc Québécois wholeheartedly agrees with him.
That being said, what is the best authority, the best government to manage a pharmacare program? The Bloc Québécois is convinced that it is the Government of Quebec and the provincial governments that should fulfill that responsibility for their citizens.
I know that the minister wants to impose a gag order because he is worried that the Conservatives will delay the debate to prevent the bill from being passed. On the other hand, the Bloc Québécois still needs to debate this bill, because it creates an agency that will manage a Canadian pharmacare program.
It is complicated. I am wondering how things will be done in Quebec because we already have a hybrid public-private program managed by the Régie de l'assurance-maladie du Québec.
That means that we have a lot of questions and we need to hear from witnesses. I understand that the minister wants to move fast on this and that he is concerned that the Conservatives will filibuster, but we still need to debate this matter and study it further. We need to hear from witnesses to determine whether this bill will work for Quebec and the provinces. Is it the best solution to provide good coverage for all Quebeckers and all Canadians? I have to wonder.
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- May/6/24 3:56:18 p.m.
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Mr. Speaker, health care is such a critical issue. It always has been in my 30-plus years as a parliamentarian. We talk a lot about health care. We have achieved health care accords or agreements with different provinces and territories. We made a $198-billion commitment toward health care. That is talking about future generations.
For many years, I have been a very strong advocate for a pharmacare program, and my question to the minister is this: As I see it, a pharmacare program is a huge step forward toward the type of health care system Canadians want to see here in Canada, and I am wondering if he could provide his thoughts on how the pharmacare legislation we are proposing today would complement our health care system into the future.
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- May/6/24 3:59:00 p.m.
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Mr. Speaker, the Conservatives have no problem with Canadians getting the drugs they need.
I am doing something the government does not often do, and that is to think ahead. This is the first bit of the pharmacare legislation it is talking about, with a couple of drugs. There are plans to do more.
Many Canadians already have drug care coverage. I am curious as to why the program is being developed in the way it is because there is a large percentage of Canadians who have coverage. One of the big questions I often get is whether Canadians are going to have to opt out and lose the coverage they have to go with this.
The costs are the big concern. The PBO has said there would potentially be tens of billions of dollars being spent on the pharmacare program once it is implemented. Why are we spending money on something that Canadians already have? This is a question I have.
On top of that, we know that Liberals cannot be trusted. We look at the cost of taxes, which have gone up. The cost of housing has gone up. The cost of groceries and food has gone up. I just do not see how Canadians can trust the Liberal government to implement something such as a pharmacare program at any kind of a cost that would not cause taxes to go up.
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Mr. Speaker, I rise to speak to Bill C-64, an act respecting pharmacare, to highlight two major concerns. The first is the federal government's intrusion into matters of provincial jurisdiction, and the second is budgetary concerns.
This neo-liberal initiative, which came from the Liberal-NDP coalition, raises serious concerns because of its impact on provincial jurisdictions. During its nine years in power, this Liberal government has not even been able to properly and competently manage its own files. How, then, do the Liberals think they can get away with interfering in provincial health care by imposing Bill C‑64 on the provinces, including Quebec, which has been offering Quebeckers its own pharmacare program since 1997, so for nearly 30 years?
Instead of continuing to overstep its boundaries by interfering in provincial affairs, the government should focus on matters within its jurisdiction, such as managing passports, fighting crime, fixing the immigration system, which it broke, and cutting inflationary taxes. These are just a few examples of areas where it needs to direct its attention and energy, instead of investing time and money in provincial matters.
A pharmacare program is not a program that should be set up at the federal level. That is a provincial responsibility. This arrogant, pretentious government wants to impose its science when it totally lacks the authority to manage this type of file.
Was this pharmacare program designed in close co-operation with all provinces, territories and indigenous peoples? Was it developed following a thorough review of what already exists in each of these areas of responsibility? Is it the result of thoughtful consultation with experts and stakeholders? We know the answer: Of course not.
We have here a shameful attempt by the Liberal government to stay in power thanks to the support of the NDP. The Journal de Montréal's Yasmine Abdelfadel writes, and I quote:
Make no mistake: Justin Trudeau has sold his soul to the NDP. The New Democrats are the ones who are really in power, the same New Democrats that did not have the support of the public in the last election.
This initiative seems well intentioned, but it is not. Because the Liberals only hold a minority, they found a dance partner, the NDP, which is keeping them in power in exchange for the implementation of various measures that the New Democrats care about, like dental care and pharmacare, the issue that is before us today.
Canadians did not vote for that or for the NDP. Only 17.7% of Canadians supported this far-left party in the last election.
Also, Radio-Canada notes that neither dental care nor pharmacare were part of the Liberals' election platforms.
Despite what they want us to believe, this pharmacare bill is therefore no reflection of the NDP-Liberal coalition's benevolence toward Canadians. It is mere political and electoral theatre. To suggest otherwise is to lie to Canadians.
Now, getting down to dollars and cents, this pharmacare plan, as proposed, would generate massive costs, a concern that seems to have been glossed over, if not completely ignored. In a report published on October 12, 2023, the Parliamentary Budget Officer wrote the following:
...we estimate the incremental cost to the public sector (that is federal and provincial governments combined) to be $11.2 billion in 2024-25, increasing to $13.4 billion in 2027-28.
I would remind the House that the Parliamentary Budget Officer thinks the total is going to reach $40 billion.
I find it hard to trust in the current government's ability not only to implement an effective pharmacare program, but also, and more importantly, to maintain it over the long term. A government that has proven repeatedly since 2015 that it cannot maintain a balanced budget and is fiscally incompetent does not exactly inspire confidence.
I think it is worth reminding the people watching at home that the national debt has doubled since the Liberals came to power in 2015. It now stands at $1.255 trillion. I also want to remind everyone that since we have to borrow money to pay for the Liberals' reckless spending—because they are spending money they do not have—we are also paying interest. The interest on this unbelievable debt is $54 billion. That is more than the total amount of health transfers to the provinces, and it is the equivalent of all the GST paid by Canadians. This money is being thrown away to pay for the creation of programs that already exist.
Access to medication is a major concern for Canadians, which is why it is imperative that we carefully examine the viability of such a program, so as to be absolutely certain that it will last over the the very long term. More than anything else, it is hard to justify creating such programs, which would require additional bureaucracy and uncontrolled spending, when the vast majority of Canadians, four out of five, or 80% according to Statistics Canada, already have drug coverage in their respective provinces, coverage that is even broader than what is proposed in Bill C‑64.
Here is what Quebec's health minister, Christian Dubé, had to say to La Presse:
Not only is the government refusing to give us the money we asked for in federal health transfers, but it wants to interfere in an area of Quebec jurisdiction. The federal government knows full well that this is an area of provincial jurisdiction. We've had our own drug insurance program since 1997. It's been nearly 30 years. We also probably have the broadest drug coverage of any Canadian province.
By the way, he also pointed out that 45% of Quebeckers are entitled to drug insurance coverage through the public plan and that 55% of Quebeckers have private insurance. Guess what? Fifty-five per cent plus 45% equals 100%.
The federal government has caused countless crises in Canada since coming to power. Canadians continue to be both witnesses and victims of this incompetence every day in things like immigration, passports—we are starting to see lineups again—the correctional system, the use of food banks or the lack of affordable housing across Canada. Do my colleagues know that since the Liberals came to power in 2015, the public service has grown by 40% and hired 100,000 public servants?
I am going to quote a sharp mind on the subject of bureaucracy. I would not bet that he is a Conservative. Listen to this:
Like a black hole, it can also absorb astronomical budgets without leading to an improvement to public services.
Look at the Phoenix pay system, the chaos in immigration management, the ArriveCAN saga, the passports saga, the airports saga, etc. Despite the huge amounts of money squandered on new programs administered by an armada of public servants and the gigantic debt it has run up, the [Liberal] government's incompetence at delivering effective services to the public continues to defy expectations.
That is a quote from Boucar Diouf.
I want to close by quoting Gérald Filion, an economics journalist who is very well respected in Quebec. In his opinion, the government is creating a lot of programs and economists are concerned about the impact that will have on Canada's credit rating. The creation of many expensive programs that must be maintained in the future means additional spending.
All of the provinces offer coverage, particularly Quebec. We therefore recommend that we not go forward with this bill because we cannot afford it right now with this government's reckless spending.
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- May/6/24 5:00:08 p.m.
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Mr. Speaker, what is clear to us is that the economic situation in Canada right now is very precarious, even worrisome. We have a government that spends money hand over fist. Canada's debt has doubled since 2015 and public debt charges are up to $54 billion. That is money that is being thrown onto the fire. It is not being used to help Canadians. That money is being given to bankers because we are spending too much here in Canada. It is therefore a very bad idea to implement a pharmacare program when the vast majority of Canadians and all Quebeckers already have drug coverage.
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- May/6/24 5:01:51 p.m.
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Mr. Speaker, this is just wishful thinking. I read the bill carefully. There is nothing specific in it and everything remains to be done. No agreements have been reached with the provinces and a list of drugs has not yet been compiled. All the bill says is that a strategy will be developed and a committee of experts will be set up.
This is just pure politics, completely partisan politics. As I demonstrated in my speech, the only reason this minority Liberal government proposed the pharmacare and dental care programs was to stay in power. It is supported by the NDP, which said that the Liberals had to bring in a pharmacare program to stay in power. Let us not kid ourselves this afternoon. That is the Liberal government's real motivation, and it is a national disgrace.
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- May/6/24 5:03:51 p.m.
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Mr. Speaker, the Liberals put on quite the spectacle. Pharmacare was not even part of their election platform. As a minority, they rely on their NDP friends to keep their hold on power, sometimes with help from their Bloc Québécois friends too—we must not forget that. Then they turn around and criticize us for supporting or not supporting measures that they never raised with Canadians themselves. They cozy up to the NDP, which received only 7.7% of the vote in the last election, and have the nerve to lecture us. We are not going to take that.
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Mr. Speaker, I am thankful for the opportunity to speak to Bill C-64, an act respecting pharmacare. I am extremely excited to talk about this, because this is a very important program, another transformative initiative for Canadians. We are again supporting Canadians. We can think back to 1968, when we brought in medicare. We knew the Conservatives were against it then, and the Liberals brought it in; today, no one wants to get rid of medicare, because of its importance.
In this speech, I will be talking about the framework on pharmacare and also talking about diabetes and the three million people with diabetes, and how difficult it is for them. Also I will share some information about the pilot project we have been running in P.E.I., which has given us some information, as well as where we sit in the G20 when it comes to health care and drug care. Finally, I will talk about all those initiatives the Liberals have brought in, which are helping Canadians today and in the many years forward. It was the Liberal Party that brought those.
Let me start off by saying that this act is focused on certain drugs that we would bring forward, and related products.
Of course, my colleague will be joining me afterwards. I will be sharing my time with the member for Dorval—Lachine—LaSalle.
To continue, we are talking about certain drugs, such as contraceptives and diabetes medication. Again, as I said, there are over three million people with diabetes in Canada. Back in December 2023, we created the Canadian drug agency, and its focus is on three major areas. One is a formulary, which is putting up a list of all the drugs that would be included in this pharmacare program. Another is bulk purchasing. As some have mentioned already, we have already saved millions of dollars, and there are billions to be saved through that process, which will continue. Third, we will be publishing, of course, appropriate use of medication in Canada.
I also want to say that once this legislation is passed and receives royal assent, within 30 days the minister will appoint a committee of experts to make recommendations within a year, so that we can move on this as quickly as possible.
When I go to get some medication at the drug store, my pharmacist often tells me, “You have to do something for people with diabetes. The cost is unbelievable. Many Canadians are facing a cost they cannot afford to pay. You need to come forward with some type of initiative.” I am so pleased to be here today to talk about that.
In the last decade, we have seen a doubling of the number of people facing challenges with diabetes, which is extremely important. Today, 3.7 million people are living with this. If we do not do something to help them, 25% of those people have indicated that they cannot afford to pay for that medication. If we do not treat that disease, we know what some of the end products would be, and they are not very good. We are talking about blindness. We are talking about amputation. There are all kinds of challenges that come with that.
Just for insulin, for type 1 or type 2 diabetes, the cost can range anywhere between $900 and $3,000 or $4,000 a year, which is extremely high. The good news is that we are going to work with the provinces and territories and have a deal, so that they can have frontline services for these individuals.
Diabetes Canada said, “We are very pleased with the government's commitment to prioritize improved access to diabetes medications and devices. This monumental step demonstrates a genuine dedication from our political leaders to enhance the well-being of the over four million individuals living with diabetes in Canada.”
For example, last year in June we started a pilot project in P.E.I., and from that pilot project we have seen the medication costs drop by over 60%, helping the residents of P.E.I. In a very small province, they have already saved up to $2 million, out of pocket. That is extremely important, and when we talk about affordability, this is another step forward that our government is bringing to the table.
Where do we sit in the G20? Well, it is important. People ask why we are bringing this in. We are bringing this in because we probably should have brought it in before, but the time is now. We are the only country in the G20 that has health care insurance but yet does not include drugs. The U.K. has included some prescription drugs. Australia has a mixed formula of private and public. France has, of course, a health care system and is now paying significant portions toward drugs. There are other countries in the G20 that have some type of pharmacare, including Germany, Italy, Japan, South Korea, Argentina, Brazil, etc.
According to a CBC article, “the federal Advisory Council on the Implementation of National Pharmacare, led by Dr. Eric Hoskins, stressed how people's lives can suffer if they skip needed prescription drugs, and noted a Canada-wide program could eventually lead to system-wide savings of nearly $5 billion annually.” When they talk about how much it would cost, we could actually save up to $5 billion. I think that is also a very easy answer as to why we should move forward.
When I talk about our government, the values and ideology of the Liberal Party have always been to tighten up the gap, help the most vulnerable and make sure that all Canadians have opportunities to be successful. Let us look at some of the things that we brought forward: 1968, medicare; 1969, the Official Languages Act, making both languages the official languages of Canada; 1982, the Charter of Rights and Freedoms, which all Canadians should be very proud of. Some of the opposition members are hesitant today on some pieces of the charter and we will see where they go with that piece.
There is the new and improved universal child benefit. When the Conservatives had it, it was 30% to 40% less and it was taxable; now it is not. There is the new and improved CPP, in 2019, which went from $11,400 a year to almost $20,000 a year. Those are programs that are helping every Canadian. These are opportunities. This is what makes Canada great. This is why people want to move to Canada.
Let me speak about some more initiatives that we are bringing to the table. The national school food program would help over 400,000 young people. The new disability program would help over 600,000 people with disabilities, who we know comprise most of the individuals living in poverty. Those are major initiatives to help. We are also building the dental care program. Nine million Canadians would have access to the dental care program. These are big numbers. There are many Canadians who have challenges, and our government has been focused on how to support the individuals facing those challenges.
I am going to end with something that Canadians must listen carefully to. If the Conservatives ever came to power, what would they cut? They do not want to tell us. They say “a dollar for a dollar”, so if there is a deficit of $40 billion today, we know they are going to cut $40 billion tomorrow. That we already know; we just do not know which programs. Therefore, I am going to ask the Conservatives. Would they cut pharmacare? Would they cut dental? Would they cut the disability benefit for people with disabilities? Would they cut the school food program that we have been talking about for 20 years? Would they cut the CCB, which is helping young families? Would they cut the early learning and child care program? I do not know. I am sure the Conservatives do, and I would love for them to share that with Canadians.
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Mr. Speaker, I am grateful for the opportunity today to speak to Bill C‑64, an act respecting pharmacare.
This bill represents the next phase of our government's commitment to a national universal pharmacare program. It proposes the foundational principles of national universal pharmacare and our intent to work with provinces and territories to provide universal single-payer coverage for many contraceptives as well as diabetes medications.
This is an important step forward in improving health equity, affordability and outcomes, and it could save the health care system money in the long term.
Public health care in Canada was built on the promise that no matter where one lives or what one earns, one will always be able to get the medical care one needs. Despite this promise, Canada is the only country in the world with universal health care that does not provide universal coverage for prescription drugs.
When medicare was first introduced, prescription drugs outside of hospitals cost less and played a smaller role in health care. Today, prescription drugs are an essential part of our health, helping to control chronic conditions, treat temporary ones, and aid in overall health and well-being.
One area that has seen significant changes is diabetes treatment. Over 100 years ago, thanks to a Canadian team of researchers, Frederick Banting, Charles Herbert Best, John J. R. Macleod and James Bertram Collip, insulin was discovered.
Since this monumental scientific discovery, there have been several advancements in diabetes treatment, from the introduction of fully synthetic human insulin to glucose monitors and insulin pumps. These breakthroughs have immensely improved the quality of life for people who have to live with diabetes, enhancing self-esteem, increasing social participation and improving the overall health and well-being of these individuals.
They have also come with higher costs, creating affordability challenges for Canadians affected by diabetes.
Outside of hospital, prescription drug coverage comes from a mix of private insurance, out-of-pocket cash payments and various provincial programs. While the majority of Canadians have access to some form of public or private insurance, about 2.8%, or 1.1 million Canadians, do not have access to private or public drug coverage.
Although most Canadians have some form of drug coverage, this does not mean that those with insurance have equal access to the prescription drugs they need. The existing patchwork system of private and public drug plans leaves millions of Canadians under-insured, and that means their out-of-pocket prescription drug costs create a financial burden that leaves them struggling to afford an essential part of health care.
In 2021, Statistics Canada found that more than one in five adults in Canada reported not having the insurance they needed to cover their prescription drug costs. Being under-insured can take many forms, for example, Canadians may have high deductibles, resulting in significant out-of-pocket costs before their insurance coverage even kicks in. They may reach the maximum annual or lifetime coverage limits for their insurance and have to pay out-of-pocket, or they may have to make co-payments, which are often 20% of the drug's cost on private plans and sometimes more on public plans.
All provinces have drug coverage to protect Canadians from catastrophic drug costs, but deductibles under these plans can range from 0% to 20% of net family income. In many cases, Canadians will never reach the deductible, leaving them without any support for their drug costs. This variability across the country creates a postal code lottery.
Let us consider the advancements in diabetes treatments. For a working-age Canadian with no private insurance, out-of-pocket costs vary widely. In some parts of the country, out-of-pocket costs for people living with type 1 diabetes can be higher than $18,000 per year out-of-pocket; for type 2 diabetes, they can be higher than $10,000 per year in out-of-pocket expenses. Even those with private insurance can face high co-pays or exceed annual plan maximums, resulting in high out-of-pocket costs.
Even for cases in which an individual is not accessing devices that cost thousands of dollars, they can face significant out-of-pocket costs. For example, we can consider a woman in her mid-twenties who is working a minimum wage job. An IUD, one of the most effective forms of birth control, can cost up to $500 with no insurance. Even with private insurance, a co-pay of 20% would be $100. While IUDs can last from three to 12 years and save money over the long term, the high upfront cost can make them inaccessible.
Under-insurance can be a particular concern for young adults who age out of their parents' private insurance but who do not have their own form of private coverage. Lower-income Canadians also make up a disproportionate share of the under-insured. While most provinces have put in place drug coverage for those accessing social assistance benefits, a gap still exists. Many lower-income households that do not qualify for social assistance continue to struggle with out-of-pocket prescription drug costs.
Employment factors contribute to differences in insurance coverage. People with low-paying jobs, such as entry-level, contract and part-time positions, often report less adequate drug insurance coverage. This may even discourage people from accessing social assistance benefits or from applying for jobs, because once hired, they may lose their public drug insurance coverage. However, many entry-level and part-time jobs do not offer drug benefits. One study found that only 27% of part-time employees reported receiving medical benefit coverage.
Under-insurance can have serious consequences. Many Canadians with high out-of-pocket costs report foregoing essential needs, such as food and heat, or not adhering to their prescription due to drug costs. Statistics Canada found that, in 2021, close to one in five Canadians spent $500 or more out-of-pocket for their prescription medication, and almost one in 10 reported not adhering to their prescription medication because of costs. This includes delaying filling prescriptions or skipping doses to contain costs.
When people do not take their prescription drugs the way they are supposed to, their health can suffer. This results in serious consequences for the individual and their household, and unnecessary costs to the health care system in the long run, as patients are more likely to visit an emergency room or to be admitted to hospital when they do not receive consistent treatment. For example, the full cost of diabetes to the health care system in 2018 was estimated to be around $27 billion and could exceed $39 billion by 2028.
I think we can all agree that no Canadian should be put in a position where they must choose between the prescription drugs they need for their health and well-being and putting food on the table. This is unacceptable, and it is why we are continuing our work to improve accessibility, affordability and appropriate use of prescription drugs as we move forward with national universal pharmacare.
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