The standing committee on Social Policy is meeting to consider Bill 140, an Act that concerns long term care. The hearings on Bill 140 are to be held in January.

A few reminders:

Your resolutions are due in the office by April 13, 2007.

Your convention will be in the last part of August, as far as we know.

If you are travelling to an area identified as medium to high risk for Hepatitis A & B, be sure to protect yourself by getting your vaccination.

Enjoy Each Day And God Bless

Marie M. Smith

Ontario Drug Reform - Bill 102 and Beyond

On April 10, 2006 the Honourable George Smitherman, Ontario Minister of Health and Long-Term Care, introduced broad and sweeping drug reform to the province. The main part of that reform was a piece of legislation entitled the Transparent Drug System for Patients Act, also known as Bill 102. This complex bill actually amended two existing laws; the Drug Interchangeability and Dispensing Fee Act and the Ontario Drug Benefit Act. On October 1st, Bill 102 came into effect, impacting the health care received by every senior citizen in Ontario. In this article, I will review how drug reform has evolved since last spring and conclude with some questions to consider.

Upon introduction, the government set out a five part plan for Ontario drug reform:

" Ensure better value for money
" Improve patient access to drugs
" Promote the appropriate use of medications
" Invest in innovative health system research
" Strengthen drug system transparency and accountability

While these objectives appear sensible and potentially beneficial for seniors, the government made an important decision. Rather than include in Bill 102 (or its regulations) all of the component parts of their five part plan, they excluded much from the law that they promised for seniors and others who rely on the provincial public drug plans. I will illustrate this further as I look at the government's plan in more detail. But first, let's review how Bill 102 came into being.

In June, 2005 Minister Smitherman appointed the Drug System Secretariat (DSS), an internal body whose job was to advise the Minister on broad pharmaceutical issues with a specific focus to find cost savings, while seeking to control and sustain the drug budget. Over the course of several months, the DSS received approximately 100 written submissions and held 105 meetings with more than 350 stakeholders to gather information about how to reform the public drug system that countless seniors rely upon everyday. Their report was delivered to the Minister in January, 2006 and contained a package of recommendations that the government decided to move forward in the April, 2006 announcement.

After Bill 102 was introduced in the Ontario Legislature, its passage was swift (only 34 sitting days). To ensure that this occurred in such short order, the government passed a time allocation motion to stop debate after 2nd Reading and send the bill to the Standing Committee on Social Policy. In fact, between the 1st and 2nd Readings of the bill, there was only seven hours of debate amongst MPPs. Between 2nd and 3rd Readings, there was less than two hours of debate.

The Standing Committee on Social Policy, which is a committee of the legislature and is made up of MPPs from each of the three parties, sat for four days in consideration of Bill 102. During that time, they heard 99 presentations of ten minutes each from organizations and individuals from across Ontario. Few of the people chosen to present, directly represented patient interests. Fewer still spoke for the province's seniors.

So with minimal debate and limited public input, Bill 102 became law on June 20, 2006 (largely coming into effect on October 1st).

Ensure Better Value for Money

The first promise made by the government was that Bill 102 would ensure better value for money by proposing a number of initiatives, including:

" Paying less for generic drugs
" Negotiating more competitive prices for brand name drugs
" Developing chronic disease partnerships with brand name drug companies
" Increasing dispensing fees to pharmacies
" Removing rebates to pharmacies
" Enforcing drug pricing compliance
" Allowing greater interchangeability

While many of these provisions were written into Bill 102, they were designed to save the government money rather than necessarily improve the health of seniors.

Improve Patient Access to Drugs

The government promised to improve access to medications by:

" Creating a Conditional Listing category for drugs under review
" Making rapid funding decisions for breakthrough drugs for life-threatening conditions
" Alignment of all of Ontario's publicly-funded drug programs
" Eliminating Limited Use and Individual Clinical Review (Sec. 8)
" Creating an Exceptional Access mechanism to allow certain patients to access certain drugs

Unfortunately, none of these government promises designed to improve seniors drug access were included in Bill 102 or its corresponding regulations. They remain, as of January, 2007 just words with no force in law and with no details about how these provisions may be implemented.

Promote the Appropriate Use of Medications

Appropriate use of medications was to be improved by:

" Paying pharmacists for providing direct patient care services
" Developing web-based, independent, best practice guidelines to ensure the right drug for the right person at the right time

Best practice guidelines are an important component to assist physicians in the prescribing of medications to patients, including seniors. But this commitment by the Minister of Health and Long-Term Care was not included in Bill 102 and therefore remains just a promise that may or may not be fulfilled.

Invest in Innovative Health System Research

The cornerstone of this part of the plan was the establishment of an Innovation Research Fund to support drug policy by investigating the value of medications across the entire health care system. Once again, though, there is no reference to this fund in either Bill 102 or the applicable regulations. We can only speculate that the government will act on this promise.

Strengthening Transparency and Accountability

Reflecting the title of the legislation, the government committed to providing greater transparency and accountability by:

" Establishing formal governance principles
" Appointing an Executive Officer
" Appointing two patient representatives to the Committee to Evaluate Drugs
" Creating a Citizens' Council to give the public an opportunity to guide drug policy
" Forming a Pharmacy Council
" Publicly reporting on the status of drug reviews

While the creation of the position of Executive Officer (who will oversee the operation of all of the public drug plans in Ontario), the Citizens' Council and the Pharmacy Council are all referenced in Bill 102, none of the other promises that would ensure more transparency and accountability are included and thereby not legally guaranteed. Again, as of January, 2007 we know nothing about the role of the patient representatives on the Committee to Evaluate Drugs, what the governance principles may entail or what form the public reporting may take.

Potential Impact for Seniors

Bill 102 and the broader drug reform process undertaken by the provincial government last year will have an impact on people who access the public drug plans in this province; primarily senior citizens. The reforms are too sweeping and comprehensive to do otherwise. But what will those impacts be? Unfortunately, with so little content in the actual legislation and regulations, it is impossible to know until all of the promises made by the government are implemented. That will be done through the introduction of policy provisions, which have been delayed for months and in which the public will have no opportunity to provide formal input.

As we approach the next provincial election in October, 2007 here are some questions for your consideration in the context of Bill 102 and beyond:

" Will you have improved access to the medications that you require, or at least the same level of access?
" Will you have access to new and innovative medications as they become available in Canada?
" Will the voice of Ontario senior citizens like you be adequately heard and represented as decisions are being made that impact your health care?

You would do well to seek answers to these questions as we all await the implementation and impact of Ontario drug reform over the coming months and years.

submitted by Ryan Clarke, LL.B., Advocacy Solutions