PACP Committee Report

OBSERVATIONS AND RECOMMENDATIONS

Veterans Affairs

Veterans Affairs’ program is approximately less than half the cost of Health Canada’s. It differs principally from Health Canada’s program in that does not provide lifetime benefits and its clients must apply in order to receive benefits.

While Veterans Affairs Canada generally manages its drug benefits programs well, the audit found a number of areas in which improvements should be made.

Veterans Affairs’ claims processing system contains a major gap — it only issues alerts to pharmacists for drugs that have been previously dispensed by other pharmacies. If a drug has been dispensed earlier by a pharmacist’s own pharmacy, no alert is issued. (4.31) This oversight needs to be addressed in order that alerts be fully effective. The Committee therefore recommends:

RECOMMENDATION 8

That Veterans Affairs Canada immediately upgrade its claims processing system so that it can provide intra pharmacy alerts related to prescription drugs that are susceptible to potential abuse and misuse.

The Committee also notes that Veterans Affairs Canada is not collecting, and therefore not analyzing, data on alerts and pharmacist overrides. The Committee believes that this information is needed in order to fully comprehend and address problems regarding potential prescription drug misuse and abuse. It accordingly recommends:

RECOMMENDATION 9

That Veterans Affairs Canada begin immediately to collect data on claims processing alerts and overrides, and perform regular analysis of the results that includes an assessment of the volume of alerts and the reasons for overrides. This data, along with the analysis, should be provided to Parliament annually in the Department’s performance reports beginning with the report for the period ending 31 March 2006.

During the course of its hearings, the Committee questioned departmental witnesses about the possibility that both Health Canada and Veterans Affairs Canada might be duplicating the provision of drug benefits to the same population of clients: Aboriginal veterans. It was apparent, from testimony, that the departments had not considered this possibility and, as a consequence, had not attempted to ensure that benefits were being paid by one or the other, but not both. To guard against the possibility of duplication of benefits, the Committee recommends:

RECOMMENDATION 10

That all federal government entities delivering drug benefits programs work together to ensure that there is no duplication in the client base for their respective programs.

CONCLUSION

The Auditor General is to be congratulated, not only for this audit, but for having performed a singularly useful service for Parliament and Canadians: this is the first time that information on full scope of the federal government’s involvement in the provision of drug benefits programs has been brought together and presented in one document. These six federal entities — Health Canada, National Defence, Veterans Affairs, RCMP, Citizenship and Immigration, and Correctional Service Canada — that provide drug benefits programs can now be situated among the 19 publicly funded drug plans operating in various jurisdictions throughout Canada.

It is particularly notable that the federal government is now the fourth largest payer of drug benefits in Canada, after Ontario, Quebec, and British Columbia. It is also significant that, prior to the publication of these audit results, very little information was being provided to Parliament in departmental reports (with the annual report of the Non-Insured Health Benefits program of Health Canada as an exception).

The Auditor General called for a centrally managed process that includes a core formulary, a common evidence-based process for formulary exceptions, a collective effort to get the best value for drugs, a single federal schedule for dispensing fees, a common risk profiling and auditing process. Efforts to meet this key objective should be reported to Parliament annually through mechanisms such as the reports on plans and priorities and departmental performance reports. Parliament should be informed by departments about the costs, objectives, operations, and performance of these programs for clients under their direct responsibility. To ensure that Parliament has full and timely access to this kind of information, the Committee strongly recommends:

RECOMMENDATION 11

That, each federal department provide information on efforts to meet the goal of a centrally managed system as well as overall program objectives, costs, and performance in their annual reports to Parliament on plans and priorities, and performance; and

RECOMMENDATION 12

That, beginning in fiscal year 2006-07, Veterans Affairs Canada, National Defence, the Royal Canadian Mounted Police, Correctional Service Canada, and Citizenship and Immigration Canada provide a comprehensive annual report (similar to that provided by Health Canada in its overall NIHB program) containing information on their drug benefits programs.

In closing, the Committee notes that the Auditor General will be conducting a follow up audit to assess the progress being made in implementing her recommendations, all of which have been accepted by the departments and the RCMP. The Committee welcomes this decision and looks forward to receiving and reviewing the results.