HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

STANDING COMMITTEE

ON

HEALTH

 

Tuesday, December 9, 2025

 

 

COMMITTEE ROOM

 

 

Seniors' and Family Pharmacare Programs

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

HEALTH COMMITTEE

 

Danny MacGillivray (Chair)

Adegoke Fadare (Vice-Chair)

Hon. Susan Corkum-Greek

Ryan Robicheau

Nick Hilton

Lisa Lachance

Rod Wilson

Hon. Iain Rankin

Hon. Derek Mombourquette

 

 

In Attendance:

 

Robin Dann

Legislative Committee Clerk

 

Gordon Hebb

Chief Legislative Counsel

 

James Charlton

Chief Clerk

 

David Hastings

Assistant Clerk

 

 

WITNESSES

 

Department of Health and Wellness

Dana MacKenzie, Deputy Minister

Lara Grant, Director, Formulary and Clinical Practice

Marina Keeping, Director, Pharmacare and Extended Health Benefits

 

Pharmacy Association of Nova Scotia

Allison Bodnar, CEO

 

Caregivers Nova Scotia

Jenny Theriault, Executive Director

 

North End Community Health Centre

Marie-France LeBlanc, President and CEO

Lana MacLean, Director of Mental Health and Community Outreach

 

CARP Nova Scotia

Bill VanGorder, Past Chair and Senior Spokesperson

 

 

 

 

HALIFAX, TUESDAY, DECEMBER 9, 2025

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

Danny MacGillivray

 

VICE-CHAIR

Adegoke Fadare

 

 

THE CHAIR: Good afternoon, everyone. I call this meeting to order. This is the Standing Committee on Health. I'm Danny MacGillivray, MLA for Pictou Centre and Chair of this committee. Today we'll hear from the Department of Health and Wellness; the Pharmacy Association of Nova Scotia; the North End Community Health Centre; CARP Nova Scotia, the Canadian Association of Retired Persons; and Caregivers Nova Scotia regarding Seniors' and Family Pharmacare Programs.

 

Please set your phones to silent. Please be sure not to touch your microphones. Staff will help you if you need any adjusting. Now I ask committee members to introduce themselves for the record by stating their name and their constituency. Go ahead.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, I also recognize the presence of Chief Legislative Counsel Gordon Hebb and Legislative Committee Clerk Robin Dann.

 

I'd like to welcome the witnesses here today. I'll ask them to introduce themselves, starting with Ms. Grant.

 

[The witnesses introduced themselves.]

 

THE CHAIR: We can move into opening remarks. If we can start with Ms. Grant, perhaps, or anyone who wants to prepare opening remarks.

 

DANA MACKENZIE: I do have opening remarks on behalf of the department. We appreciate the chance to speak about Nova Scotia's Pharmacare programs and to outline how we are ensuring Nova Scotians can access the medications they need in a way that is affordable, sustainable, and responsive to their circumstances.

 

You've already met my colleagues. I will take the opportunity, however, to reintroduce my colleagues Lara Grant, who is the Director for Formulary and Clinical Practice at the Department of Health and Wellness, and Marina Keeping, our Director of Pharmacare and Extended Health Benefits. I will be sharing my time with them today.

 

Pharmacare programs, as you all know, are vital to helping seniors, families, and vulnerable individuals reduce the financial burden of prescription drugs. They ensure people have support when they need it most. Approximately 160,000 seniors are enrolled in our Seniors' Pharmacare Program, one of the more generous programs in the country. Premiums and co-payment maximums have remained unchanged since 2007, and half of enrolled seniors pay no premium at all.

 

The program also offers income-based premium assistance and capped copayments to help keep out-of-pocket expenses manageable. We continue to ensure eligible older Nova Scotians have the information they need to make informed decisions when it is time to enrol.

 

Family Pharmacare also plays an important role for individuals and families who do not have private coverage or who face significant medication costs. The program is income-based, and once a family reaches its annual deductible and copayment maximums, the program covers the fully approved cost of eligible medications for the rest of the program year. This provides a meaningful financial safety net.

 

There are broader system realities that shape pharmacare programs, both here and across Canada. No provincial plan can cover every medication as the number and cost of new drugs continue to grow. However, our focus remains on ensuring pharmacare programs are strong, clear, and accessible. These programs play an essential role in supporting the health and well-being of Nova Scotians, and we are committed to continuing to evolve them to meet the needs of both current and future generations.

 

Thank you, and I look forward to your questions today.

 

THE CHAIR: I believe Mr. VanGorder might want to deliver opening remarks as well.

 

BILL VANGORDER: Thank you, Chair. The CARP Nova Scotia chapter really appreciates the opportunity to appear before you today. Our chapter of the Canadian Association of Retired Persons - our real name - has almost 10,000 paid members in the province, but CARP is a national, non-partisan, non-profit organization with over 330,000 members across the country in 27 chapters like ours. CARP seeks to take an active role in the creation of policy and legislation that impacts older Canadians, and CARP advocates on behalf of older Canadians on health, ageism, housing, and financial issues.

 

CARP Nova Scotia knows that the Seniors' Pharmacare Program in Nova Scotia provides important protection against very high drug costs, and we believe the government has done a good job in holding the basic costs of the insurance program at a constant level for the past 14-plus years. Our members are also aware that the staff of the department have done their best to make the coverage available to the seniors who apply, and they've been exceptional in their efforts to assure that everyone who applies has the coverage that they're able to access under the current regulations.

 

However, seniors in Nova Scotia are generally concerned about a number of areas. Number one is the overall affordability. Number two is the gaps in coverage. Number three is the complexity of the Seniors' Pharmacare Program, which in spite of the good efforts of the department - they try to make them more clear - they have difficulty understanding sometimes. The rules around what is and what is not covered can leave them with unexpected out-of-pocket expenses and premiums and copays that are still too high for those on fixed incomes. CARP is calling for changes such as reducing or waiving copays for more low-income seniors and improving protection for those with high drug needs. We argue that the current cost sharing can discourage seniors from adhering to their prescribed medications.

 

I look forward to your questions later on.

 

THE CHAIR: Does anyone else want to deliver opening remarks? Ms. Bodnar.

 

ALLISON BODNAR: I'm here today to represent the members of our association. We represent pharmacists, technicians, assistants, pharmacy learners, and pharmacies across the province. We are committed to advancing pharmacy practice for the benefit of our patients across Nova Scotia. Every year, our pharmacy professionals dispense over 14 million prescriptions, of which approximately half are for the beneficiaries of the Nova Scotia Pharmacare programs.

 

Generally speaking, our members feel that these programs meet the needs of many patients. However, there are concerns around communications, process, and affordability. In a recent member survey, only 38 percent of our members agreed that patients understand the programs and find them easy to join. Additional information and promotion of the programs would be helpful. Only 32 percent of our members believe that it's simple to transition a patient from private coverage to Seniors' Pharmacare. In many cases, a patient's previously covered medication is no longer covered or may become special authorization, potentially resulting in delays of care or medication changes, even when a patient is stable.

 

Only 34 percent of our members believe that their patients understand the consequences of not joining the program at age 65. We hear from many seniors who are struggling with the reset of the copay and payment of the deductible at the beginning of each fiscal year, and over 60 percent of members agree that their seniors struggle with these payments, resulting in delays or forgoing of treatment. Only 29 percent believe that their patients even understand that they can spread these copayments and deductibles over the course of the year.

 

With respect to the Family Pharmacare and community services programs, most of our members believe that these programs meet the patients' needs and that the $5 copayment is reasonable. However, they have heard many times that the annual renewal process and documentation requirements can be a barrier to care and lead to frustration in some of these patients. Furthermore, when these patients turn 65, it can be challenging to transition them from a $5 copay to a 30 percent copay. Many are unaware of this change, and it can also become a barrier.

 

Overall, the Family Pharmacare Program is not well understood by patients. Only 34 percent of our members believe that this program is understood, and 84 percent believe that the way the deductible is calculated is a barrier to care. With today's financial realities, even middle-income earners can sometimes not afford the deductible and forgo care. Consideration needs to be given to how that deductible is calculated and when to ensure that there are no patients in Nova Scotia who forgo medical treatment because of financial constraints.

 

THE CHAIR: Anyone else? Ms. Theriault.

 

JENNY THERIAULT: Good afternoon, and thank you for the opportunity to speak with you today. As I said, I'm Jenny Theriault, executive director of Caregivers Nova Scotia, an organization dedicated to supporting the one in three Nova Scotians who provide unpaid care for a family member or friend.

 

In our work providing navigation, education, and support, we hear how pharmacare policies directly affect seniors, families, and the caregivers who manage or support their medication needs. Caregivers often take care of the costs, the paperwork, and the emotional load when things get complicated or expensive, sometimes at a high personal cost. One caregiver shared that she discontinued her own pain medication so that they could afford her husband's cancer medication. Stories like hers show how deeply cost and access barriers can affect families' health and well-being.

 

Our hope is simple. When pharmacare is accessible, affordable, and easy to navigate, seniors, families, and caregivers experience better health outcomes, reduced stress, and greater stability at home. Strengthening these supports ultimately benefits families and the wider health system.

 

Thank you again for inviting Caregivers Nova Scotia to contribute to this important discussion.

 

THE CHAIR: Thank you, Ms. Theriault. Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: Thank you for inviting the North End Community Health Centre and giving me and my colleague Lana MacLean the opportunity to speak to the needs of a group whose strength, stories, and needs guide much of our work: the older adults and elders in our community.

 

At NECHC, we clearly see that aging is not simply a health outcome. It's a reflection of housing, income, culture, food access, community, and dignity. For many seniors, the idea of aging in place is becoming harder, not easier. Right now, the By-Name List - the list that identifies those experiencing homelessness in the community that we serve shows approximately 240 seniors experiencing homelessness in our region. These are grandmothers, grandfathers, residential school survivors, veterans, retired workers, and caregivers - elders who should be living in safety and connection, not navigating shelter systems, unsafe rooming houses, and chronic displacement. This is why our work in seniors' support must include housing support.

 

Ozanam Place is one example of what dignity-based, health-oriented housing can look like. It's not simply a building. It's a recognition that safe, permanent supportive housing is necessary for health. Opened just a little over a month ago, Ozanam Place offers housing for 38 people. As stated above, we had 240 people eligible for these spots. All residents who apply to live there must be chronically homeless, cycling between hospitals, shelters, and the street. At Ozanam Place they will have stability, wellness support, clinical care, and community-based programming rooted in safety and respect.

 

As we do this work, we must be explicit. Indigenous and African Nova Scotian seniors are disproportionately represented among those experiencing homelessness and poverty. Culturally appropriate, community-guided care is not an addition. It is foundational. Seniors deserve supports that honour identity, land, language, and cultural healing, not systems that overlook or erase their history.

 

While housing and clinical care are essentials, seniors also need expanded supports like appropriate pharmacare coverage - I emphasize the word “appropriate” - medication affordability and access to essential therapies. Too many older adults on fixed incomes are making impossible choices between medication and food, rent and mobility aids, and eye care and dental care. We see it every day.

 

[1:15 p.m.]

 

Aging with dignity must include access to the medications and treatments that keep people well, safe, functioning, and out of hospital. At NECHC, our clinic, MOSH outreach, community wellness programs, food security initiatives, and supportive housing work all reflect the same principle: Aging with dignity is not a luxury; it is a right. It must include housing, cultural safety, health care, and equitable access to medication and supports.

 

As leaders in community-driven health and wellness, we remain committed to every elder in our community - those who are housed, those on the margin, and those who are still waiting for a safe place to call home. They are the storytellers, knowledge keepers, and community builders who deserve nothing less than stability, belonging, and care rooted in respect. Thank you for the opportunity to share this.

 

THE CHAIR: Would anyone else like to deliver opening remarks? We'll move into the question-and-answer period. I remind everyone to wait for their microphone to turn on. The staff takes care of that. We'll wrap up questioning at 2:40 p.m. We'll start with the NDP. MLA Lachance.

 

LISA LACHANCE: Thank you so much, everyone, for being here. In the last year, B.C., Manitoba, P.E.I., and Yukon have all signed deals with the federal government to deliver free contraceptive and diabetes medications to their residents. My question to start is for the deputy minister: Why has the Government of Nova Scotia passed up this opportunity for Nova Scotians to have access to the same things?

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: In terms of responding, I think it's important that we talk about the very serious negotiations the Province engaged in with respect to the proposal that was on offer that our colleagues in B.C., Manitoba, Yukon, and P.E.I. availed themselves of under the national pharmacare program. By way of history, in terms of why Nova Scotia - I think you characterized it as passing up on the deal. The deal was actually looked at very closely. Whenever there's a proposal from our federal counterparts, the lenses of clarity, fiscal sustainability, and what is in the best interest in terms of improved care outcomes for Nova Scotians would be the lenses that we would look at and that we did employ with respect to the federal proposal.

 

We begin with the clarity of what was on offer. You will recall that those discussions happened in late 2024 into the beginning of 2025. At no time was there a specific monetary amount put before the Province of Nova Scotia. There was no template agreement offered, no draft language. There was a lot of follow-up that happened in terms of trying to discern exactly what would have been available to Nova Scotians.

 

The other piece that I think is really important to think about, notwithstanding that only four of the other 13 provinces and territories availed themselves of the deal in that period of time between January and March of 2025, is the fiscal sustainability piece. You will recall that the federal government's offer was for $1.5 billion over four years. The funding had an end. In provincial terms, we call that the fiscal cliff. With respect to the review that would have been taken of whether or not to take up on the offer, I think is the term you used, the availability and affordability of the programs for diabetes and contraception that were on offer were significant amounts of money.

 

The federal program was also proposed as a program of first payer. The federal government would be - what was on offer would displace all private insurance offerings in the same sphere. Careful review had to be done about whether spending was the absolute best use of resources in a very - I'm sure you can appreciate - compressed or stressed environment for financial resources in a pharmaceutical environment where there's constant demand for drugs of all kinds for many different conditions. The federal offer also bundled diabetes and contraception together. We actually did a lot of due diligence with respect to following up on the diabetes piece . . .

 

THE CHAIR: I'll call order. MLA Lachance indicates the answer was full enough, so thank you. MLA Lachance.

 

LISA LACHANCE: I have to apologize. We don't have very long for questions, so I appreciate that. I do have a couple of follow-up questions from that story. You said that there was never any number put on the table for Nova Scotia. I'm just curious why. Did Nova Scotia ask for a number? Did you ask to see a clearer deal? What do you think the status is now of federal pharmacare? Is it still on the table?

 

DANA MACKENZIE: Just to note that I'm not telling a story, I'm sharing facts. The characterization of my answer as a story is perhaps not accurate.

 

Yes, there would have been a lot of inquiries about how much would have been allocated and under what terms and conditions, which is the clarity piece. There were active inquiries made of our federal counterparts. You will recall that we actually did successfully conclude the drugs for rare diseases bilateral in the same time period because there was far more clarity offered on that side of the offer.

 

I think your question asks us to talk about - do you want to remind me about the second part of your question?

 

LISA LACHANCE: Do we expect the federal pharmacare offer to still be on the table?

 

DANA MACKENZIE: I think it's worth noting that the federal government recently published - the legislation that enabled the federal government to enter into universal pharmacare discussions with PTs - Provinces and Territories - empanelled a committee of experts who delivered its report in November of 2025. The federal government at that time - their response to that tabling was the fact that the recommendations were non-binding. We've always maintained a posture in the Province of being willing to listen, discuss, and entertain whatever the federal government is willing to talk about, and we haven't been approached with respect to that particular piece.

 

LISA LACHANCE: I think with the bundle of diabetes and birth control from my perspective and from what we know of the context of Nova Scotia, those seem like two ideal things for Nova Scotia to sign onto. I believe that Nova Scotia has the highest disease burden per capita of diabetes in the country. I hear from people all the time for whom the copayments and deductibles - where they have a lot of trouble managing their diabetes effectively. We know what can happen if it's not managed effectively.

 

I also think, with regard to contraception, specifically right now, there's so much disinformation being propagated to young people. I have two young adults. We've just gone through the teenaged years with them and their friends and many of their friends really not having access to contraception. They're maybe young people who don't feel comfortable going to the sexual health clinic at school. There were a number of unwanted pregnancies in their peer group which, of course, has a high cost in itself. The evidence that we have from B.C. is that there was an almost 15 percent increase in number of folks accessing certain types of contraception after B.C. started covering the cost, and they started covering the cost a bit before pharmacare.

 

I guess the question is: Why were these two areas in particular not prioritized in terms of getting access for Nova Scotians?

 

DANA MACKENZIE: I think that the question proves the point because diabetes is such a significant condition. For example, if we take the diabetes example that it was imperative to ensure that the most effective use of the resources on offer was going to prevail in terms of what was on offer. The fact that private plan coverages would be displaced and only certain medications for diabetes would have been included, excluding others, it was exactly that point that you're making that because diabetes is so prevalent in Nova Scotia and so important that we have to have a very finely tuned lens on what was being proposed. It's because of the degree of that problem in Nova Scotia for diabetes, for example, that the Province, in 2024, increased the Nova Scotia Insulin Pump Program and the Sensor-based Glucose Monitoring Program to such significant success, most recently in 2024-25. The contraception piece, with respect to them bundling together, the contraception is available under the Family Pharmacare Program.

 

When you're looking at all of those things together, you're trying to make sure of the most prudent use of public resources, and the fact that I think 160,000 Nova Scotians avail themselves of these programs - 195,000, actually, between the Family and Seniors' - we remain attuned to those issues. It's exactly why they're so important that we would want to be very careful about taking on a program that we would have to fund in the long term and make resource allocation decisions about in 2029 when it fell away - how it was going to displace private plans and coverages that exist for other people. It's not a simple proposition of turning money down or not. It's a very complex matrix of factors that we look at when we're looking at offers like this.

 

THE CHAIR: MLA Wilson.

 

ROD WILSON: Thank you, everyone, for coming today, and thank you, community members and pharmacists, for your candid remarks. I echo them, having worked in Canso recently. I've seen people who couldn't afford their meds and simply stopped taking them, so they showed up in emerg sicker than ever. I'm not getting a clear answer about what the Province is doing with pharmacare, so let's look forward. Given what you've heard - we've heard questions about accessibility costs - what's the plan going forward? What would be your advice to the minister in the upcoming budget and year for pharmacare, based on what we heard today from our colleagues?

 

THE CHAIR: I assume that's for Deputy Minister MacKenzie.

 

DANA MACKENZIE: With respect to the advice, opportunities like this are incredibly valuable to inform those briefings moving forward. I think that one of the things I heard quite clearly from our presenters here today is with respect to information-sharing about the program - how people can apply, how they can apply in a timely way, what their coverages are with respect to transitioning potentially between Family Pharmacare and Seniors' Pharmacare, or private pharmacare and Seniors' Pharmacare. We will definitely make sure that we are making Nova Scotians aware of the programs and how comprehensive they are with respect to coverages that exist.

 

The program is always growing with respect to the number of drugs that we're adding for Nova Scotians to the formulary. I'm going to ask my colleague Lara Grant, who is our Director of Formulary and Clinical Practice, to talk about the size and extent of what we added to the formulary in the past year, for example. That type of comprehensive knowledge about where the program is and the funding levels that are there is something we're always alive to in the department.

 

THE CHAIR: Ms. Grant.

 

LARA GRANT: As Deputy Minister MacKenzie has mentioned, we have added 196 new drugs over the last few years. In the last year alone, there have been 53 new drugs added. We're keeping up to date with our other colleagues across Canada as well, following through on what should be listed according to Canada's Drug Agency as well. Recommendations are up to date on that front. A lot of medications have been added recently for autoimmune diseases, and cancer of course. We have also adjusted criteria and attempted to streamline a number of things, make some medications full benefit as well.

 

ROD WILSON: I look forward to expansion of the program. What I have to go back to is, all of our community members keep saying the deductible is a barrier. We don't have a universal pharmacare program, hence people are doing without their medications. Two questions, and I'll try to be concise. Would you agree the deductibles are a barrier today, here and now? The other thing that blows my mind is that if you're late for signing up for the Seniors' Pharmacare Program, there's a penalty. Why are we having penalties? I expect there are savings to the government if the person is not using their medications or not getting them, yet they're faced with a penalty. We're hearing how great the program and coverage is, but there seems to be a penalty if people are late for whatever reason.

 

[1:30 p.m.]

 

Two quick questions. Would you agree the deductibles are a barrier, and what's the purpose of the penalties?

 

THE CHAIR: Once again, I assume that's for Deputy Minister MacKenzie.

 

DANA MACKENZIE: Yes, and I'll just preview that. With respect to both the deductibles and the barrier question, I'll call on my colleague Marina Keeping to talk about the deductibles that exist currently to give a bit of a frame for what they are exactly, and also some of the programs that we have about addressing the barriers that you're talking about.

 

To get to your question about penalties, in terms of people who apply late and who are assessed a penalty for doing so - that's a reality of funding an insurance program. If we were to only apply for insurance at the date at which the insurable event happened, there's no insurance plan that would be able to cope with that type of erratic funding. So part of it is related to stability and the nature of how an insurance program works. That's on the issue of the penalty piece. I think that's a bit of a table set that we have to work from in that particular line of questioning.

 

With respect to the size of the deductibles, I'll look to Marina, who runs the program for the Department of Health and Wellness, to talk about the deductibles under both programs and how they work. I'll hand the microphone to Marina at this point for that answer.

 

THE CHAIR: Ms. Keeping.

 

MARINA KEEPING: With the Family Pharmacare Program, it's a deductible and a copayment - a family deductible and family copayment. It's based on the family income and family size, so how much you pay would be relative to that. In terms of communication, there's a calculator available on the website where people can put in their income and determine what they would have to pay. The way it works is . . .

 

THE CHAIR: Order. MLA Wilson is satisfied with the response.

 

MLA Wilson with three minutes and 45 seconds remaining.

 

ROD WILSON: Excellent. I think we all know the deductibles and we all know that they're a barrier. Regardless of the cost, they're a barrier.

 

I guess my question would be in response to late signing up and the penalty that people endure because it's an insured program. We've also heard people aren't accessing information. What can the Department of Health and Wellness do to ensure that people know and sign up early and avoid these penalties?

 

THE CHAIR: Minister MacKenzie - or Deputy Minister MacKenzie.

 

DANA MACKENZIE: I've been elevated. (Laughs) I'm going to actually ask my colleague Marina to address that answer.

 

MARINA KEEPING: What happens when you're eligible to join the program is you get a package of information that tells you you're eligible now and you need to pay by a certain time so that you don't have to have a late-entry penalty. That message is reiterated in the brochure that goes out. It's also, of course, on our website.

 

If you don't sign up when you're eligible, then a letter goes out to remind you 30 days later, then another letter 30 days later, and then another letter goes out to you. You do get a number of opportunities where you would be made aware that if you don't sign up, there's a late-entry penalty that would apply.

 

The other thing that I think is really noteworthy is that we do sometimes make exceptions when someone would be normally paying a late-entry penalty. Those exceptions are made if it's a situation where someone has a cognitive impairment or there's a language impairment. Sadly, more often than we like, we do see situations where someone has a power of attorney who doesn't send the information in on time. If there's demonstration of undue financial hardship, we would make an exception.

 

Right now, out of the 160,000 people in the program, there are about 3,700 or maybe 3,800 people paying a late-entry penalty. The average late-entry penalty, just for context, is about $145 per year, which is roughly $12 per month. The maximum penalty would be about $18 per month - it's one and a half times your assessed premium.

 

If you think about it as well, about 50 percent of the people in the program don't pay a premium at all. If they signed up late, they would not have a late-entry penalty.

 

THE CHAIR: MLA Wilson with one minute and 25 seconds remaining.

 

ROD WILSON: Excellent. How do we get that number to zero? How can you get that number to zero from - is it 3,700, I believe - late penalty? How can you get it to zero?

 

THE CHAIR: A question for Ms. Keeping, I believe.

 

DANA MACKENZIE: Maybe I'll start.

 

THE CHAIR: I'll start with Deputy Minister MacKenzie.

 

DANA MACKENZIE: Getting any number in a public sector program to zero I think would be very difficult. It's a binary proposition that I think would be very difficult to achieve, but always in the attempt to get there. I think some of the programming we're doing, we're moving things online sooner rather than later and hoping to add the Seniors' Pharmacare to an online tool that, over time - because we have to live in both worlds, both paper and digital - will help us spread the news. Discussions like this today are really helpful as well to educate us all about how we can better inform Nova Scotians about avoiding penalties, the reason for them, and encouraging people to attend to the issue when it shows up in their mailbox three times. We're always looking at ways and discussing how we can get the message out better, and today is a great example.

 

I cut Marina off, but I'll let you take it from there.

 

THE CHAIR: Ms. Keeping with four seconds remaining. (Laughter)

 

MARINA KEEPING: We're doing lots. (Laughter)

 

THE CHAIR: Thank you. We'll move on to the Liberals and MLA Rankin.

 

HON. IAIN RANKIN: Thank you, Chair, and thank you all for being here today on an important topic. I think with the context of today with seniors trying to keep up with costs unrelated to drugs and, of course, related to their medicines and making the choices that were referenced today, as an example, with their partner in trying to afford a power bill and trying to afford all the other costs - groceries going up.

 

I think today we can get more answers. We're starting to find out why the agreement hasn't been signed with the federal government. But I am curious, given that there was an answer that it is a four-year fixed agreement offer, this provincial government gives grant money to organizations across the province - several, hundreds and hundreds - and they often say there are challenges with that fixed term, yet the Province still delivers funding that community organizations depend on year after year. It's not atypical for governments to fund really important things and not have some kind of end date where there's a renewal. I think, to put it politely, that it's a stretch to say that it would be an impediment to say no to significant funding that's going to help our seniors.

 

Another example is the child care agreement. We know that was a certain number of years for $605 million. Our Province signed on, as did every other province in the country, and that was a fixed term like the offer that's on the table. Not only that, but this government actually signed the extension to that agreement - the child care agreement. It's not in perpetuity; there are always renegotiations.

 

My question around this is: Has the government said no? Are they at the point now where they're not going to entertain a pharmacare deal based on the fallacy that this somehow is an atypical arrangement with the federal government that money runs out? As part of that answer, did the federal government actually ever say that there won't be funding beyond 2029?

 

I find it hard to believe that there wouldn't be an entertaining of extending the agreement. No government comes up with a significant program like this at the scale of the child care program with plans to abruptly end it. That's why B.C. signed on. That's why a number of provinces have signed on. Different parties - P.E.I. next door with the PC government have signed on because they're willing to accept the hundreds of millions of dollars to help and work together with another order of government to see this program through.

 

I think most Canadians want to see coverage for diabetic care and for birth control in perpetuity, and it has to start somewhere. Is the government at a point now where they're saying no, and is it because they're not guaranteed funds forever?

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: To answer your question, the government has not said no to the pharmacare discussion. We await an outreach from our federal partners with respect to what the current iteration might be. I note that the federal budget had no allocation for it, so that might be a message in and of itself. Unclear, but we remain open to those discussions.

 

With respect to the fact of the fiscal cliff sometimes not being a deterrent in other contexts like the agreements you referenced and the fact that government funding is typically term based, that is true, but it actually becomes incumbent on decision-makers to ensure that, if the funding isn't there, there's affordability and practicality and prudence built into whatever does get built, so that it is responsive and the best use of public resources that it can be. Without clarity with respect to coverages and flexibility, that type of investment doesn't become very easy to assess when not only do you have a fiscal cliff, but a real lack of clarity with respect to what the impacts are going to be on your system about displacing private programs and also whether there'll be federal funding moving forward.

 

I note that in health care, for example, we did hit a fiscal cliff with the federal government recently with the COVID vaccine, where they exited that funding last year. We do see it happening in our context in other domains as well, where there will be a discontinuation of a program.

 

To sum up, the Nova Scotia Government has not said no to pharmacare discussions, and we await any type of overture that might be made with respect to it. I'm going to look at my colleague Lara to see if she has anything to add in that regard.

 

THE CHAIR: Ms. Grant.

 

LARA GRANT: Also, in November, there was a report released from a panel of experts. It was commissioned by Health Canada to look into national pharmacare and make further recommendations. We reviewed that closely. It's a report with recommendations to the federal government. We're discussing that both internally and with our colleagues across Canada. A lot of the recommendations focused around essential medications and what should be funded federally. I believe they looked at a list that originated out of the World Health Organization. There were 790 medications they looked through; 500 and some they recommend be included in the essential medications list. There is still lots of work going on in this space for sure, and we're keen to continue those conversations with the federal government as well.

 

IAIN RANKIN: I'm just curious if that is the reason that it's a fixed four-year, $1.5 billion, then if that term and condition doesn't change, then it sounds like it's a no. Is that a red line for the government, that if it's not funding that won't be available in perpetuity, which I don't think it ever will be, then it's a no from the Province of Nova Scotia?

 

THE CHAIR: I believe that's for Deputy Minister MacKenzie.

 

DANA MACKENZIE: Just to clarify for the record, the idea of the fiscal cliff was not the only prohibitive factor with respect to Nova Scotia's position on it. It was a factor in the analysis as the discussions continued, and that conversation changed, obviously, over the past eight months since the spring of 2025. We're always open to whether they want to provision in-year spending to make sure that Nova Scotia's needs - and whatever we would identify as being most appropriate for coverage. I can't say that it would be a no. We were interested in obviously having the discussions.

 

IAIN RANKIN: Interested, but probably not interested enough to accept $375 million a year it seems is being left on the table. Is there analysis that can be publicly available in terms of the cost-benefit of signing on or not? There are incremental costs that we focused on today relative to the diabetes medication and birth control, but there would be savings within the pharmacare program. I'm just wondering if the department can provide any kind of analysis that looks at - or even tell the committee where the savings are that we would achieve in the provincial pharmacare program by leveraging federal funds.

 

DANA MACKENZIE: We could do an analysis, for sure, and share that with the committee.

 

IAIN RANKIN: I would venture to say that most committee members would want to see eventually coverage for birth control and coverage for diabetes care. If we can make that assumption, and the government is interested in that, which I think certainly members of the government would be, what are those costs for eventually the government taking on that cost alone?

 

[1:45 p.m.]

 

I speak to that because there is a massive opportunity in front of us with federal funds. I wonder if the department, if they were negotiating with the government, this would be probably the first thing you would look at. What is the cost, if the government is giving direction that they're interested in it? What would be the cost for the Government of Nova Scotia taking it on alone, versus leveraging the federal funds to taking on the coverage for diabetes medication and birth control?

 

DANA MACKENZIE: With respect to your question about the funding that would have to happen to cover off the federal contribution, because of the particular characterization and information that was on offer, the estimates, I think, to cover the contraception and the diabetes was $35 million, I believe, to $80 million per year.

 

IAIN RANKIN: And it's the government's intention that that's just too much of a fiscal pressure on the budget, despite the billion-dollar overspending that we're seeing year over year by the government? This didn't fit the criteria of the government incurring that incremental cost?

 

DANA MACKENZIE: There would never have been an analysis that this cost too much. It was an analysis about what was on offer. With respect to what would be left to be paid by Nova Scotia, if those particular drugs were left unfunded at a future date - it's not a binary that it was too much money. It's a proper use of resources with respect to how much would be displaced from private coverage, how much coverage that would actually achieve for marginalized groups, and what the downfall would be of displacing and going with a national formulary versus what would be available privately for Nova Scotians.

 

In the landscape of what could be covered with that money with respect to all other drugs that get added to the formulary over time - what is the relative comparability of that analysis? It wouldn't be accurate to characterize it as just too much.

 

IAIN RANKIN: It was noted that the stage of looking at a potential draft or any kind of agreement - that we were nowhere close to that. It's fair to say - to characterize it as not in the remote possibility that there could be an agreement. Like, there were no details shared back and forth. I think you said that. I don't want to misquote you, but earlier on, you said that there was no draft type of agreement even contemplated.

 

DANA MACKENZIE: I'll look to my colleague, Ms. Grant. She can correct me if I'm wrong.

 

With respect to the actual number that would have even been in play for Nova Scotia, that wasn't received from the federal government either. That would have been a key piece.

 

I'll hand the microphone to Lara to elaborate on that.

 

LARA GRANT: Yes, we had reached out a number of times to the federal government to continue conversations and get more specifics, but unfortunately, after the election there hasn't been any communication. We remain ready to listen to more details that we would need in order to move forward.

 

IAIN RANKIN: Why would you wait until after the election to follow up and reach out? The federal government provided four provinces and a territory with numbers and Nova Scotia didn't get numbers and you waited until December to get these numbers?

 

LARA GRANT: It was the federal election that I was speaking of. Prior to that, there were those offers signed. We had been made aware that they were running out of money, and as Deputy Minister MacKenzie has mentioned, it wasn't in the recent budget announcement. We haven't been told what that means for us. But that money had been spent by the federal government prior to the election.

 

IAIN RANKIN: The program was characterized earlier as one of the most generous in the country - our provincial program. I want to talk about some of the out-of-pocket spending and capping of it. I know that some provinces have a wider range of meds that they do these caps for. Currently caps are obviously only eligible for the eligible drugs that are covered. With respect to the current formulary, the drugs that are not on the formulary do remain out of pocket. I think that's a really important part for our fixed-income seniors. I want to ask: How do we compare in terms of what is covered, and what is the authorization processing time of catastrophic drugs?

 

LARA GRANT: We had actually undertaken over the last couple years a very comprehensive comparison of our formulary across Canada. We also reviewed almost 400 Canada's Drug Agency recommendations that had been issued over the years and found that we were in line, both with other provinces as well as the recommendations. We are very up to date in what medications have been released, as well as what other provinces and territories fund.

 

In terms of the turnaround time, I believe you asked, it depends if the medication is considered urgent. If it's urgent, it's a one-day turnaround for a response on the request. If it's non-urgent, it could be up to six days, but it could be less.

 

IAIN RANKIN: My understanding is there is a wider range of drugs that are capped in different provinces, but maybe you can correct me if I'm wrong on that.

 

I do want to also ask: The issue around when folks do turn 65 and enter into the program. It was often brought to our office that they were not able to stay on the existing medication that they were on that worked well for them with blood thinner medication and other types. I wonder if there's any progress that has been made in making those kinds of decisions to ensure that consistent delivery of medication. The specific kind of medication is often important to patients. I was wondering if there was progress on that issue.

 

LARA GRANT: It's an important issue that we're aware of as well, and we've been making steps to alleviate this stress on patients joining the program. The anti-coagulants that you speak of as well, we've also made those full benefits along with a number of other products just to alleviate that process and streamline administrative burden as well.

 

We also work with patients on a case-by-case basis. If there's a medication that would be detrimental to their health - destabilizing - we can work with them and their prescriber on getting the information we need in order to determine how to make that a consistent transition for them.

 

IAIN RANKIN: Finally, we have a lot of anecdotal examples. One was referenced today in terms of how many seniors actually forgo prescriptions due to cost. When you're making these kinds of decisions on the formulary and out-of-pocket expenses, what kind of data do you have in the department that actually tracks how many seniors are actually making these decisions? Do you track that kind of data?

 

DANA MACKENZIE: I was just conferring with our director of the program to figure out how we track those things. With respect to the anecdotal information about an individual who privately makes a decision to pay for a medication or not, one of the most frequent channels we hear through is our correspondence files. As you would appreciate, we get a lot of communication from the public addressed to the Minister of Health and Wellness and the Department of Health and Wellness. We respond to all of them and track, and there will be reach-outs as appropriate when the issue is raised to our attention. We also would have, in some instances, like Dr. Wilson experiencing in the ER people who would have foregone - we would hope that would find its way back to us from the NSHA, from information that would have been provided to us about particular challenges individuals were having. There's always a willingness on the part of the department to even reach out at the individual level when we're made aware of something.

 

It's incumbent on us, as it always is, to advertise the program, to be as comprehensive as we can with respect to seniors knowing about the program and being able to avail themselves of some of the copayment forgiveness programs and premium forgiveness programs and things that are in play.

 

THE CHAIR: MLA Rankin with eight seconds remaining.

 

IAIN RANKIN: Do you have an estimate of how many seniors are not able to afford the copay on the program?

 

THE CHAIR: Deputy Minister MacKenzie. Order. Sorry.

 

We'll move on to the PC Party. MLA Hilton.

 

NICK HILTON: Thank you all for being here. I just want to come back to your opening remarks and say how powerful they were. I heard the fact that many believe that there are a lot of good things happening with the pharmacare programs. I also heard that we have some work to do around information sharing with seniors, maybe through our offices, things like that. I just wanted to get started with a high-level overview of the Seniors' and Family Pharmacare Programs, and just ask how many people are using them, how much the government is spending on them. I guess that's more of a question for the department. I do apologize. I know we have witnesses here who haven't had a question yet, but we'll start with the department, if you don't mind.

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: Just let me pull up my notes here. Seniors' Pharmacare is about a $280 million program, and Family Pharmacare is an approximately $60 million program. I think it's about $58 million currently. I'm rounding up there, but $58 million, and about $280 million. With respect to Family Pharmacare, in 2024-25, 30,000 people were enrolled in Family Pharmacare, and government paid those claims, which results in that approximately $60 million number. With respect to Seniors' Pharmacare, there are 157,000 people enrolled in Seniors' Pharmacare. That would result in the claims being paid of about that $280 million. You can get a bit of a sense there of how many people are enrolled and then what that rolled-up number is.

 

My colleague Lara talked about the number of drugs that are added to the program every year. That's something that I think people don't really see a whole lot because they get added to the formulary, but they do represent a significant pressure with respect to the program. There were 196 new drugs added to the Nova Scotia formulary since April 2021. In terms of new therapies and expanded indications for last fiscal, 2024-25, that's about $13.5 million annually. Those are the numbers with respect to how many people are in the program and what the spending is.

 

NICK HILTON: Maybe a question for Lara: What are the types of drugs most commonly accessed by Nova Scotians?

 

THE CHAIR: Ms. Grant.

 

LARA GRANT: For the Seniors' and Family Pharmacare Programs, the most commonly accessed medications are medications for treating cholesterol, stomach acid, thyroid, and blood pressure; there are also inhalers, diabetes medications, and diabetes supplies as well.

 

NICK HILTON: Clearly, the topic today has been a lot about the agreement with the federal government. It's nice to hear that we are already adding some of those medications to the formulary. Your comments today have been heard loud and clear that if there was an agreement to be made there with the federal government - I believe in hearing that the Nova Scotia Pharmacare programs are working - if there was an agreement there, we would be making that agreement.

 

[2:00 p.m.]

 

Just talking about the formulary again, you mentioned the 196 drugs. Can you speak to the process in the decision that - how one medication gets added to that formulary?

 

LARA GRANT: It all starts with Health Canada. A drug gets reviewed there for safety and efficacy, and then if it gets cleared by Health Canada, it is safe to sell on the Canadian market. Typically for publicly funded programs, it would progress to Canada's Drug Agency, and they would review it as well for evidence related to safety, efficacy, but also cost effectiveness. For cost effectiveness, of course, they would take into consideration what is already funded, how it impacts the disease state, and the value to the health care system as a whole.

 

After that, we would get a recommendation depending on the evidence that was reviewed by the expert committees. We would get a recommendation that's informed by experts on the committee, as well as patient advocacy groups who can have a voice, which is very important at the table as well. The recommendation, if it's positive, is usually contingent on a better price to bring it into a cost effectiveness range.

 

In that case, it would proceed to the pan-Canadian Pharmaceutical Alliance, which is our collective across Canada that negotiates drug prices with drug companies in order to get them into that cost effectiveness range. After that occurs, if the negotiation is successful, we develop agreements with drug companies. Then we can proceed to listing on our formulary and making that announcement in our pharmacare bulletins.

 

THE CHAIR: MLA Fadare.

 

ADEGOKE FADARE: Thank you for being here, everyone. I think I'm glad, just listening to the DM speak today. I wasn't sure really about the federal government agreement, and we can see clearly that there's nothing to hide. We can see clearly that the government is really working hard on behalf of Nova Scotians. Yes, there might still be gaps in terms of communication and that, but we can clearly see that there's a lot of work that is happening. Just the thought about 196 new drugs since 2021; just last year, a little over 53 new drugs. I think we're not sitting on our hands, right? While there's no deal yet, we're obviously expanding how we can reach and help our people. I think that needs to be clearly stated and said today.

 

My question goes to the department. Nova Scotia is part of the National Strategy for Drugs for Rare Diseases. I understand that work is already helping people. I just wanted you to be able to speak more about a worker's (inaudible), how the frustration level has been, and the strain in supporting patients here at home in Nova Scotia, because one of the things I've heard clearly today is that we don't accept just any deal. Why? Because Nova Scotians expect us to do the best for them. I think it's important because there might be some thoughts around the table that feel like we should just take anything, but we need to recognize that we need to do what's best for our people.

 

Please, can you talk to us about how we've been supporting patients here at home around rare diseases? Do you think you could speak a bit about that? I know people have started engaging with the program itself. Could you just talk to us about it, especially on a level around that, please?

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: I referenced this earlier. Around the same time as the national pharmacare agreement was the bilateral agreement with respect to drugs for rare diseases with the federal government. That offer was for $39 million spread over three years, so $13 million a year. Nine new therapies have been funded with the support of that federal funding. Those include therapies for a variety of rare conditions, rare cancers, and CAR T-cell therapy.

 

With respect to the number of Nova Scotians who have been helped, I don't have that exact number. I'm happy to share that with the table. My colleague Lara can probably - we can get more information and share it with the committee with respect to the number of Nova Scotians who have been helped.

 

One of the things in the back and forth with respect to the drugs for rare diseases piece, one of the important things for us was to ensure that there was a portion of money attributed to screening and diagnostics so that we weren't just actually dealing with the rare diseases on the pharmaceutical front, but also being able to use some of that federal funding for issues like screening and diagnostics. We were able to achieve that in those discussions with our federal counterparts.

 

They also agreed that with respect to the funding that was available, they could dedicate a resource to the Department of Health and Wellness - a funded position to work on the drugs for rare diseases file because when those exceptional cases come forward, they are very expensive, but we want to be able to participate meaningfully in them.

 

The back and forth in the discussions on that particular agreement were quite fruitful with respect to creating a dialogue about participating in research and evidence-gathering with respect to the common set of drugs that had been identified by the Province - by all of the provinces and territories working with the feds for the common set of drugs that would be the original set we'd be working off. There was a lot of flexibility built into the deal to ensure that rare diseases that might be more prevalent in Nova Scotia - we could also fund those and have that flexibility with respect to not actually being hamstrung by the common set of drugs that were in play there. We're very excited about that work, and we think it's a good arrangement for Nova Scotians.

 

ADEGOKE FADARE: Could we bring it down to the human experience for families because it's good. Sometimes people will see data here, but they don't know how the stories are. Could you help with examples or experiences of how families depend on those rare, highly expensive, highly costly drugs? Can you share experiences in terms of - because I want it to be people you know, people who have been part of this process. Could you share experiences on how families who depend on it - how their experiences have been so far so that we bring it to the human point? Beyond all data, there are always people behind that.

 

DANA MACKENZIE: I don't have a specific example that I can point to because I don't work at the program level. Our colleague Kathleen Coleman, who is our dedicated resource, works in that space and has for many years. I think that perhaps to give some narrative, I'll look to Lara to talk about what the experience can be in a general, anonymized way when somebody needs a drug for a rare disease, then maybe just generally describe the process that existed prior and what prevails now when there's some funding available.

 

THE CHAIR: Ms. Grant.

 

LARA GRANT: I've had the privilege of being involved in a few cases with approvals for drugs for rare diseases. I recall one particular case - it was for a child who was four at the time. It was for a medication that had to be administered out of province, so there was a lot of coordinating with the family, as well as the out-of-province treating province and the physician specialist as well. It was a real privilege and honour to be able to work at that level and really see a positive outcome back and forth with the specialist on how the patient was doing after having received the medication. The family and the patient were so grateful, of course. Just to see that side of it as well really brings that human element, which I think is so important in all of this conversation as well.

 

ADEGOKE FADARE: Because all that we do is for people. If we ever lose sight of people, then everything we do would be meaningless, right? It would just be theoretical. I think that's always important for us to underscore and to bring to the fore.

 

I know we've heard a bit about diabetes today in terms of the number of Nova Scotians who are ravaged by it or experiencing it. I'm also aware that there's been a lot of expanded coverage and services around the support that we have for people who are experiencing that. I know things through the medical wigs and also through diabetic accoutrements.

 

I just wanted you to be able to speak about what this difference is making on the ground. Like I said, I wanted you to do more of the human side of it because today, there was a lot of information that was being passed. Unfortunately, people were calling out quickly. I think that was wrong because you would have been, I think, very educated today. I was learning some new information, and it was helping me clear out some whatever assumptions too. It's important for us to remember that this is about people, and people have this opportunity to not just be a traffic warden, to get through traffic, but also being able to offer people the opportunity to have valuable information that might be imperative to be able to help change the trajectory of their lives.

 

I just want you to talk on how these expanded services are on the diabetics - how the accoutrements, the coverage, are helping people on the ground and how people are responding to these expanded services. Anyone from the department.

 

DANA MACKENZIE: I'm going to actually rely on Lara for this one as well to talk about the diabetes program that has seen some increased investment in 2024-25. She'll be better able to talk about some of the exact improvements and what they mean on the ground for Nova Scotians more meaningfully than I can.

 

LARA GRANT: Thank you again for the opportunity to speak at the individual level. For diabetes supplies, we had been hearing from patients as well as parents who have children with diabetes. They had a lot of concerns around low blood sugar levels throughout the evening and things that could be very detrimental to their children's health. We had worked to put in place funding for a number of sensor-based glucose monitoring products. We announced that last June as well. The uptake has been fantastic.

 

Before rolling it out, we did collaborate with diabetes clinics, diabetes education centres, with patients and parents to get the input that we needed in order to roll out the program that would fit the need most relevant to this population. Since that time, we've heard really great benefits, in particular around parents who have young children. I can imagine that would be a scary thing - going to bed at night and not being able to know what their blood sugar level is, or having to wake them up through the night and prick for the traditional blood glucose test strip method. This has been a great program and offers parents that peace of mind, really, in order to know what their children's glucose levels are throughout the evening as well.

 

It's things like that that really help the population. When you know you put that work in and it turns out the way that you'd hoped it would, it's very rewarding, for sure.

 

THE CHAIR: MLA Fadare, with three minutes and 20 seconds remaining.

 

ADEGOKE FADARE: Do you have a quick example to show, like you had regarding the rare disease one? I'm just wondering if there's an example to share. What I hear today is that we're definitely not sitting on our hands, right? Yes, there are some waiting for some help to come from outside, but internally, we're doing what we can for Nova Scotians. Is there any example you want to quickly share about that?

 

LARA GRANT: The example that comes to mind is like previously mentioned, we get ministerials - people writing in. Prior to announcing the expanded funding for the Sensor-based Glucose Monitoring Program, a lot of the letters we received showed a lot of concern and worry. It's been great to see after the gratitude and the real-life stories of the difference it's made in their lives and what they've been able to do now that they couldn't previously - for caregivers out there as well.

 

THE CHAIR: MLA Robicheau, with two minutes and 20 seconds remaining.

 

RYAN ROBICHEAU: Thank you to the witnesses. Just to change course a bit here, this is for the Pharmacy Association of Nova Scotia. Can you talk about the role of expanding the scope of practice and the pharmacy primary care clinics? We have one in our area, and we're very proud of it. They provide timely and appropriate care. Do we have data to share on access or patient satisfaction? Just discuss that.

 

THE CHAIR: Ms. Bodnar.

 

ALLISON BODNAR: I do. We issued a final report last year that shared all of that data. What I can say from memory - I wasn't prepared to speak on the clinics today - is just over 200,000 clinical appointments that we conducted over the period of that pilot program, with exceptionally high satisfaction rates - I think something in the neighbourhood of 97 percent rating service between an eight and a ten. We treated about an equal number of attached and unattached patients.

 

[2:15 p.m.]

 

We did a fair amount of work in acute areas - things like strep throat, common conditions; those would have been in the highest numbers on the acute side - and then did a lot of chronic disease work to support patients, both unattached and attached, to support other primary caregivers to allow them to spend more time doing higher-value work - allowing the pharmacist to manage patients who needed ongoing, let's say, blood glucose monitoring, whether they needed having their blood pressure checked periodically. Those are things that can be done in collaboration with a primary caregiver or if the patient doesn't have one, taking care of them. We saw a lot of patients come through those clinics who hadn't been cared for in a number of years, who got back into the system.

 

It's been great for Nova Scotians. It's also been great for our practitioners. These are highly trained individuals who have for decades been working below their scope of practice. It's really nice to see a collaboration with the government that allowed us to better help patients but also to finally recognize the role that these professionals should have been playing for a long time.

 

THE CHAIR: Order. Thank you very much.

 

We'll move on to our second round of questioning. It'll be eight minutes per party. I'll start with MLA Lachance.

 

LISA LACHANCE: I think it's clear to us and to what we've seen in our offices - it's not just about information sharing. There are very real affordability issues with the current pharmacare programs.

 

For the North End Community Health Centre - when I look at the fact that a single individual earning $25,000 a year would have to pay almost a thousand dollars before the pharmacare program starts to kick in - are people whom you support in your clinic able to afford out-of-pocket costs for things like birth control, or are they going without?

 

THE CHAIR: Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: I'm actually going to let Ms. MacLean answer that. Yes. I'll just you answer.

 

THE CHAIR: Ms. MacLean.

 

LANA MACLEAN: We are a very unique organization. Where the need is, we will do our very best to fill in the gap. We are also an organization that partners very well with other community organizations like the Halifax Sexual Health Centre. When folks are experiencing chronic illness and there is a gap in affordability, we take the lemons and make lemonade.

 

To answer your question: The majority of our patients have a high level of distress, particularly folks who are in the senior category. The general population of our patient population - most of them are on income assistance. We work with our social workers and our housing-support workers to navigate care systems. I would say we do our very best to create ways where folks can get access to care, particularly their medication. There are days we are not successful, but we leverage partnerships and capacities and relationships with our pharmacy that's connected in our building to offset some costs for people.

 

THE CHAIR: MLA Wilson.

 

ROD WILSON: Mr. VanGorder, you mentioned that CARP has concerns about the deductibles and the copay. We know at the same time that all of us - and seniors renting have experienced increases in rent, electricity, water. Putting all that together - and this is probably a question for either you or Caregivers Nova Scotia - something's got to give. What's the impact and what's the gap that the deductibles, along with all the other living expenses, are having on our seniors?

 

THE CHAIR: Mr. VanGorder.

 

BILL VANGORDER: A good question, because any kind of increase is affecting seniors who are at fixed incomes. It doesn't matter whether your fixed income is here or here - if there's an increase, then it affects, and certainly it's an increase that we're concerned about. We also know and understand that there needs to be an increase to the coverage. It puts seniors on the horns of a dilemma. We don't want our taxes to go up, but want to have those increased services. For the last 14-plus years, there have been no increases. Our suggestion is that we look carefully at going back to the 25/75 split between the government and the payees rather than the 30/70 that came back a few years ago. There has to be a way to balance this so that we don't ruin the program in one way by trying to support it in another. That's when we would like very much to work with the department to try to come to some way of handling that.

 

ROD WILSON: Ms. Theriault, any thoughts on what gives - how are people making out with this?

 

THE CHAIR: Ms. Theriault.

 

JENNY THERIAULT: I would just agree with what Bill was saying. To further expand on that is, in general, caregiving - there are a lot of outside expenses and financial strains related to caregiving. Many caregivers have to leave work altogether or reduce their hours related to caregiving. There are costs related to respite and adult day programs. There are a lot of additional costs related to caregiving to begin with. Furthermore, many caregivers, it's almost as if they're penalized for being a caregiver, if there's a caregiver there in that situation. I think medication should not be something that has to give in this case. Yes, there are also tons of financial strains on caregivers. Definitely something always has to give, and it certainly shouldn't be medications.

 

THE CHAIR: MLA Lachance, with two and a half minutes.

 

LISA LACHANCE: Just quickly, one of the other medications that we've been really concerned about the uptake and accessibility of in Nova Scotia has been the use of PrEP. We understand that only 8 percent of PrEP eligible users in Nova Scotia take the medication. In B.C., Alberta, Saskatchewan, Manitoba, and P.E.I., people can access PrEP at no cost at all. Both MLA Wilson and I have met repeatedly with numerous people, community members who just can't afford - even with it on the pharmacare program - they cannot afford the copay for PrEP.

 

We've made this case before at this committee. We understand there was a proposal for universal access to PrEP that was developed in the department. I'm wondering where that proposal is and will the department be implementing it.

 

THE CHAIR: Deputy Minister MacKenzie, with one and a half minutes remaining.

 

DANA MACKENZIE: I know we've been in discussions about PrEP as well, and I think it's more appropriate if we respond in writing to the committee about the current PrEP programming we're doing inside the department.

 

LISA LACHANCE: Maybe we can get a preview here today at committee. Is there a current proposal in the department for universal coverage of PrEP in Nova Scotia?

 

DANA MACKENZIE: I haven't seen one. That doesn't mean one doesn't exist. I'm going to ask my colleague Lara to speak to what we're doing currently with PrEP.

 

THE CHAIR: Ms. Grant, with 27 seconds remaining.

 

LARA GRANT: Like Deputy Minister MacKenzie said, we can certainly respond with a fuller response on the universal PrEP. What I can say is that we have updated criteria recently in response to the last standing committee around PrEP. We had heard loud and clear that there was some language in there that needed to be updated. We have made those changes, as well as listed Apretude, which is a great advancement . . .

 

THE CHAIR: Order. We'll move on to MLA Rankin.

 

IAIN RANKIN: I just wanted to ask about the vaccine for shingles. Back in the spring of 2025, there was a commitment for publicly funded doses of the Shingrix vaccine for eligible seniors over 65. I wanted to ask the question, because I've heard from some physicians that they have very few doses for their patients. Just a question around the tracking of this. When you're looking at how many doses to put out in the community, how many eligible seniors have received the vaccine since that coverage has begun? I'll start there.

 

THE CHAIR: Deputy Minister MacKenzie.

 

DANA MACKENZIE: The shingles vaccine program is actually run out of our public health group. If it's okay, I think it's probably best if we reply in writing to get you those numbers. Just to be sure, it's how many eligible Nova Scotians received the vaccine over the 65?

 

IAIN RANKIN: Yes, since we're able to get a comprehensive response, I was going to go to how many individuals are actually eligible and what's the annual budget for the program? Then we'll see if there's enough budget to cover the number of vaccines we need for the senior population and what the uptake is like.

 

I just want to ask the organizations that are here and the Pharmacy Association of Nova Scotia their thoughts around the national pharmacare agreement, what we're seeing in other provinces, speaking to your counterparts and learning from the advantages of having the agreement and the increased federal funds, how that might be able to help in the province to confront some of the barriers that our senior population is facing. So comments from any of the organizations that are here.

 

THE CHAIR: Ms. LeBlanc.

 

MARIE-FRANCE LEBLANC: That's a big question but thank you for it. I think that, really, anything is helpful in our situation. My colleague spoke to this earlier. We see those decisions being made all the time, but we also see people who don't even have the opportunity to have the decisions. Earlier, we were talking about them finding out about the pharmacare - that they get mailouts. Well, they don't have mailboxes so they're not even getting the information. Our social workers are overwhelmed with trying to meet up with all of the various - the paperwork, and then you find out that they're getting a penalty, and who's going to pay for the penalty - all these various factors.

 

For us, and the population we serve, and the people we see every day, we would just advocate for a universal system, whether it's federally paid or provincially paid. We don't have the ability to support all of the individuals who need this. We also don't have the ability - when we're talking about various types of pharmacare, when we're talking about the Family Pharmacare, what we're seeing is that because there's an annual fee, they're not paying the annual fee, hoping that nobody actually gets sick and that they need the medication. Then when they do, they come and see us and they're like, “Okay, how do we fix this?”

 

We have lots and lots of wonderful partnerships. As a not-for-profit community, we work very hard to support those individuals, but it would be great if we had the opportunity, in particular for the populations that we serve, to have a different venue in order to achieve our goals.

 

THE CHAIR: Is there anyone else who wanted to speak to that question? Mr. VanGorder.

 

BILL VANGORDER: CARP is very concerned about the federal pharmacare. We would call it a framework, not a program. It's got two drugs. Our friends at Diabetes Canada, when we were working with them and concerned about seniors and diabetes, found that the drugs that were being covered were not actually the ones that Diabetes Canada nationally was recommending in the first place. In many ways, we've positioned it - what we have now is a kind of blanket approach with all kinds of holes in it, and what's being proposed is more like a piece of burlap, which is broader, but still not the quality that we want.

 

We're really concerned about what happens to our members who already have private insurance, and why shouldn't they continue to be covered and have this as an addition so people who really need coverage from pharmacare can get it. We have some huge questions about the current national pharmacare program, which we understand from talking with our contacts in Ottawa is not on their radar at the moment with all their other concerns - not something we think we're probably going to have to deal with in Nova Scotia for a while.

 

[2:30 p.m.]

 

IAIN RANKIN: I just wanted to bring up the IWK Foundation's recent survey, The Voice of Maritime Women, that found that 75 percent of women admitted to delaying or avoiding care altogether. I just want to ask our witnesses - organizations - here if they see women disproportionately unable to pay for and therefore missing doses of their medication due to high costs.

 

THE CHAIR: Ms. MacLean with two minutes remaining.

 

LANA MACLEAN: It is certainly a demographic that we at the North End Community Health Centre see frequently - mums who are deferring medication for the needs of their children or food. We certainly see disproportionately our street-involved women who don't have access to their health care in a timely and affordable manner. What women tend to bear is a lot more disproportionate shame about how they're not taking care of themselves, when in fact there are so many social determinants of health that disproportionately impact women's wellness than it does for other communities. Then if you add issues of gender, orientation, or race, those compound for women even more around their access to care and their access to medication needs. Their value orientation around who is the highest value - there's more sacrificing and supporting and putting food on the table than purchasing their medications.

 

So yes, it certainly is disproportionately impacting women and women's wellness overall.

 

IAIN RANKIN: That's an excellent answer. I'll leave it there.

 

THE CHAIR: We'll move on to the PC Party and we'll start with MLA Robicheau.

 

RYAN ROBICHEAU: In addition to Seniors' and Family Pharmacare, what are some of the other programs in place to support Nova Scotians who might need more specialized and higher-costing drugs?

 

THE CHAIR: Ms. Keeping.

 

MARINA KEEPING: We have several other drug- and disease-specific programs. We have an umbrella group of programs called Assistance for Cancer Patients, under which we have Drug Assistance for Cancer Patients. We have the Boarding, Transportation, and Ostomy Program and we also have the Wig Program. The eligibility for that program would be income-based. You have to have a diagnosis of cancer, and then you would be eligible for benefits under those specific programs.

 

We also have funding for cystic fibrosis, multiple sclerosis, diabetes insipidus, growth hormones, and then a number of other programs, like palliative care, for example. You can end your days at home now, as opposed to having to be in hospital to get free medications.

 

RYAN ROBICHEAU: I'll pass it on to my colleague here.

 

THE CHAIR: MLA Corkum-Greek.

 

HON. SUSAN CORKUM-GREEK: I am glad that in this second round, there has been a fuller tapping of all of you who have taken time out of your days to be here as witnesses. I want to make best use of that. There were certain lessons learned in 2016 that a big overhaul of a program like pharmacare requires and deserves a lot of consultation. It can also create a lot of anxiety. From time to time we must undertake that kind of expansive review and overhaul of programs.

 

What I'd really like to use time remaining for the non-governmental witnesses is just if you have any other - we've heard the importance of just better communicating and finding alternative communications. The point about mail - if somebody doesn't have a mailbox - is very, very relevant.

 

If you have some - I'll call them “bite-sized,” like Timbit-sized suggestions and adjustments that could be made to improve the affordability or accessibility of pharmacare programs, and if you can just signal to the Chair who might like to answer, it is asked of all of you.

 

THE CHAIR: Mr. VanGorder.

 

BILL VANGORDER: I think the first thing that we would talk about would be a faster approval process. As you know, the process going through the CDA and then to the provinces can take 12 months or 18 months or even longer sometimes. There has just been a program developed - a pilot program in Ontario to fast-track that process for some drugs. I would think, given the good state that our program is in here in Nova Scotia, we would be in a good position to give even more leadership in that area across the country, so that the drugs, once approved, can come to our seniors more quickly than they have been in the past.

 

THE CHAIR: Ms. MacLean.

 

LANA MACLEAN: We at the North End Community Health Centre had the privilege last year of hiring a summer student with the intention of looking at the needs of our senior population that we serve. That summer student interviewed over 150 seniors. That's to start small. We have a large clinic. Out of that, our interdisciplinary team of allied health took the data and said, “What can we do that's low-barrier that we can actually give some access to improve the quality of the lives of the seniors we support?”

 

The simplest one around Seniors' Pharmacare is our allied health, particularly our social work team. They developed each quarter - again, our staffing model isn't as robust as we'd like it to be, but each quarter, we do what we call 64-plus birthday. We have all of our seniors pulled off our roster before their 64^th birthday bridging 64-and-a-half. Our social workers pull them all off the roster and host low-barrier meet-and-greets with a little snack, where they can actually say, “Hey, pharmacare's coming up. Let's get the paperwork together. Let's get you organized about your overall health and wellness.”

 

A lot of our seniors who we serve have diabetes and multiple co-morbidities. We have - I believe it's a 0.4 foot-care person. The prevalence of the need for foot care - and it's not covered in our formularies - with people needing those supplemental supports to keep themselves ambulatory - just the need for additional resources from a small summer student grant indicated the meaningful pieces of work that can be done that we have access to, but also told us about the barriers.

 

So every quarter we have a party, and we try to get our people out. They get to be celebrated, but we also get some paperwork done. It's very low barrier. Because we have trusting relationships with our providers and with our patients, it's a very simple thing that folks feel very supportive in accessing. If we added on foot care, we would actually get double the number of people, but we don't have the financial resources in our pocketbooks right now to support the addition of a foot-care nurse, the addition of nutrition, the addition of all of the other resources that this particular population - we could actually support them in a wraparound way. Low-barrier, easy access, affordable - and it's something that's in their backyard.

 

THE CHAIR: Ms. Bodnar.

 

ALLISON BODNAR: I'm going to build off that. I won't take credit for it; it was one of my team members. When he understood that I was coming here, we were talking about how we help. It was right around that 64^th birthday conversation. We see a lot of issues of transition of care. Going from private coverage to the public coverage at age 65 results in a lot of stress and a lot of concern over either losing coverage or having transition drugs. Quite frankly, we see the same thing sometimes when they're coming out of hospital, that they have been on a hospital formulary and then have to transition back to a community-based formulary.

 

The suggestion that was put forward was that on everybody's 64^th birthday, they do have a comprehensive medication review, so that a year before that transition happens, they know which drugs that they're currently on are going to be covered or not covered or go to special authorization. They can start that process with their primary caregiver to get either those transitions or the special authorization process started, so that there is significantly reduced stress at the time of enrolment, when they move into the pharmacare programs.

 

THE CHAIR: There are 15 seconds remaining. MLA Corkum-Greek.

 

SUSAN CORKUM-GREEK: I will only take this opportunity to say thank you. That crux of that idea, that's such a positive - people being seen, people being informed.

 

THE CHAIR: Order.

 

SUSAN CORKUM-GREEK: Thank you.

 

THE CHAIR: Now we will ask if there are any closing remarks. Who'd like to make closing remarks? Anybody? No? We're good? Okay, well thank you all for coming today. We really appreciate your time and your information that you shared with us. Thank you very much. We'll have a two-minute break.

 

[2:40 p.m. The committee recessed.]

 

[2:45 p.m. The committee reconvened.]

 

THE CHAIR: I call order. We have a motion from the NDP. I'd ask the member to please read the motion. MLA Lachance.

 

LISA LACHANCE: This has been circulated to members of the committee. I'd like to move the following motion:

 

Whereas residents in British Columbia, Manitoba, Yukon, and Prince Edward Island have access to free birth control and diabetes medication, and Nova Scotians need and deserve the cost savings at the pharmacy counter that other Canadians currently have;

 

Therefore be it resolved that this committee express support for making birth control and diabetes medications free for Nova Scotia.

 

THE CHAIR: Discussion? MLA Fadare.

 

ADEGOKE FADARE: I think today's conversation has been very enlightening for me. I've learned a lot, most especially around the federal government and the conversations. We've heard a lot from the deputy minister today. I think it's obvious that, from what we've heard, the conversations are still ongoing. They have not ended. The government has not said no. They're still looking at it, and the conversation is still ongoing. I want to say that our government will continue to work towards finding solutions for Nova Scotians that are well thought-out and properly implemented.

 

My father used to say that because you're the first house on the block does not mean you have the best house. I don't think we're in a race to be the first when the race is to offer the best for Nova Scotians. I think that this motion, as I've heard it today - I was hoping that they'd probably not bring it up again because of the enlightening conversation we've had here today, but it's still being brought up. I think this motion mischaracterizes the situation as it currently stands. We do not believe that this committee will be serving the people of Nova Scotia by (inaudible) rush into agreement that is not satisfactory, that is not the best for Nova Scotians.

 

We also can see from the federal government's appetite that even within the recent budget, it did not reflect an increase in the funding and only affirmed some of our concerns around this deal, which we've already heard today. I think we should look at the Canada - Nova Scotia Canada-Wide Early Learning and Child Care Agreement as a recent instance where we made haste in order to partner on the federal formal agreement. That led to the Province owning a substantial amount of risk long-term. Therefore, we will not be supporting this motion. I just want to state that clearly today.

 

THE CHAIR: Would anyone else like to speak on the motion? MLA Wilson.

 

ROD WILSON: I'd just like to add clarity. The motion does not say it's dependent on an agreement with the federal government. We'd like to see leadership from the Nova Scotia government in accessing birth control and diabetes medications for all Nova Scotians.

 

THE CHAIR: Any further discussion? MLA Fadare.

 

ADEGOKE FADARE: I think clearly as a government, we're not sitting on our hands. That's why we've heard about expanded services that we're doing. We're constantly looking at how to expand services and coverage for both diabetic care and, like we've also heard, we do know some aspects of birth control are covered with pharmacare. Some of this has come out in the light today, and one of these I could say is that we have a department that's actively looking for how to improve services and enhance services for Nova Scotians. I think that we as a committee, our job is not to try to push them in a particular direction, but to see and encourage the conversations that we've heard today to see how that can constantly be expanded as we continue to have the conversations within the department.

 

THE CHAIR: Any further discussion? We'll call for the vote then.

 

All those in favour? Contrary minded? Thank you.

 

The motion is defeated.

 

We'll now move on to the letter that was addressed to the Health Committee deferred from November's committee meeting. The committee received a letter from the deputy ministers of the Department of Health and Wellness and the Office of Addictions and Mental Health. Another letter was addressed to Chief Clerk James Charlton. Representatives from the Clerk's Office are here with us today, as you can see. For the purposes of LTV, Mr. Charlton is seated in Ms. Keeping's seat, and Mr. Hastings is in Deputy Minister MacKenzie's seat.

 

Who'd like some discussion on this? Who'd like to - do we want to hear from the Clerks, perhaps? Okay. Mr. Charlton.

 

JAMES CHARLTON: Thank you very much, Chair. The committee received the letter addressed to the vice-chair at the time, as the Chair position was vacant, I believe. I also received a letter from the departments.

 

Just to comment on this very quickly, it's several requests to the committee and to us. As Chief Clerk, I really don't have any power to do any of this. Most of this really lies with the committee. It's a combination of things that I think we already do to some extent. Some are things that might reflect changes that would have to be made by the committee if it chose to accept these requests, and some of these things are probably not practicable, just given certain things that I don't think the departments would be aware of.

 

Just to go through them very quickly, the requests that were made to the committee - and I saw some of these in my letter as well - set a clear sequence for scheduling topics following agenda-setting meetings, which alters only to accommodate scheduling conflicts or votes from the committee. That's basically already done. It's not a numbered sequence, but they're given a sequence that rotates through the various caucuses here. It's precisely the exceptions that are identified by the departments that result in changes occurring. It's scheduling conflicts, trying to nail down the departments and when they can be available, but also the other witnesses - the non-governmental witnesses who are coming.

 

Then, of course, there are directives of the committee. If the committee decides they want to hear a particular topic on a particular day, if they want to get someone in early, or they want to change witnesses, that can have an effect on that.

 

All that is to say that we could sequence them in terms of putting a priority - say this is Topic 1, this is Topic 2, this is Topic 3 - but if we treat that as a hard sequence that has to be adhered to, that's going to result in the cancellation of meetings, which I don't think is what the committee would want. Or if it's a little softer in its application, where we say, “Well, we try to maintain this order, but if we can't, then we don't” - that's basically what's already going on. There's not a lot that can be done, from my perspective.

 

The request to send a confirmation no later than four weeks prior to appearance - again, that's a best practice, but confirmation can only be sent once all the witnesses are actually nailed down for a committee hearing. For the first committee meeting after an agenda-setting, that won't be possible. The committee meets monthly; just as a matter of practice, it'll be impossible to have the four weeks. Even beyond that, depending on how many witnesses are expected to appear and how long it takes them to be able to nail down their schedules and be able to confirm, four weeks is a standard we aim to adhere to. It's simply not something that's necessarily possible. A lot of that depends on the witnesses and their availability. Some of it also depends on the committee in terms of if the committee wants to request that certain people be there, and if there are more witnesses rather than fewer, that increases the complexity and will make it harder to get everyone confirmed before the four-week mark.

 

I think there was someone looking to ask a question, maybe?

 

THE CHAIR: MLA Lachance.

 

LISA LACHANCE: Are we opening up to questions and discussion, Chair?

 

THE CHAIR: Yes.

 

LISA LACHANCE: Thank you to the Clerk for having a look at this and looking at the request in terms of what happens currently and what's realistic in terms of committee scheduling.

 

The legislative committee process is a really important one for understanding what's happening in government. I think it shouldn't be surprising that of course the Department of Health and Wellness and of course the Nova Scotia Health Authority are frequently sought after to be part of the discussions. The budget for the Department of Health and Wellness is nearly $6 billion, and that single department is 34 percent of government spending. This is a large-ticket item within a complex system that this government has promised to fix.

 

It's part of the job of being a deputy minister - that you appear before legislative committees. When I worked federally, we certainly never considered it an option when our deputy head was asked to appear before a parliamentary committee, and we prepared them. It does take some time, but it's not - I don't think it's onerous, and I think it's really part of the job of senior officials to be available to make that link between the bureaucracy and the legislative function of government.

 

As far as I know, clerks do tons of work around trying to be congenial and efficient with scheduling, and that should continue, but I don't think any one department or organization can ask to be excused from appearing before legislative committees.

 

THE CHAIR: MLA Wilson.

 

ROD WILSON: I would just like to add to my colleague's comments, having worked in the Department of Health and Wellness in the past and having been asked to prepare for committees, I find it shocking - the option of saying “Not this time.” I think, as a civil servant in my past life, which was incredibly rewarding - it's a duty to appear before legislative committees of any government.

 

We can be practical and purposeful and principled on this. I think it's practical that if there's something going on, we have done it many times - changed our meeting to accommodate guests, whether it's online or - I think we can be practical and accommodate the department's guests, but I do think in principle - health care is so important.

 

We heard today that people want more information and clarity of information. This is a good opportunity for the Department of Health and Wellness to sometimes clear up some of the myths and share information. I think there's a principle of accountability and transparency that this committee serves, and it behooves the Department of Health and Wellness to appear when requested, with some degree of accommodation to make it work.

 

THE CHAIR: MLA Rankin.

 

IAIN RANKIN: I don't think we need to overcomplicate it. These are letters that were sent to James. He made - the Clerk made comments on that. In terms of what they're requesting, it's suggestions. It's not asking for any structural change to the committees. We continue to operate how we are and we take it under advisement, I think, is probably the way to go about this. It is the Health Committee that most times wants the Department of Health and Wellness here. It's a monthly committee, and Health and Wellness ends up at Public Accounts too, often, because they're half of the budget.

 

That's the reason the Health Committee was actually created - the Department of Health and Wellness was at Public Accounts almost all of the time. That's why we accommodated another meeting that was in the Chamber too. It used to be Health and Public Accounts in the Chamber, and at some point they were transitioned over here.

 

As the Clerk said, this is about trying to accommodate best practices anyway. I think we just take it under advisement.

 

THE CHAIR: Any further discussion?

 

Mr. Charlton.

 

JAMES CHARLTON: I just wanted to point out a couple of things. One thing - I was talking with our very knowledgeable committee clerk earlier and she indicated that if the committee found it helpful, she might be able to undertake a jurisdictional scan about health committee practices, just so you could see where this committee is vis-à-vis other committees. That might be helpful to inform your decision-making in terms of how to reply to the letter to the committee.

 

The other thing was that there was one specific suggestion that I thought I did want to make a point of bringing to your attention. I think it might actually be quite helpful for the committee. This was the suggestion of, with the letter of confirmation, including a high-level outline of desired areas of focus, including outlining specific data or clinical information of interest. This is something that really the committee would have to instruct the clerk on. It might be something that whoever is suggesting the topic might want to involve their caucuses to do some research on and prepare this kind of small outline and request for information. That might be helpful in terms of providing that information to the department so that the committee can get the information that it's seeking and make sure the department knows exactly what to prep on. It might also be helpful for the committee when it's considering what topics to choose. I simply offer that up.

 

THE CHAIR: Is the committee interested in the jurisdictional scan? Doesn't seem like - we're okay without it, it looks like. Okay.

 

I think that will bring us - there are no motions or anything regarding this? We've come to a conclusion.

 

IAIN RANKIN: I think we're adjourned, unless you want to extend . . . (Laughter)

 

THE CHAIR: There we go.

 

[3:00 p.m.]

 

This meeting is adjourned. The next meeting is Tuesday, January 13^th at 1:00 p.m. in the new year, 2026. The topic is Community Wellness Framework.

 

[The committee adjourned at 3:00 p.m.]