Inter-Provincial Variation in Government Drug Formularies

By Gregoire, Jean-Pierre; MacNeil, Pierre et al. | Canadian Journal of Public Health, July/August 2001 | Go to article overview

Inter-Provincial Variation in Government Drug Formularies


Gregoire, Jean-Pierre, MacNeil, Pierre, Skilton, Kevin, Moisan, Jocelyne, et al., Canadian Journal of Public Health


A B S T R A C T

In Canada, coverage for ambulatory prescription drug expenditures is provided to some groups by provincial drug plans through a provincial formulary. Little is known about the drugs provincial formularies give access to. We report the variation in availability of new drug molecules (NDM) across provincial formularies.

We identified 108 NDM approved in Canada between 1991 and 1998. From each drug plan bulletin or formulary, we abstracted names of NDM listed as per 15 January 1999. We compared the level of listing across provinces using kappa coefficients.

In the Quebec, BC, Manitoba and Saskatchewan formularies, more than 70% of the NDM were listed. In four provinces, this proportion was lower than 50%. In general, the agreement between formularies was poor.

There is a wide variation across provinces in terms of NDM listed in the formularies. This variation reflects inter-provincial differences in the way drugs are selected for coverage.

A B R E G E

Au Canada, les programmes provinciaux d'assurance-medicaments permettent aux citoyens admissibles d'obtenir sur ordonnance les medicaments dont le nom figure sur la lisle provinciale. On en sait tres peu sur le contenu de ces listen. Notre etude visait a repertorier les ecarts entre les listen provinciales quant aux nouvelles molecules (NM).

Entre 1991 et 1998, 108 NM ont ete approuvdes au Canada. Nous avons extrait le nom des NM figurant sur les listen provinciales le 15 janvier 1999, puffs evalue la concordance entre les listes a l'aide de coefficients Kappa.

Au Quebec, en Colombie-Britannique, au Manitoba et en Saskatchewan, plus de 70 % des NM figuraient sur les listen. Dans quatre autres provinces, cette proportion n'atteignait pas 50 %. En general, la concordance entre les listen etait faible.

Les listen varient beaucoup d'une province I'autre, ce qui traduit les differences interprovinciales dans la facon de selectionner les medicaments remboursables.

Pharmaceuticals play an important role in health care. When used appropriately, prescription drugs can efficiently treat or prevent many illnesses.' They can replace more invasive treatment modalities2 or reduce the use of expensive health resources.', Technological advances in pharmacotherapy have shortened the length of stay in hospitals and, therefore, have contributed to the substitution of ambulatory care for inpatient care.5 As a result, there are increasing concerns about appropriate access to and use of outpatient prescription drugs.'

In Canada, ambulatory prescription drug expenditures are generally paid through private insurance or directly outof-pocket by patients, but coverage of such expenditures is also provided to some groups by provincial drug benefit plans. Drugs that are eligible for reimbursement are included in a list called the provincial formulary. In most provinces, there also are "special programs" outside of the provincial formulary through which some high-cost drugs are provided as a benefit to certain patient groups (e.g., AIDS/HIV or cystic fibrosis). Out of a Canadian population of 28.8 million, 3.2 million seniors, 3.2 million people with low incomes, and 1.5 million others depend on provincial drug benefit programs for drug coverage.6

Most health policy reports on prescription drug coverage have focused on eligibility for enrolment and cost-sharing issues.7-9 To our knowledge, the issues of which drugs are reimbursed and the differences between provinces in reimbursement policies have not been specifically examined.

We examined the variation in listing of new drug molecules across Canadian provincial formularies. We also assessed to what extent provinces limit access to new drugs through administrative formulary processes.

METHODS

We identified new drugs approved in Canada that received a notice of compliance (NOC) between 1 January 1991 and 31 December 1998 using the information published by the Therapeutic Products Program, Health Canada, on the Government of Canada web site. …

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