Comparison Of Provincial Prescription Drug Plans

Results: We found that eligibility criteria and cost-sharing details of the publicly funded prescription drug plans differed markedly across Canada, as did the personal financial burden due to prescription drug costs. Seniors pay 35% or less of their prescription costs in 2 provinces, but elsewhere they may pay as much as 100%. With few exceptions, nonseniors pay more than 35% of their prescription costs in every province. Most social assistance recipients pay 35% or less of their prescription costs in 5 provinces and pay no costs in the other 5. In an example of a patient with congestive heart failure, his out-of-pocket costs for a prescription burden of $1283 varied between $74 and $1332 across the provinces. Interpretation: Considerable interprovincial variation in publicly funded prescription drug plans results in substantial variation in annual expenditures by Canadians with identical prescription burdens. A revised pharmaceutical strategy might reduce these major inequities. -------------------------------------------------------------------------------- Although the Canadian health care system attempts to provide universal coverage for all hospital stays and medically necessary procedures regardless of the patient's health status or ability to pay, outpatient prescription drugs are excluded from this arrangement. Because no federal guidelines or laws currently cover outpatient drug reimbursement policies, provinces establish and fund their own plans. Prescription drugs constitute the second largest category of health spending in Canada, after hospital expenditures.1 In 2005, $20.6 billion was spent on outpatient prescription drugs, including over-the-counter and personal health products purchased as a result of a prescription or paid by a third-party insurer. Of this sum, $4 billion represents direct out-of-pocket expenditures by patients. Several studies have reported that patient health is potentially compromised when access to drug therapy is restricted. Although 75% of Canadians have private insurance coverage for prescription drugs, about 25% (ranging from 9% in Manitoba to 43% in Quebec9) qualify for government reimbursement. Thus, it is crucial to understand the differences between provincial drug reimbursement policies and the potential impact of this variation on out-of-pocket expenditures. Previous studies have determined that disparities in publicly funded reimbursement policies for prescription drugs between provinces could result in cost inequities for individual patients. However, the nature and extent of variations within or between provinces have not been adequately characterized. We sought to compare the extent of coverage and costs relating to publicly funded reimbursement plans for prescription drugs for seniors, nonseniors and recipients of social assistance across Canada. We used case studies and clinical scenarios to assess disparities in out-of-pocket expenditures borne by beneficiaries with identical annual prescription drug costs living in different provinces. ... details here: http://www.cmaj.ca/cgi/content/full/cmaj;178/4/405

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