Coverage of new medicines in Federal-Provincial public drug plans in Canada 2009-2018



Coverage of new medicines in Federal-Provincial public drug plans in Canada 2009-2018

ABSTRACT: Since 2013, CHPI has regularly compared the coverage of new medicines across Federal and Provincial public drug plans. The analysis raises awareness about differences in the public benefits provided to patients across the country. The study is relevant to a lot of people in Canada. Of the 36.3 million people who lived in Canada in 2016, 13.1 million people had first-payer public drug benefits or were otherwise eligible for safety-net coverage under public drug plans. The study is also relevant to the public debate about the federal government replacing Canada’s current prescription drug insurance system with a universal single-payer national pharmacare program. The 23.2 million Canadians now covered under private plans need to know that the limited scope of coverage in existing public drug plans is the most that they can expect from national pharmacare. In fact, the Parliamentary Budget Officer modeled its national pharmacare cost analysis on Quebec’s public drug plan formulary.  Our analysis shows that Quebec had the best public drug plan in the country, but the provincial formulary listed only one-third of all new drugs approved by Health Canada from 2009 to 2018, and the wait for coverage of these few drugs was more than a year on average. This study is also useful for evaluating the performance of the pan-Canadian Pharmaceutical Alliance (pCPA). The pCPA negotiates prices and terms of coverage for new drugs under federal, provincial, and territorial public drug plans.  The pCPA was initiated under the expectation that all jurisdictions would uniformly adopt its decisions and that it would improve access to new drugs. This study informs Canadians about whether the pCPA is actually achieving uniform adoption of new medicines across the country’s public drug plans, and whether it facilitates or hinders coverage of new medicines. Our analysis suggests that the pCPA is failing on both counts. The data show significant variation in the coverage of new drugs across jurisdictions. Where commonality exists, it is mainly that all public drug plans cover few new medicines and take a long time to do so.

CITATION: Canadian Health Policy Institute. Coverage of new medicines in Federal-Provincial public drug plans in Canada 2009-2018. Canadian Health Policy, September 2019.

AUTHOR(S): This paper is corporately authored and edited based on proprietary template models and methods that are intended to facilitate regular updates. The design and content are a cumulative reflection of the diverse contributions collectively attributable to the CHPI affiliated researchers who may have variously participated in updating each edition. Data sources, methods and editorial presentation may evolve from previous editions.

DISCLAIMER: This study uses data from IQVIA Inc. The analysis, conclusions and opinions expressed in this paper do not necessarily reflect the views of the data supplier.