Coverage for new medicines in Canada’s public drug plans, 2015.

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Authors

Mark Rovere (Ph.D. candidate); Brett J Skinner (Ph.D.)

Introduction

The federal government and each of the provincial and territorial governments operate separate publicly funded prescription drug benefit plans within their jurisdiction. Previous research shows that the quality of drug benefits varies significantly between public drug plans. The quality of public insurance coverage for new drugs is an important policy issue because millions of Canadians are dependent on public drug plans for access to their prescription medications, and there are significant health and economic implications associated with access to pharmaceutical innovation.

Objective

To compare the quality of benefits under Canada’s public drug programs in terms of the number of new drugs approved for public insurance coverage; the time that patients must wait for publicly insured access to new drugs; and the scope of insured access (Full Benefit v. Special Access / other access). 

Data 

Data were obtained from Health Canada and IMS Brogan covering the period from January 1, 2004 to January 31, 2015.

Findings

As of 2013 over 11.0 million Canadians were eligible for prescription drug coverage under public drug plans. Of the 464 new drugs approved for sale by Health Canada over the 10-year period from 2004-2013 the average of the coverage rates observed across the 11 federal and provincial public drug plans was only 24.2% (listed for either Full Benefit or Special Access / other access) as of January 31, 2015. Of the new drugs that were covered, the average of the delays observed across all 11 public drug plans was 731 days to list a new drug on the public formulary.  Quebec and Ontario provided the highest coverage rates for new drugs, while the federal NIHB, Alberta, Manitoba, British Columbia and Prince Edward Island provided the lowest coverage rates. Quebec had the shortest delays to listing new drugs in its public drug plan, while New Brunswick and PEI had the longest delays to listing. New Brunswick and Quebec had the highest number of new drugs listed as Full Benefit, while British Columbia, Manitoba, Nova Scotia, and the federal NIHB had the lowest number of Full Benefit listings. Among all 11 public drug plans, Quebec provides the best overall access to new drugs.

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