Prescription drug coverage: An essential service or fringe benefit?

One of the contradictions of the Canada Health Act is that it covers medically necessary services provided by physicians in hospital or in the community, but when it comes to medically necessary drugs, it covers only those prescribed in hospital.

In British Columbia, patients aged 65 years and older are required to pay dispensing fees of their prescription drugs up to an annual maximum of $200, beyond which all of their drug costs are covered for the rest of the year.

Aslam Anis and colleagues wondered whether this policy could be detrimental. They identified almost 3000 patients with a severe chronic illness (rheumatoid arthritis) in British Columbia and looked at their patterns of physician visits, filling of prescriptions and hospital admissions during the cost-sharing period (before the annual maximum of $200 had been reached) and during the "free" period (when all drug costs were covered to the end of the year) in each of 4 years. The authors found that there were 0.38 more physician visits per month and 0.50 fewer prescriptions filled per month during the cost-sharing period than during the free period. In addition, among patients who were admitted to the hospital, there were 0.013 more admissions per month during the cost-sharing period than during the free period.

In an accompanying commentary, Robyn Tamblyn points out that, although the federal government's national drug strategy goes beyond many prior policy reforms in addressing the challenges in optimizing the cost-effective use of prescription drugs, it ignores the fundamental inequity between the provinces. She adds that the results reported by Anis and colleagues probably underestimate the true effects, because only patients who could afford to pay the annual maximum amount were included in the study.


Contact: Dr. Aslam Anis
Canadian Medical Association Journal

Page: 1

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