Comparison of provincial prescription drug plans and the impact on patients' annual drug expenditures

Abstract

Background: Reimbursement for outpatient prescription drugs is not mandated by the Canada Health Act or any other federal legislation. Provincial governments independently establish reimbursement plans. We sought to describe variations in publicly funded provincial drug plans across Canada and to examine the impact of this variation on patients' annual expenditures.

Methods: We collected information, accurate to December 2006, about publicly funded prescription drug plans from all 10 Canadian provinces. Using clinical scenarios, we calculated the impact of provincial cost-sharing strategies on individual annual drug expenditures for 3 categories of patients with different levels of income and 2 levels of annual prescription burden ($260 and $1000).

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.

Figure 1: Variation, by province, in annual drug costs paid by a 65-year-old woman whose annual income is below the national average. The patient has diabetes mellitus, hypertension and insomnia and is married to a senior receiving Old Age Security and Guaranteed Income Supplement. Their annual household income is $23 315. The patient's prescription drugs are metformin (850 mg twice daily), lorazepam (0.5 mg at bedtime), hydrochlorothiazide (25 mg/d) and ramipril (5 mg/d). The total annual cost of the drugs is $454 excluding professional fees.

Figure 2: Variation, by province, in annual drug costs paid by a 73-year-old man whose annual income is at the national average. The patient has heart failure and hyperlipidemia and is married to a senior receiving Old Age Security. Their annual household income is $44 806. The patient's prescription drugs are furosemide (20 mg twice a day), acetylsalicylic acid (80 mg/d), metoprolol (50 mg twice daily), atorvastatin (40 mg/d), ramipril (5 mg/d) and digoxin (0.125 mg/d). The total annual cost of the drugs is $1283 excluding professional fees.

Figure 3: Variation, by province, in annual drug costs paid by a 23-year-old woman whose annual income is below the national average. The patient has hypothyroidism and hyperlipidemia. She is single, has a child and works part time. Her annual household income is $14 000. Her prescription drugs are levothyroxine sodium (0.075 mg/d) and atorvastatin (40 mg/d). The total annual cost of the drugs is $807 excluding professional fees.

Figure 4: Variation, by province, in annual drug costs paid by a 40-year-old man who is an income security recipient. He has hypertension and hyperlipidemia. His prescription drugs are hydrochlorothiazide (25 mg/d), diltiazem (120 mg twice daily) and atorvastatin (40 mg/d). The total annual cost of the drugs is $1389 excluding professional fees.