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A Dog’s Breakfast:: Prescription Drug Coverage Varies Widely Across Canada

Anis, Aslam H. PhD; Guh, Daphne MSc, and; Wang, Xiao-hua MSc

Original Articles

Background. Each province in Canada independently assesses drugs for their reimbursement eligibility. Publicly funded access to specific drugs is therefore dependent on province of residence.

Objective. Evaluate the variability of access and its determinants for publicly available prescription drugs across Canada, and discuss the feasibility of implementing a national plan.

Methods. For a sample of 58 drugs receiving Health Protection Branch approval in Canada between 01/01/1996 and 12/31/1997, all provinces were surveyed about their formulary inclusion/exclusion decision. Kappa values were estimated to measure concordance between provincial coverage decisions. Logistic analysis using Generalized Estimating Equations was used to assess the impact of key features of provincial plans on the decision.

Results. Among the 58 drugs, 5 (9%) were included in all 10 and 14 (24%) by at least 8 provincial formularies. None were e-cluded by all the provinces. Concordance rates among provinces were low (overall κ-like statistic = 0.20 and range of pairwise κ = -0.11 to 0.64). Logistic regression showed that therapeutic category, price ratio to comparator, the integration of public with private coverage, and the e-istence of ability-to-pay criteria were significant determinants of the inclusion decision.

Conclusions. Findings show that public access to the same prescription medications differs widely across provinces. If Canada were to adopt a “National” plan without disrupting current individual prescriptions, all currently funded drugs in each province would have to be “grandfathered” and included in the new National formulary. Such an all-inclusive list would also make such a plan unaffordable.

From the Department of Health Care and Epidemiology, University of British Columbia, Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, Vancouver.

Supported by a grant from the BC Ministry of Health and the Ministry responsible for Seniors.

An earlier version of this paper was presented at the 2nd World Conference of International Health Economics Association, June 6-9, 1999, Rotterdam, the Netherlands.

Address correspondence to: Aslam H. Anis, PhD, Centre for Health Evaluation & Outcome Sciences, 620-1081 Burrard Street, Vancouver, BC Canada, V6Z 1Y6. E-Mail:

Received June 9, 2000; initial review August 11, 2000; accepted November 20, 2000.

© 2001 Lippincott Williams & Wilkins, Inc.