case study: drug cost and pharmacare

Question 1

since when was pharmacare (prescription drug care) discussed as a comprehensive proposal in canada?

Answer 1

as far back as the 1940s

Question 2

what are the general policy stages for OHIP?

Answer 2

hospital insurance,

then medical insurance,

then drug insurance

Question 3

what are policy makers waiting for before expanding medicare to include pharmacare?

Answer 3

pharmaceutical spending to plateau

Question 4

which province has had universal, comprehensive drug coverage in the past?

Answer 4

saskatchewan

Question 5

what percentage of canada’s total health expenditure has been spent on drugs?

Answer 5

13.6%

2nd more expensive category along with physicians after hospitals

Question 6

compared to other countries, how expensive are canada’s drugs?

Answer 6

canada’s drug prices are the third highest among the 38 Organisation for Economic Co-operation and Development (OECD) countries,

influencing canadians’ access to drugs (impacting their health) and the sustainability of canada’s health care system

Question 7

what fraction of canadians do not have prescription drug insurance?

Answer 7

1/5 canadians either don’t have prescription drug insurance or have inadequate insurance to cover their medication needs

Question 8

describe drug coverage for older adults

Answer 8

all jurisdictions in canada provide public drug coverage for seniors aged 65+

governments may choose to avoid public liability associated with an age-based entitlement to drugs and switch to means-tested or catastrophic drug plans

older adults account for more than half of public drug program spending

Question 9

what are the requirements for one to access the the ontario drug benefit plan?

Answer 9

over 65 years old

below 25 years old and not covered by a private insurance plan

living in a long-term care/special care home

receiving professional home and community care services

receiving benefits from ontario works or ontario disability support program

enrolling in the trillium drug plan (for people who spend 4%+ of their after-tax household income on prescription drug costs)

Question 10

who sets drug pricing?

Answer 10

health canada regulates drugs. they look at safety and efficacy of the drug.

now reviews (common drug review) are conducted by the canadian agency for drugs and technology in health. they determine if canada should fund it - depending on cost-effectiveness (before 2003, this was done by provinces)

pharmaceutical companies will determine prices with each province/territory

health canada -> common drug review -> ontario ministry of health -> ontario drug benefits program

Question 11

what does the patented medicine prices review board do?

Answer 11

an independent tribunal that limits the prices set by patentees for all patented medicines sold in canada to ensure they’re not excessive

does not regulate the prices of generics and has no jurisdiction to review the prices negotiated with the federal, provincial, or territorial drug plans

Question 12

what does the patented medicine prices review board evaluate?

Answer 12

prices of other drugs from the same therapeutic class in the market

prices of the same medicine and other medicines in the same therapeutic class in comparator countries (France, Germany, Italy, Sweden, Switzerland, UK, USA)

changes in the Consumer Price Index