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From the Divisions of General Internal Medicine (Demers, Pilote) and Clinical Epidemiology (Pilote), McGill University Health Centre, Montréal, Que.; the Institute for Clinical Evaluative Science (Melo); the Departments of Health Policy, Management and Evaluation (Jackevicius) and of Medicine (Tu), University of Toronto, Toronto, Ont.; the Departments of Medicine (Cox) and Surgery (Kalavrouziotis), Dalhousie University, Halifax, NS; the Department of Medicine (Rinfret), Centre Hospitalier de l'Université de Montréal, Montréal, Que.; the Division of Cardiology, Department of Medicine (Humphries), University of British Columbia, Vancouver, BC; Health Information and Research Division (Johansen), Statistics Canada, Ottawa, Ont.; the Department of Medicine, Sunnybrook Health Sciences Centre (Tu), Toronto, Ont.; and the Faculty of Health Sciences, University of Western Ontario (Jackevicius), London, Ont.
Correspondence to: Dr. Louise Pilote, Division of General Internal Medicine, McGill University Health Centre, 687 Pine Ave. W, Rm. A4.23, Montréal QC H3A 1A1; louise.pilote{at}mcgill.ca
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.
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  G. Thanassoulis, I. Karp, K. Humphries, J. V. Tu, M. J. Eisenberg, and L. Pilote Impact of Restrictive Prescription Plans on Heart Failure Medication Use Circ Cardiovasc Qual Outcomes, September 1, 2009; 2(5): 484 - 490. [Abstract] [Full Text] [PDF]
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