Table 1:

Barriers and proposed solutions to improve patient access to prescription drugs, and their anticipated effect on government expenses

Players	Current barriers to drug access	Currently active and proposed solutions	Anticipated immediate effect on government expenses
Federal government	Patented Medicine Prices Review Board regulates prices of patented drugs in Canada by comparing them with the prices at which they are sold in 7 comparator OECD countries (some of which have the highest drug prices worldwide) and with the prices of other medicines in the same therapeutic class sold in the relevant Canadian market6	Change the comparator countries to include all OECD countries, or select a group of more diverse countries to better reflect true international market drug prices6	Decrease
	No regulation of generic drug prices	Individual provinces and territories have taken on this role13,14 by setting maximum generic prices at a percentage of the brand-name drug price	Decrease
	No regulation of generic drug prices	Alternatively, the mandate of the Patented Medicine Prices Review Board could be expanded to include regulation of generic drugs	Decrease
Provincial/territorial governments	Limited negotiation with pharmaceutical companies to lower prices of generic and brand-name drugs	In 2012, the premiers committed to work together to bulk buy generic drugs to enhance collective bargaining power15	Decrease
		Alternatively, a national drug agency, with a single formulary, could negotiate drug prices more effectively	Overall decrease to both levels of government, but costs may shift to the federal level
	Variation in provincial/territorial drug plans and formularies, leading to inequity in drug access9,10	Create a national drug agency, universal drug plan and single formulary	Increase, especially at federal level
	Variation in drug coverage for the working poor, whose copayment levels are high relative to their income	Implement different copayment systems: People with lower incomes could have lower copayments than those with higher incomes	Increase
		Copayments for highly beneficial drugs could be waived or lowered to improve access to the most effective drugs1,23	Increase
Physicians	Lack of knowledge about drug prices18,24	Improve physician knowledge of drug prices: Provide price information in the form of a manual,25 prescription template26 or electronic prescribing system27 Provide frequent feedback and reminders to be conscious of drug costs25,28 Encourage “step-up therapy”: if different drugs have comparable clinical effectiveness, start with the least costly one	Uncertain, although the costs of an effective educational intervention could be offset by cost savings in drug expenses
Physicians	No routine physician–patient communication on the financial impact of prescribed medications22	Improve communication: Increase awareness that drug expenses are an important barrier to access and that patients want to discuss this issue22 Provide easily accessible information on drug prices to physicians, as a reminder of the financial impact of patient-borne expenses	Uncertain, although the costs of an effective intervention to improve communication could be offset by cost savings in drug expenses

Note: OECD = Organisation for Economic Co-operation and Development.