Table 1:

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

PlayersCurrent barriers to drug accessCurrently active and proposed solutionsAnticipated immediate effect on government expenses
Federal governmentPatented 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 market (6)Change the comparator countries to include all OECD countries, or select a group of more diverse countries to better reflect true international market drug prices (6)Decrease
No regulation of generic drug pricesIndividual provinces and territories have taken on this role (13), (14) by setting maximum generic prices at a percentage of the brand-name drug priceDecrease
Alternatively, the mandate of the Patented Medicine Prices Review Board could be expanded to include regulation of generic drugsDecrease
Provincial/territorial governmentsLimited negotiation with pharmaceutical companies to lower prices of generic and brand-name drugsIn 2012, the premiers committed to work together to bulk buy generic drugs to enhance collective bargaining power (15)Decrease
Alternatively, a national drug agency, with a single formulary, could negotiate drug prices more effectivelyOverall 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 access (9), (10)Create a national drug agency, universal drug plan and single formularyIncrease, especially at federal level
Variation in drug coverage for the working poor, whose copayment levels are high relative to their incomeImplement different copayment systems:
  • People with lower incomes could have lower copayments than those with higher incomes

  • Copayments for highly beneficial drugs could be waived or lowered to improve access to the most effective drugs (1), (23)

PhysiciansLack of knowledge about drug prices (18), (24)Improve physician knowledge of drug prices:
  • Provide price information in the form of a manual, (25) prescription template (26) or electronic prescribing system (27)

  • Provide frequent feedback and reminders to be conscious of drug costs (25), (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
No routine physician–patient communication on the financial impact of prescribed medications (22)Improve communication:
  • Increase awareness that drug expenses are an important barrier to access and that patients want to discuss this issue (22)

  • 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.