Table 1:

Summary of parameters chosen for the economic models of the cost of adding universal public coverage of an essential medicines list to the existing complement of public drug plans in Canada*

ParameterExplanationBase-case scenarioBest-case scenarioWorst-case scenario
Direct change in the use of the essential medicinesIncreased accessibility of essential medicines to Canadians who are currently uninsured or underinsured (34)30% increase in utilization12% increase in utilization39% increase in utilization
Indirect change in the use of the essential medicinesExpected product substitutions among patients currently filling prescriptions for drugs similar to the essential medicines (35)Average of 37% of such patients switchAverage of 66% of such patients switchAverage of 7% of such patients switch
Changes in prices of generic versions of the essential medicinesExpected reductions achieved with tendering and other generic pricing tools, gauged on the basis of prices in comparable single-payer systems: United States (US Department of Veterans Affairs), Sweden and New Zealand (36), (37)Median comparator pricesBest comparator pricesWorst comparator prices
Changes in net prices of brand-name essential medicinesExpected price reductions achieved with universal application of negotiated rebates, gauged on the basis of published estimates of prices and rebates, and average net price information for the US Department of Veterans Affairs (38) (40)15% lower net prices20% lower net prices10% lower net prices
Changes in prices of drugs not on the essential medicines listExpected changes in the price of drugs not on the essential medicines listNo changeNo changeNo change
Standard co-payment per prescription for the essential medicinesExpected co-payment for standard beneficiaries, set as a maximum dispensing fee that could be lowered if pharmacies competed on price to patient$11 or less, depending on pharmacy$11 or less, depending on pharmacy$11 or less, depending on pharmacy
Percentage of prescriptions filled by patients exempted from co-payments for essential medicinesExpected co-payment exemptions for vulnerable populations (e.g., older people, low-income people, children) as a share of all prescriptions filled for the essential medicines30%30%30%
Other changes in existing public drug plans in CanadaExpected changes in public coverage of drugs not on the essential medicines listNoneNoneNone
Patient savings from shopping at pharmacies with lower dispensing feesExpected patient savings arising from pharmacies competing for business by lowering dispensing feesNot included in estimatesNot included in estimatesNot included in estimates
Indirect reduction in government cost of extended health benefits for public sector employeesExpected government savings from reduced cost of private insurance for public sector employees, which would be equal to about 20% of total private sector savings (41)Not included as government savings in estimatesNot included as government savings in estimatesNot included as government savings in estimates
Health care system savings from increased adherence to essential medicationsExpected savings to the broader health care system resulting from increased adherence to essential medicines (6) (9)Not included in estimatesNot included in estimatesNot included in estimates