Income-Based Drug Coverage in British Columbia: Lessons for BC and the Rest of Canada

Abstract

Background: In May 2003, the government of British Columbia adopted incomebased pharmacare, replacing an age-based drug benefits program. Stated policy goals included reducing government spending, maintaining or enhancing access to medicines and improving financial equity. The province' s experience on these policy dimensions can inform policy making in other jurisdictions and offers insight into priorities for Canada' s National Pharmaceuticals Strategy. Method: The research team created an anonymized database with information about drug use, private and public expenditure and household income for all residents of British Columbia from 1996 to 2004. This database was used to evaluate the impact of the policy on trends in drug expenditures, utilization and sources of payment for seniors and non-seniors of different income levels. Results: In the immediate term, Fair PharmaCare appears to have met many of its policy goals. Government spending was reduced. Access to medicines was maintained (though not enhanced). And the distributions of private and public expenditures were brought more closely in line with distribution of income. Long-run impacts depend largely on how a reduced role for government affects trends in costs, access and equity. Early indications suggest that a larger role for government may be needed to maintain performance on desired policy objectives over time. Conclusion: In the long run, there is reason for setting a new national standard for pharmacare that increases, not decreases, the share of publicly covered spending in every province. The federal government could play a key role by helping provinces increase public funding for prescription drugs and thereby facilitate cost control, maintain access to medicines and enhance financial equity.

Estimating the Cost of Cancer Care in British Columbia and Ontario: A Canadian Inter-Provincial Comparison

“…In BC, PharmaNet provides data on all out-patient prescription drugs, including those covered by BC PharmaCare (publicly paid plan) (BC MOH 2012c). This plan was age-based until 2002 and then became income-based (Morgan et al 2006). In Ontario, only data on out-patient drugs paid by the publicly paid ODB program, which covers individuals aged 65 years and older and special cases (MOHLTC 2014), were available, which limited our ability to account for all drug-related costs.…”

What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries

“…What this suggests is that one of the main effects of prescription drug charges is to shift costs from third party payers (public or private) to patients. Indeed, a policy change in the Canadian province of British Columbia that slightly lowered prescription drug user charges for low-income groups and substantially increased them for middle- and higher-income groups directly transferred around CDN $134 million in prescription drug costs from the provincial government budget to patients, leading to substantial cost savings for the public purse [82]. …”

Impact of income-based deductibles on drug use and health care utilization among older adults

“…For example, an analysis undertaken shortly after BC's income-based Fair PharmaCare Plan was implemented in 2003 suggested the plan did not alter populationlevel use of prescription drugs. 7 But the province's previous drug plan already included high deductibles for adults under 65 years of age; therefore, the study was not a clean test of deductibles versus no deductibles. Similarly, evidence from Manitoba suggested that income-based deductibles decreased the use of inhaled corticosteroids by children with asthma.…”