Difference in drug cost between private and public drug plans in Quebec, Canada

Chamoun M,Chabot I,Blais L,Schnitzer M,Forget A

doi:10.1186/s12913-022-07611-4

Abstract

BackgroundWe expect a difference in drug cost between private drug plans and the Public Drug Plan (PDP) because the dispensing fee is fixed and regulated by the PDP for publicly insured patients, whereas it is determined freely by the pharmacy owner for privately insured patients. This study compared the drug cost of Quebec residents covered by private drug plans with those covered by PDP.MethodsWe used a sample of prescriptions filled between 1 January 2015 and 23 May 2019 selected from reMed, a database of Quebecers’ drug claims. We created strata of prescriptions filled by privately insured patients and matched them with strata of prescriptions filled by publicly insured patients based on the Drug Identification Number, quantity dispensed, number of days of supply, pharmacy identifier, and a date corresponding to the publication of List of Medications of Régie de l’Assurance Maladie du Québec. The differences in drug cost between private plans and the PDP were analyzed with linear regression models using prescription strata as the unit of analysis.ResultsBased on 38 896 prescription strata, we observed that privately insured patients payed $9·35 (95% confidence interval [CI]: 5·58; 13·01) more on average per drug prescription than publicly insured patients, representing a difference of 17·6%.ConclusionsThis study showed that, on average, drug cost is substantially higher for privately insured Quebecers. Knowing that adherence to treatment is affected by drug cost, these results will help public health authorities to make informed decisions about drug policies.

Highlights

Since 1997, every Quebec resident has been required to have prescription drug insurance coverage at all times
There were 3 188 963 prescriptions filled by patients covered by private drug plans between 1 January 2015 and 23 May 2019 in Registre de données sur les médicaments (reMed)
After excluding 203 additional prescriptions because of discrepancy between drug cost and quantity dispensed, we had 2 335 643 prescriptions and created 1 636 401 strata based on the Drug Identification Number (DIN), quantity dispensed, number of days supplied, pharmacy identifier, and version of Régie de l’Assurance Maladie du Québec (RAMQ)’s List of Medications used to establish the cost of filled prescriptions

Summary

Introduction

Since 1997, every Quebec resident has been required to have prescription drug insurance coverage at all times. There are two types of insurance plan: the Public Drug Plan (PDP), which is administered by the Régie de l’Assurance Maladie du Québec (RAMQ), and private plans (group insurance or employee benefits plans) [1]. Individuals and their family eligible for a private plan must join that plan. We expect a difference in drug cost between private drug plans and the Public Drug Plan (PDP) because the dispensing fee is fixed and regulated by the PDP for publicly insured patients, whereas it is determined freely by the pharmacy owner for privately insured patients.

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Conclusion