Abstract
On 1 December 2016, British Columbia’s (BC) provincial drug insurance program changed which medications in certain classes would benefit under the insurance program in an attempt to reduce expenditure. As part of the modernization, HMG-CoA reductase inhibitors (Statins), Angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (CCB) were affected. Prescribers and pharmacists had six months to discuss the changes with patients, and change medications if deemed necessary. Purpose: To quantify the changes made to prescriptions and to adjust to the Modernized Reference Drug Program. Methods: A retrospective chart review was conducted at two clinics in Prince George, BC. Charts for patients that were prescribed any drugs in the affected classes were reviewed to determine if, and when, they had been changed, and by which health care professional. In December 2016, a clinical pharmacist, integrated within the study clinics, informed prescribers of the changes, and made patient-specific clinical notes within the charts. The notes described the changes and recommended alternative agents and appropriate dosing in order to assist the prescriber to have a conversation with the patient regarding the switch. Results: Out of 429 unique patients, 233 patients were prescribed a Statin, 229 patients an ACEI, 110 an ARB and, 83 a CCB. Sixty-five drug changes were indicated to reflect the modernization, and with guidance from a clinical pharmacist, nurse practitioners (NPs), and family physicians (FPs), 65% of these identified drugs were switched to reflect the modernization. Community pharmacists made no drug changes in the study sample, despite the prescriptive authority and compensation available to do so. Province-wide, approximately 21% to 33% of affected drugs were switched during the same time-frame. Direct collaboration between a clinical pharmacist, working alongside NPs and FPs, was more successful in optimizing these medications when compared to standard practice, or community pharmacists alone.
Highlights
British Columbia (BC), Canada, has a provincially funded prescription drug insurance program called Pharmacare
Direct collaboration between a clinical pharmacist, working alongside nurse practitioners (NPs) and family physicians (FPs), was more successful in optimizing these medications when compared to standard practice, or community pharmacists alone
A retrospective chart review in two primary care practices, that was composed of prescribing NPs and FPs, and an associated, integrated, non-dispensing, clinical pharmacist (RTP), was conducted in Prince George, British Columbia in December 2016 to determine the extent to which providers adapted prescriptions in response to the modernized reference drug program (RDP) during the transition period
Summary
British Columbia (BC), Canada, has a provincially funded prescription drug insurance program called Pharmacare. Pharmacare includes a number of plans, which covers many prescription medications for eligible beneficiaries. The most common plan incorporates an income tested deductible which must be paid prior to receiving medication at a reduced cost for beneficiaries. The reference drug program (RDP) has been part of Pharmacare for over two decades [1], and applies to a number of therapeutic drug classes where the evidence supports the drugs within these classes to be safe and effective. Through the RDP, Pharmacare fully covers the selected drug(s), which are the most cost effective within these drug classes for its beneficiaries. As of 1 December 2016, the RDP underwent a modernization which changed the medications within these classes that would be eligible for full benefit as part of Pharmacare. Due to an increase in the number of generic drugs available in Pharmacy 2019, 7, 6; doi:10.3390/pharmacy7010006 www.mdpi.com/journal/pharmacy
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