PHP221 - The Out-Of-Pocket Cost Burden of Prescription Drugs: A Pan-Canadian Comparison

Abstract

In Canada, prescription drug reimbursement policies by public payers vary across each provincial jurisdiction. This study aimed to 1) characterize the current provincial public drug insurance programs, and 2) compare Canadians’ out-of-pocket (OOP) drug costs across provincial jurisdictions. Information concerning each provincial drug plan was collected as of August 2016, including eligibility, cost-sharing strategies, maximum payable, dispensing fee, drug cost, drug markup, and maximum days supply.. Multiple clinical scenarios highlighting common chronic conditions were developed for analysis from the senior and non-senior perspectives, applying five different income thresholds. Public prescription drug plans varied across jurisdictions in terms of eligibility and cost-sharing strategies. Consequently, OOP costs differed for Canadian residents depending on their income, age, and province of residence. Income was found to have a greater role in determining OOP costs for non-seniors relative to seniors. In one case, annual OOP cost for a non-senior earning the national average income ranged from $461 in Saskatchewan to $2526 in Quebec. Differences in OOP costs were largely attributed to cost-sharing strategies under each provincial drug programs, while drug costs remained fairly consistent across provinces. Prescription drug coverage varied across Canada and resulted in disparate OOP cost for Canadians across all income levels and age groups., While recent strategies (i.e. pan Canadian Pharmaceutical Alliance) have reduced and standardized drug pricing across the country for several therapeutic agents, future policy should focus on minimizing the disparity in cost-sharing schemes between provinces to improve equitable prescription drug access for Canadians.