Public Drug Programs Research Articles

Evaluating the early impacts of delisting high-strength opioids on patterns of prescribing in Ontario.

Ontario delisted high-strength fentanyl, hydromorphone and morphine from the public drug formulary for non-palliative care prescribers on 31 January, 2017. Our aim is to assess the early impact of this policy on prescribing patterns and to examine whether this impact varied by prescriber type, opioid type and opioid strength. We conducted a population-based, cross-sectional study on palliative and non-palliative care patients dispensed fentanyl, hydromorphone or morphine through the Ontario public drug program between 1 January, 2014, and 31 July, 2017. For each month during the study period, we reported the total number of high-strength opioid recipients stratified by prescriber type, and the total volume of each drug dispensed, stratified by strength. We used interventional autoregressive integrated moving average (ARIMA) models to assess the policy's impact on prescribing patterns. We observed a 98% decrease in the total number of publicly funded recipients of high-strength opioids between December 2016 and July 2017 (5930 to 133 recipients) for all prescribers. The policy led to a significant decline in the total volume of all three opioids dispensed: hydromorphone from 20 374 621 to 16 952 097 mg (p < .01); morphine from 40 644 190 to 33 555 480 mg (p < .03); and fentanyl from 9 604 913 to 5 842 405 mcg/h (p < .01). For both fentanyl and hydromorphone, this reduction generally corresponded to an increase in the number of low-strength opioids dispensed. Delisting high-strength opioids substantially reduced the number of highstrength opioid recipients and reduced the overall volume of long-acting opioids dispensed in Ontario through the public drug program. Future studies should examine its impact on patient outcomes.

Publicly Funded Oral Chronic Hepatitis B Treatment Patterns in Ontario over 16 Years: An Ecologic Study.

Reimbursement for the use of hepatitis B virus (HBV) treatments has not been previously reported for public payers. To describe the number of users and total cost of HBV treatments over the last 16 years among residents of Ontario, Canada, who were covered by the public drug program. We conducted a repeated cross-sectional study for HBV treatments reimbursed by the public drug program in Ontario from January 1, 2000, to December 31, 2015. We projected total spending to 2020 based on current utilization trends. HBV drug users per year increased 30-fold, from 132 users in 2000 to 4,035 users in 2015. Total spending on HBV treatments increased 150-fold, from $136,368 annually in 2000 to $21.0 million in 2015. The spending on HBV agents is projected to increase by 65%, with an estimated drug cost of $34.6 million by 2020. Although not reimbursed as first-line therapy, tenofovir disoproxil fumarate has become the most commonly reimbursed HBV treatment and was associated with an increase in HBV treatment use and total spending. Results of this study found that rapid growth of HBV treatments led to a sustained increase in spending for public payers in Ontario. This study was funded by grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC) and Ontario Strategy for Patient-Orientated Research (SPOR) Support Unit, which is supported by the Canadian Institutes of Health Research and the Province of Ontario. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), a non-profit research institute sponsored by the Ontario MOHLTC. The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors and not necessarily those of CIHI. Mamdani has received honoraria from Boehringer Ingelheim, Pfizer, Bristol-Myers Squibb, and Bayer. Janssen has received research support, consulting, and/or speaking fees from Gilead, Roche, Merck, AbbVie, Bristol-Myers Squibb, Arbutus, Janssen, and MedImmune. No other authors have any conflicts of interest to declare.

Uptake and impact of regulated pharmacy technicians in Ontario community pharmacies.

Since 2010, most provincial Colleges of Pharmacists have licensed pharmacy technicians. The colleges hoped this would give pharmacists time to provide "expanded scope" activities such as medication reviews. Little is known, however, about the uptake and impact of pharmacy technicians on pharmacists' provision of such services. We address these questions using data for Ontario community pharmacies. Data on pharmacists and pharmacy technicians were obtained from the Ontario College of Pharmacists website in September 2016. Their place of employment was used to calculate the number of full-time equivalent (FTE) pharmacists and technicians employed at each community pharmacy. Pharmacy claims data for the 12-month period ending March 31, 2016, were obtained from the Ontario Public Drug Programs (OPDP). These data included number of MedsChecks performed, type of MedsCheck and number of prescriptions dispensed to OPDP beneficiaries. Pharmacy technicians were employed in 24% of the pharmacies in our sample. Technician employment rates were highest in Central Fill pharmacies and pharmacies serving long-term care facilities. In general, pharmacies employing 1 or fewer technician full-time equivalents (FTEs) had a slightly higher probability of providing MedsChecks and, of those that did provide Meds Checks Annuals, provided more of them. Pharmacies that hired 3 or more technician FTEs were markedly less likely to provide MedsChecks. Pharmacies differ in their employment of technicians and in the apparent impact of technicians on the provision of MedsChecks. However, these represent associations. Additional research is needed to assess the causal effect of technician employment on the provision of MedsChecks.

Development of a provisional essential medicines list for children in Canada: consensus process.

Worldwide, many countries have developed a list of essential medicines for children to improve prescribing. We aimed to create an essential medicines list for children in Canada. We adapted the previously created preliminary list of essential medicines for adults in Canada and the WHO Model List of Essential Medicines for Children to create a provisional list of essential medicines for children in Canada. Canadian clinicians made suggestions for changes. Literature relevant to each suggestion was presented to clinician-scientists, who used a modified nominal group technique to make recommendations on the suggestions. Ontario Public Drug Programs prescription data were reviewed to identify commonly prescribed medications missing from the list. Literature relevant to these medications was shared with a clinician-scientist review panel to determine which should be added, and a revised list was developed. A total of 76 items were removed from the list of essential medicines for adults in Canada because they were not indicated for use in children or were not relevant in the Canadian health care context; 7 medications were added to the child list based on Ontario Public Drugs Programs prescribing data and clinician-scientist review. Suggestions to add, remove or substitute medications were made by peer-reviewers and resulted in removal of 1 medication and replacement of 1 medication. The process produced a provisional list of 67 essential medications for children. A provisional list of 67 essential medicines for children was created through a peer-reviewed, multistep process based on current clinical evidence, Canadian clinical practice guidelines and historical prescribing data. It is publicly posted at http://cleanmeds.ca/. The list should be further developed based on wider input and should be continuously revised based on emerging evidence of the safety and effectiveness of these medicines in all pediatric age groups.

Real World Effectiveness of Treatment With OBV/PTV/R ± DSV In HCV Patients With Cirrhosis In Poland

In chronic hepatitis C virus-infected patients cirrhosis is associated with less effective INF-based treatment and higher risk of complications. New IFN-free direct-acting antiviral therapies have greatly improved sustained virologic response (SVR) rates in patients with cirrhosis, nonetheless the rates are still lower than in patients without cirrhosis. To assess the real world effectiveness of treatment with OBV/PTV/r ± DSV in patients with HCV infection and compensated cirrhosis participating in Polish public drug program. Registry that included patients with cirrhosis treated with OBV/PTV/r ± DSV, who entered the drug program from Oct 1 2015 to Jan 31 2016 in seven non-randomly selected hospitals (N=265). Data on genotype, comorbidities, past treatment, end of treatment response, SVR24 and reason for early treatment cessation (including AE) was collected retrospectively. From 265 patients with cirrhosis receiving treatment (ITT population) 263 completed treatment (2 fatalities) and 256 had SVR24 assessed (4 lost to follow up and 3 fatalities) (PP population). Analysed group comprised 50% male, 54% treatment-experienced, prevailing comorbidities were hypertension (38%) and diabetes (16%). 250 patients achieved SVR24 – 94% in ITT population, 98% in PP population. Results are consistent with the efficacy in noncirrhotic patients from the same registry; from 238 patients with liver fibrosis stages F1-F3 (ITT) SVR24 was assessed in 225 patients (PP) and 222 achieved SVR24 (93% in ITT population, 99% in PP population). Real world data from Poland regarding OBV/PTV/r ± DSV therapy of HCV infected patients with cirrhosis confirms the high effectiveness of this regimen. Presented results are further reinforced by RWE study performed by Flisiak et al. (2017), where 90 patients with cirrhosis reached SVR24 (72% in ITT and 99% in PP population). The results indicate the effectiveness of Polish drug program.

What Does the New Ontario Pharmacare Plan offer Children and Young Adults with Rare Disorders?

A publicly-funded pharmacare program (OHIP+) was announced in the 2017 Ontario budget for all children and young adults that will begin in January 2018 and cover drugs in the Ontario Public Drug Programs (OPDP) formulary. In this commentary, drugs indicated for rare disorders commonly occurring in childhood that were reviewed by the Common Drug Review (CDR) between 2004 and 2016 are examined to assess the Ontario reimbursement situation. OPDP reimburse few of these drugs and only about half of those covered are accessible with consistency and without onerous conditions. Providing reimbursement for rare disorder drugs that received a positive CDR recommendation would likely cost less than a quarter of OHIP+'s projected cost. Children who will benefit most from OHIP+ are those with common conditions whose parents do not presently have access to provincial or private insurance. Children with rare disorders deserve accessible provincial financial support for potentially life-transforming drugs.

Self-Monitoring of Blood Glucose: Impact of Quantity Limits in Public Drug Formularies on Provincial Costs Across Canada.

For most patients with diabetes, routine use of blood glucose test strips (BGTS) has not been shown to be beneficial, yet the economic implications of broad publicly funded reimbursement for BGTS are substantial. We assessed the potential impact of BGTS quantity limits on utilization and costs for 6 publicly funded drug plans across Canada. A cross-sectional analysis was conducted in 6 provinces (Alberta, Saskatchewan, Manitoba, Nova Scotia, Newfoundland and Labrador and Prince Edward Island) for patients who received at least 1 prescription for BGTS in 2014 through the public drug program. We determined the number of BGTS that would have exceeded the quantity limits and the associated costs to the provincial drug program. A total of $38,051,026 was spent on BGTS reimbursed through public drug programs among the 6 provinces. In provinces where BGTS use is largely restricted to patients using insulin, the potential annual savings were minimal, ranging from 0.4% to 2.3%, whereas in provinces with more liberal listings, potential savings ranged from 12.4% to 19.8%. Combining these results with data from a previous analysis in Ontario and British Columbia, the cost savings associated with BGTS quantity limits for 8 provinces across Canada (capturing approximately three-quarters of the Canadian population) is estimated to be $30.3 million annually. The national implementation of a quantity limit policy for BGTS that aligns with evidence of efficacy, optimal prescribing and patient safety can lead to considerable savings for most public drug plans across Canada.

Persistence of Antipsychotic Treatment in Elderly Dementia Patients: A Retrospective, Population-Based Cohort Study

BackgroundAntipsychotics are commonly used to manage behavioral and psychological symptoms of dementia. Concerns over their safety and efficacy in this role have resulted in antipsychotics typically being recommended for short-term usage only when used among dementia patients. However, there is little work examining the duration of antipsychotic treatment in the elderly dementia patient population.ObjectiveTo determine the persistence of use of antipsychotics in elderly dementia patients and the role of dose on therapy duration.MethodsA retrospective, population-based cohort study using administrative data, including dispensing records from a provincial public drug program, from Ontario, Canada between 2009 and 2012. Elderly dementia patients newly initiated onto antipsychotics were followed until drug discontinuation, death, 2-year follow-up, or end of study. Competing risk analysis was performed to determine time to discontinuation, stratified by categories of initial dose.ResultsAfter 2 years 49.1 % of the cohort (N = 22,927 of 46,695) had discontinued treatment. When stratified by dose, the high-dose group (51.1 % discontinued) discontinued more frequently than the medium- (48.7 % discontinued) and low- (47.5 % discontinued) dose groups (p < 0.0001).ConclusionApproximately half of elderly dementia patients treated with antipsychotics discontinue within 2 years, with those on higher doses more likely to discontinue. However, the number of patients remaining on therapy represents a serious public health concern.

Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus.

AimsTo determine whether blood glucose test strip (BGTS) utilization in patients with type 2 diabetes (T2D) is associated with the type of diabetes therapy, classified according to hypoglycemic risk.MethodsA retrospective, longitudinal (2006–2012) study of Canadian private drug plans (PDP) and Ontario Public Drug Programs (OPDP) prescription claims was conducted. Analyses were restricted to patients with T2D with or without a claim for BGTS. Daily BGTS utilization (TS/patient/day) was evaluated by diabetes therapy classified by hypoglycemic risk. Multivariate analyses were conducted to identify determinants of BGTS utilization.ResultsThe T2D cohort comprised 5,759,591 observations from 1,949,129 claimants. Mean BGTS utilization was 0.84 TS/patient/day and differed between PDP and OPDP (0.66 vs. 1.00). Daily utilization was greatest in patients receiving therapy associated with a pre-defined high risk of hypoglycemia [insulin: basal + bolus (2.16), premixed (1.65), basal (1.16), other insulin regimens (2.13), and sulfonylureas (0.74)] versus non-sulfonylurea non-insulin-based regimens (0.52). For non-insulin therapy, BGTS utilization was greater for patients on multiple non-insulin therapies versus monotherapy (0.74 vs. 0.53 TS/patient/day). In multivariate analyses, drivers for BGTS utilization included insulin use, previous BGTS use, and female gender. Previous diabetes therapy and duration of therapy were negatively correlated with BGTS utilization.ConclusionsBGTS utilization varies depending on the type of therapy used to treat T2D according to hypoglycemic risk. Decision making regarding BGTS needs to account for robust analyses of current utilization and its value in those settings, including in patients not receiving diabetes therapy and the prevalence of circumstances conducive to more intensive monitoring.

Professional Pharmacy Services and Patient Complexity: An Observational Study.

To examine the association between the provision of professional pharmacy services (PPS) and patient complexity as determined by the number of distinct medications dispensed in Ontario. We conducted a cross-sectional study among all individuals dispensed one or more medications under the Ontario Public Drug Program (OPDP) between April 1st, 2012 and March 31st, 2013. We compared characteristics of patients receiving -1 or more PPS to those receiving no PPS. To assess the relationship between patient complexity (as measured by the number of chronic medications dispensed) and receipt of PPS, we reported the number and proportion of patients eligible for Ontario Drug Benefits (ODB) who received a PPS within each patient complexity group, and compared these proportions using the Cochran-Armitage test. Over the 1-year study period, 27.1% (N = 799,674 of 2,946,183) of ODB beneficiaries received at least one professional pharmacy service. Among these services, more than two-thirds of the patients received a MedsCheck service (N=511,490; 64.0%). Overall, individuals who received a PPS tended to be older, more likely to reside in a long-term care (LTC) facility, have multiple comorbidities, and were more likely to have been prescribed 9 or more medications in the past year. As patient complexity increased, the proportion of ODB beneficiaries who received PPS also increased; 3.0% of individuals prescribed between 1 and 2 medications in the past year received PPS, while 53.6% of those treated with 13 or more medications received PPS (p<0.0001). Although the findings of our study suggest the use of PPS increases with patient complexity, many complex patients are not receiving these services. Further studies are required to better understand why patients do not access these services, the impact of professional pharmacy services on patient health outcomes, and their value for the health care system.

Rates of Anomalous Bupropion Prescriptions in Ontario, Canada.

Reports of bupropion misuse have increased since it was first reported in 2002. The purpose of this study was to explore trends in bupropion prescribing suggestive of misuse or diversion in Ontario, Canada. A serial cross-sectional study was conducted of Ontarians aged younger than 65 years who received prescriptions under Ontario's public drug program from April 1, 2000, to March 31, 2013. We determined the number of potentially inappropriate prescriptions in each quarter, defined as early refills dispensed within 50% of the duration of the preceding prescription, as well as potentially duplicitous prescriptions, defined as similarly early refills originating from a different prescriber and different pharmacy. We replicated these analyses for citalopram and sertraline, antidepressants not known to be prone to abuse. We identified 1,780,802 prescriptions for bupropion, 3,402,462 for citalopram, and 1,775,285 for sertraline. Rates of early refills for bupropion declined during the study from 4.8% to 3.1%. In the final quarter, rates of early refills for bupropion were more common than for citalopram (3.1% vs 2.2%) (P <.001) but not for sertraline (3.1% vs 2.9%) (P =.16). Potentially duplicitous prescriptions for bupropion increased dramatically, from <0.05% of all prescriptions in early 2000 to 0.47% in early 2013 and by the final quarter were more common than both citalopram (0.11%) and sertraline (0.12%) (P <.001). Although no marked differences were seen for early refills of bupropion relative to its comparators, potentially duplicitous prescriptions have increased dramatically in Ontario, suggesting growing misuse of the drug.

Reimbursement-Based Economics--What Is It and How Can We Use It to Inform Drug Policy Reform?

In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers. To describe the reimbursement-based economics approach. Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies. The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptamine-based selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented. The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments.

PCV102 - Drug Use Among Seniors On Public Drug Programs In Canada, 2012

Seniors take more drugs than younger Canadians because, on average, they have a higher number of chronic conditions. Although taking multiple medications may be necessary to manage these conditions, it is important to consider the benefits and risks of each medication and the therapeutic goals of the patient. This article provides an in-depth look at the number and types of drugs used by seniors using drug claims data from the CIHI’s National Prescription Drug Utilization Information System Database, representing approximately 70% of seniors in Canada. In 2012, almost two-thirds (65.9%) of seniors on public drug programs had claims for five or more drug classes, while 27.2% had claims for 10 or more, and 8.6% had claims for 15 or more. The most commonly used drug class was statins, used by nearly half (46.6%) of seniors. Nearly two-thirds (60.9%) of seniors living in long-term care (LTC) facilities had claims for 10 or more drug classes. Proton pump inhibitors were the most commonly used drug class among seniors living in LTC facilities (used by 37.0% of seniors in LTC facilities), while statins ranked seventh (29.8%). Introduction Seniors take more drugs than younger Canadians because, on average, they have a higher number of chronic conditions (Ramage-Morin 2009; CIHI 2011). Using multiple prescription medications is an important part of managing many of these conditions (CIHI 2011; Terner et al. 2011; Kwan and Farrell 2012). Although taking multiple medications may be necessary to manage these conditions, it is important to consider the benefits and risks of each medication and the therapeutic goals of the patient. This article uses drug claims data from the CIHI’s National Prescription Drug Utilization Information System (NPDUIS) Database to provide an in-depth look at the number and types of drugs used by seniors, and to compare drug use among seniors living in long-term care (LTC) facilities and those living in the community. The NPDUIS Database currently contains claims data from public drug programs in eight Canadian provinces – Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia – as well as one federal drug program, managed by the First Nations and Inuit Health Branch. Data include drug claims for approximately 70% of Canadian seniors. How Many Drugs Are Seniors Using? In 2012, almost two-thirds (65.9%) of seniors on public drug programs had claims for five or more drug classes, while 27.2% had claims for 10 or more, and 8.6% had claims for 15 or more. The number of drug classes used by seniors increased with age (Figure 1). In 2012, 42.7% of seniors aged 65–74 had claims for fewer than five drug classes and 20.0% had claims for 10 or more. Among seniors aged 85 and older, 20.5% had claims for fewer than five drug classes, while 39.3% had claims for 10 or more, including 13.2% with claims for 15 or more classes. As seniors age, they tend to use more prescription drugs owing to a higher prevalence of certain chronic conditions (Ramage-Morin 2009; CIHI 2011; Kwan and Farrell 2012). Which Drugs Are Most Commonly Used by Seniors? In 2012, 6 of the 10 most commonly used drug classes among seniors on public drug programs were cardiovascular-related (Table 1). The most commonly used drug class was statins, which are used to lower cholesterol. Nearly half (46.6%) of seniors had at least one claim for a statin in 2012. The next most commonly used drug classes were angiotensin-convertingenzyme inhibitors, used to treat high blood pressure and heart failure, and proton pump inhibitors (PPIs), which are used to treat gastroesophageal reflux and peptic ulcer disease. These were used by 28.2% and 26.9% of seniors, respectively. Statins were the most commonly used drug class in each age group, although the rate of statin use varied with age, from 46.1% among seniors aged 65–74, peaking at 50.9% in seniors aged 75–84 and declining to a low of 39.1% in seniors aged 85 and older. Two drug classes – sulfonamide diuretics (used to treat high CIHI Survey

Drug Use among Seniors on Public Drug Programs in Canada, 2012

Seniors take more drugs than younger Canadians because, on average, they have a higher number of chronic conditions. Although taking multiple medications may be necessary to manage these conditions, it is important to consider the benefits and risks of each medication and the therapeutic goals of the patient. This article provides an in-depth look at the number and types of drugs used by seniors using drug claims data from the CIHI's National Prescription Drug Utilization Information System Database, representing approximately 70% of seniors in Canada. In 2012, almost two-thirds (65.9%) of seniors on public drug programs had claims for five or more drug classes, while 27.2% had claims for 10 or more, and 8.6% had claims for 15 or more. The most commonly used drug class was statins, used by nearly half (46.6%) of seniors. Nearly two-thirds (60.9%) of seniors living in long-term care (LTC) facilities had claims for 10 or more drug classes. Proton pump inhibitors were the most commonly used drug class among seniors living in LTC facilities (used by 37.0% of seniors in LTC facilities), while statins ranked seventh (29.8%).

Ontario pharmacists' perceptions of the Pharmaceutical Opinion Program.

In 2011, the Ontario government introduced the Pharmaceutical Opinion Program (POP),1 through which pharmacists are compensated $15 for identifying a potential drug-related problem. This can occur during the course of dispensing a new or repeat prescription or when conducting a MedsCheck medication review. The pharmacist is expected to provide a clinical recommendation and rationale to the prescriber to address the problem. The end outcome of the consultation could be to dispense the prescription originally prescribed, to change the prescription (dose, duration, product, etc.) or to refuse to fill the prescription. The POP is currently only available to recipients of the Ontario Public Drug Programs. Since the program was introduced in April 2011, pharmacists have provided more than 700,000 pharmaceutical opinions, the majority (68%) of which resulted in a changed prescription (Allan Malek, Ontario Pharmacists Association, personal communication, June 20, 2013). Anecdotal reports suggest that pharmacist uptake of this program has been suboptimal, in part due to the misunderstanding of program requirements. Yet there has been no research to date about pharmacists’ experiences with and perceptions of the program. The goal of this research project was to ascertain the barriers and facilitators that community pharmacists have experienced while providing pharmaceutical opinions to their patients.

The Ontario Drug Policy Research Network: Bridging the gap between Research and Drug Policy

Policymakers have cited several barriers to using evidence in policy decisions, including lack of research relevance and timeliness. In recent years, several reports have focused on the successes and challenges of researcher–policymaker collaborations, a form of policy engagement intended to help overcome barriers to the use of research evidence in policymaking. Although these reports often demonstrate an increase in research relevance, rarely do they provide concrete methods of enhancing research timeliness, which is surprising given policymakers’ expressed need to receive “rapid-response” research. Additionally, the impact of researcher–policymaker collaborations is not well-discussed. In this paper, we aim to describe the collaboration between the Ontario Drug Policy Research Network (ODPRN) and its policymaker partner, the Ontario Public Drug Program (OPDP), with a particular focus on the ODPRN's research methodology and unique rapid-response approach for policy engagement. This approach is illustrated through a specific case example regarding drug funding policies for pulmonary arterial hypertension. Moreover, we discuss the impact of the ODPRN's research on pharmaceutical policy and lessons learned throughout the ODPRN and OPDP's five-year partnership. The described experiences will be valuable to those seeking to enhance evidence uptake in policymaking for immediate policy needs.

PC-FACS

PC-FACS

PMH64 - The use of selected psychotropic drugs among seniors on public drug programs in canada, 2001 to 2010

PMH64 - The use of selected psychotropic drugs among seniors on public drug programs in canada, 2001 to 2010

How does complementary private prescription drug insurance coverage affect seniors’ use of publicly funded medications?

BackgroundLike in many other high-income jurisdictions, the public drug program in Ontario, Canada provides comprehensive coverage of prescription drugs to the 65 years and older population with some cost sharing. The objective of this study was to examine the marginal impact of holding private drug coverage on the use of publicly funded medicines among the senior population in Ontario. MethodsWe drew on linked survey and administrative data sources to examine the impact of private drug coverage first on total spending and utilization of medications, and second, on clinically recommended medications for individuals with a diagnosis of diabetes. ResultsApproximately 27% of Ontario seniors reported having private prescription drug insurance from a current or prior employer. The population-level analysis of all seniors found that individuals with private insurance coverage, on average, took about a quarter of an additional drug and incurred 16% more in costs to the public program in a year compared to those without additional coverage. The disease-specific analysis of seniors with a diagnosis of diabetes found that private coverage was associated with two-fold higher odds of taking an anti-hypertensive drug, but it had no association with the use of statins or anti-diabetic medications. DiscussionThe results of this study provide some evidence that seniors in Ontario are sensitive to the price of drugs. These findings raise equity concerns relating to the cost sharing arrangements in the public system and our policy of allowing private plans to “top-up” the public plan.

Money Left on the Table: Generic Drug Prices in Canada

Generic drugs are a major cost-saving opportunity for patients and drug plans. While almost every province has reduced generic drug prices, we have no information on whether these new prices are internationally competitive. Therefore, I compared Canadian prices to those in two other countries. I used 2009 data from the IMS Brogan Canadian CompuScript and PharmaStat databases and studied the 100 most frequently dispensed generic products in Ontario, which has Canada's lowest generic prices. I compared these prices to those in public drug programs in the United States and New Zealand that use tendering. Using these alternative prices, I calculated the potential savings in Ontario. Of the top 100 generic products, 82 were listed on an international formulary. In 90% of cases, generic products were less expensive in other countries. If Ontario had obtained the lowest comparator price for these products, the annual public sector and overall drug expenditure savings would have been $129 million and $245 million, respectively. Further, the province could have publicly paid for all these generic drugs - both public and private - and saved $87 million compared to current public sector expenditures. Even after recent reforms, generic drug prices in Canada remain high by international standards. I found that if Ontario had obtained commonly used generic drugs at international best prices, the province could have publicly paid for all generic drugs and lowered annual expenditures by nearly a quarter-billion dollars.