Outcomes-based drug coverage in British Columbia: A unique approach to public drug coverage that uses academic advisers and saves money

Health Affairs

Volumn 23, Issue 3, 2004, Pages 269-276

  Morgan, Steven ^a,b   Bassett, Ken ^a,c,d,e   Mintzes, Barbara ^a,f  

^a UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^b Health Care and Epidemiology   (Canada)

^c Depts Fam Pract Pharmacol T

^d Drug Assessment Work Group   (Canada)

^e CHSPR ^*  (Canada)

^f CHSPR   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

CYCLOOXYGENASE 2 INHIBITOR; GLYCERYL TRINITRATE; HISTAMINE H1 RECEPTOR ANTAGONIST; NONSTEROID ANTIINFLAMMATORY AGENT;

CANADA; COMPARATIVE STUDY; COST CONTROL; DRUG COST; DRUG EFFECT; DRUG EFFICACY; DRUG INDUSTRY; DRUG MANUFACTURE; DRUG MARKETING; DRUG PROGRAM; FINANCIAL MANAGEMENT; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HUMAN; MEDICAL DECISION MAKING; MEDICAL EDUCATION; OUTCOMES RESEARCH; PATIENT COMPLIANCE; PRESCRIPTION; PROSPECTIVE PAYMENT; PROSPECTIVE PRICING; REVIEW; SIDE EFFECT;

BRITISH COLUMBIA; COST SAVINGS; EVIDENCE-BASED MEDICINE; INSURANCE COVERAGE; INSURANCE, PHARMACEUTICAL SERVICES; OUTCOME ASSESSMENT (HEALTH CARE); PUBLIC SECTOR;

EID: 2442608668     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.3.269     Document Type: Review

References (32)

1. C. Smith, "Retail Prescription Drug Spending in the National Health Accounts," Health Affairs 23, no. 1 (2004): 160-167; and Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P.L. 108-173 (8 December 2003).
2. C. Smith, "Retail Prescription Drug Spending in the National Health Accounts," Health Affairs 23, no. 1 (2004): 160-167; and Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P.L. 108-173 (8 December 2003).
3. With funding from eight states and two non-profit organizations, the Center for Evidence-Based Policy at the Oregon Health and Science University is coordinating reviews of twenty-five top-selling therapeutic classes. Dan Fox, president, Milbank Memorial Fund, New York, personal communication, 29 January 2004. See also OHSU News and Information, "New OHSU Center Will Compare Similar Drugs for Effectiveness," Oregon Health and Science University, 4 December 2003, www.ohsu.edu/news/2003/120403drugs.html (19 February 2004); and S.R. Tunis, D.B. Stryer, and C.M. Clancy, "Practical Clinical Trials: Increasing the Value of Clinical Research for Decision Making in Clinical and Health Policy," Journal of the American Medical Association 290, no. 12 (2003): 1624-1632.
4. The seniors' plan was established in 1973. Other PharmaCare plans covered all prescriptions for social-assistance recipients (est. 1946); subsidized "catastrophic" drug expenses for non-seniors (est. 1977); and paid drug costs for patients with specific illnesses (est. 1977-1997). See B.C. Ministry of Health Services, PharmaCare Trends 2000, 2001, www.hlth.gov.bc.ca/ pharme/outgoing/PcareTrends2000.pdf (11 March 2004).
5. P. Grootendorst, "Beneficiary Cost Sharing under Canadian Provincial Prescription Drug Benefit Programs: History and Assessment," Canadian Journal of Clinical Pharmacology 9, no. 2 (2002): 79-99.
6. M. Maclure and T. Potashnik, "What Is Direct Evidence-Based Policy-Making? Experience from the Drug Benefits Program for Seniors in British Columbia," Canadian Journal on Aging/Canadian Public Policy 23, Supplement 1 (1997): 132-146; and S.B. Soumerai et al., "A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline," Milbank Quarterly 71, no. 2 (1993): 217-252.
7. M. Maclure and T. Potashnik, "What Is Direct Evidence-Based Policy-Making? Experience from the Drug Benefits Program for Seniors in British Columbia," Canadian Journal on Aging/Canadian Public Policy 23, Supplement 1 (1997): 132-146; and S.B. Soumerai et al., "A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline," Milbank Quarterly 71, no. 2 (1993): 217-252.
8. G.M. Anderson et al., "Trends and Determinants of Prescription Drug Expenditures in the Elderly: Data from the British Columbia PharmaCare Program," Inquiry 30, no. 2 (1993): 199-207.
9. A.M. Garber, "Evidence-Based Coverage Policy," Health Affairs 20, no. 5 (2001): 62-82.
10. In preparation of this paper (July and August 2003), we sought interviews from six people who were senior PharmaCare decisionmakers between 1993 and 2003. Five were interviewed by telephone or in person; one could not be reached. Further information is available from the authors.
11. This advisory role has been closer to a "knowledge exchange" relationship than the more traditional "user-pull" or "producer-push" models of knowledge transfer. See J. Lavis et al., "Measuring the Impact of Health Research," Journal of Health Services Research and Policy 8, no. 3 (2003): 165-170.
12. K. Bassett and K.L. Rhone, "The Efficacy and Effectiveness of Sustained Release Oral Nitroglycerin in Comparison to Regular Delivery Isosorbide Dinitrate for the Prophylactic Treatment of Stable Angina Pectoris" (Vancouver: British Columbia Office of Health Technology Assessment, 1994).
13. See, for example, D.L. Sackett, Clinical Epidemiology: A Basic Science for Clinical Medicine, 2d ed. (Boston: Little, Brown, 1991).
14. Policy interviews (July and August 2003).
15. P.V. Grootendorst et al., "Impact of Reference-Based Pricing of Nitrates on the Use and Costs of Anti-Anginal Drugs," Canadian Medical Association Journal 165, no. 8 (2001): 1011-1019; T.K. Hazlet and D.K. Blough, "Health Services Utilization with Reference Drug Pricing of Histamine(2) Receptor Antagonists in British Columbia Elderly," Medical Care 40, no. 8 (2002): 640-649; S. Schneeweiss et al., "Impact of Reference-Based Pricing for Angiotensin-Converting Enzyme Inhibitors on Drug Utilization," Canadian Medical Association Journal 166, no. 6 (2002): 737-745; and S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829.
16. P.V. Grootendorst et al., "Impact of Reference-Based Pricing of Nitrates on the Use and Costs of Anti-Anginal Drugs," Canadian Medical Association Journal 165, no. 8 (2001): 1011-1019; T.K. Hazlet and D.K. Blough, "Health Services Utilization with Reference Drug Pricing of Histamine(2) Receptor Antagonists in British Columbia Elderly," Medical Care 40, no. 8 (2002): 640-649; S. Schneeweiss et al., "Impact of Reference-Based Pricing for Angiotensin-Converting Enzyme Inhibitors on Drug Utilization," Canadian Medical Association Journal 166, no. 6 (2002): 737-745; and S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829.
17. P.V. Grootendorst et al., "Impact of Reference-Based Pricing of Nitrates on the Use and Costs of Anti-Anginal Drugs," Canadian Medical Association Journal 165, no. 8 (2001): 1011-1019; T.K. Hazlet and D.K. Blough, "Health Services Utilization with Reference Drug Pricing of Histamine(2) Receptor Antagonists in British Columbia Elderly," Medical Care 40, no. 8 (2002): 640-649; S. Schneeweiss et al., "Impact of Reference-Based Pricing for Angiotensin-Converting Enzyme Inhibitors on Drug Utilization," Canadian Medical Association Journal 166, no. 6 (2002): 737-745; and S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829.
18. P.V. Grootendorst et al., "Impact of Reference-Based Pricing of Nitrates on the Use and Costs of Anti-Anginal Drugs," Canadian Medical Association Journal 165, no. 8 (2001): 1011-1019; T.K. Hazlet and D.K. Blough, "Health Services Utilization with Reference Drug Pricing of Histamine(2) Receptor Antagonists in British Columbia Elderly," Medical Care 40, no. 8 (2002): 640-649; S. Schneeweiss et al., "Impact of Reference-Based Pricing for Angiotensin-Converting Enzyme Inhibitors on Drug Utilization," Canadian Medical Association Journal 166, no. 6 (2002): 737-745; and S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829.
19. British Columbia, The Report of the PharmaCare Review Panel (Victoria: PharmaCare Review Panel, 1993).
20. Policy interviews (July and August 2003).
21. Therapeutics Initiative, "Celecoxib (Celebrex): Is It a Breakthrough Drug?" Therapeutics Letter 31, Aug/Sep 1999, www.ti.ubc.ca/pages/letter31. htm (19 February 2004).
22. F.E. Silverstein et al., "Gastrointestinal Toxicity with Celecoxib vs. Nonsteroidal Anti-Inflammatory Drugs for Osteoarthritis and Rheumatoid Arthritis: The CLASS Study: A Randomized Controlled Trial," Journal of the American Medical Association 284, no. 10 (2000): 1247-1255.
23. J.B. Hrachovec et al., "Reporting of Six-Month vs. Twelve-Month Data in a Clinical Trial of Celecoxib," Journal of the American Medical Association 286, no. 19 (2001): 2398-2400.
24. TI, "COX-2 Inhibitors Update: Do Journal Publications Tell the Full Story?" Therapeutics Letter 43, Nov/Dec 2001 and January 2002, www.ti.ubc.ca/pages/letter43.htm (19 February 2004).
25. M. Paterson et al., "What Effects Do Provincial Drug Plan Coverage Policies for New Drugs Have on Patterns of Use and Cost?" (Toronto: Institute for Clinical Evaluative Sciences, 2003).
26. Authors' calculations based on data from the Canadian CompuScript Audit, IMS Health, Canada (2003).
27. Ongoing studies are being conducted by several research teams; see D. Willison et al., "Effects of a Prior Authorization Policy to Restrict Access to COX-2 Inhibitors in a Public Insurance Program" (McMaster University, funded by the Canadian Institutes of Health Research); and G. Anderson et al., "Pharmaco-Surveillance and Drug Formulary Decision Making in B.C. and Ontario, Canada" (Institute for Clinical Evaluative Sciences, funded by Health Canada).
28. Ongoing studies are being conducted by several research teams; see D. Willison et al., "Effects of a Prior Authorization Policy to Restrict Access to COX-2 Inhibitors in a Public Insurance Program" (McMaster University, funded by the Canadian Institutes of Health Research); and G. Anderson et al., "Pharmaco-Surveillance and Drug Formulary Decision Making in B.C. and Ontario, Canada" (Institute for Clinical Evaluative Sciences, funded by Health Canada).
29. M. Maor, "The Classification of Drug Reimbursement Mechanisms" (Working Paper, Department of Political Science, Hebrew University of Jerusalem, 2003), 56.
30. Canadian Institute for Health Information, "Drug Expenditures in Canada 1985-2002" (Ottawa: CIHI, 2003).
31. S.G. Morgan, "Sources of Variation in Provincial Drug Spending," Canadian Medical Association Journal 170, no. 3 (2004): 329-330.
32. Policy interviews (July and August 2003).