BC’s drug plan deductibles do not lower drug use for some seniors
Adding a modest 2% income-based deductible for prescription drugs did not appear to deter some seniors from filling prescriptions, found a study of British Columbia's public drug plan published in CMAJ (Canadian Medical Association Journal).
"This finding differs from the results of other Canadian studies, which showed that increased drug cost-sharing reduced drug use and increased use of other health services in at-risk groups (e.g., those on social assistance)," writes Dr. Michael Law, Centre for Health Services and Policy Research, University of British Columbia (UBC), with coauthors.
A deductible is the amount a household must pay for prescription drugs before a public drug plan will cover any costs. British Columbia uses income-based deductibles, meaning households must spend a percentage of household income on drugs before public coverage becomes active.
Researchers looked at the impact of such deductibles in the province's Fair PharmaCare plan on prescriptions and health care service use among 280 615 seniors. In BC, people born before 1939 with household incomes of less than $30 000 a year do not pay a deductible, but those born after 1939 and earning between $15 000 and $30 000 pay a 2% deductible as well as coinsurance to a maximum of 3% per household.
Within this group, they found that the deductible reduced the number of people who qualified for public subsidy and decreased public drug spending. However, it did not reduce overall prescription drug use, which can lead to health issues from not taking prescribed medications, nor did it increase use of other health services.
"Our study showed that BC's income-based deductibles considerably lowered public spending on prescription drugs for the group of seniors we studied. However, it did not appear to affect overall access to medicines and use of other health services. While governments must always consider more vulnerable populations when making policy, these results may increase the options available to them when considering health care financing reforms," Dr. Law suggests.
In a related commentary http://www.cmaj.ca/lookup/doi/10.1503/cmaj.170169, Dr. Marc-André Gagnon, Carleton University, Ottawa, Ontario, writes, "Although cost-sharing mechanisms may be viewed as helpful in funding a public drug plan, they are problematic and should be implemented with caution. The best way to use them may be as copayments to cover only the additional cost of drugs that are more expensive than equivalent cost-effective reference products. This approach would help to minimize cost-related nonadherence, increase cost-effectiveness and still offer patients choice."
The study was conducted by researchers from the University of British Columbia, Vancouver BC; St. Michael's Hospital, Toronto, Ontario; and the University of Alberta, Edmonton, Alberta. It was funded by a grant from the Institute for Health System Transformation and Sustainability.