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Au, Shania

University of British Columbia

Introduction: The Reference Drug Program (RDP) was established to steer patients toward equally safe and cost-effective medication within British Columbia’s public drug coverage program. At least one drug in each RDP class is covered normally, the reference drug(s), and non-reference drugs are only reimbursed up to the cost of the reference drug. In 2016, the RDP expanded to include other drug classes, including proton pump inhibitors (PPIs) and statins. This thesis evaluated the impact of these changes on drug expenditures, prescription patterns, and health services utilization. Methods: We identified a cohort of individuals covered by Fair Pharmacare who used PPIs or statins. We also established a control group, users of H2 Blockers, for PPIs. Using administrative data files from June 2014 to December 2019, we analysed the longitudinal trends for our outcomes of interest using interrupted time series (ITS). We studied changes for PPIs and statins in the following outcomes: 1) new users 2) average day supply 3) expenditures 4) drug costs 5) proportion of reference drug use and 6) physician visits and costs. Results: For PPIs and statins, the RDP had little impact on overall drug use patterns. We did not observe any changes in reference drug uptake, nor did we see an increase in new users, or significant changes to total days supplied post-policy. We also observed cost savings for total statin expenditure. These savings were larger for patients and third-party insurers than the PharmaCare program. In contrast, we did not see any savings for PPI users. However, these expenditure results were likely biased due to co-occurring changes to drug prices. Finally, we found no evidence of changes in physician visits following RDP changes. Conclusion: We found that there were cost savings to the provincial drug program with the addition of statins, but not PPIs, to the RDP. However, these savings may be all or in part due to drug price reductions. The program also had little impact on prescribing patterns. Overall, our findings are consistent with existing evidence that the RDP is safe for similar therapeutic alternatives, but the impact on cost for these classes remains unclear.

Text

2024-09-30

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/82770

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/