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An intra- & inter-provincial analysis of the Fair Pharmacare policy in British Columbia Coombes, Megan Eileen

Abstract

In the wake of several recommendations for a national approach to pharmacare, the provincial government of British Columbia made the most significant changes to its PharmaCare program in over two decades. On May 1, 2003, two major PharmaCare plans - the seniors' plan and the universal plan - were combined into a single income-tested plan known as "Fair PharmaCare". Through semi-structured interviews with seventeen policy makers I gathered insights about the fairness principles underlying this policy change. Based on the fairness objectives described by these participants, I aimed to evaluate whether the new pharmacare model would achieve its goals. Through simulations I estimated the distribution of financial burdens that would occur under the pre- and post-pharmacare models by applying the cost-sharing rules to hypothetical family types. The family compositions, income levels, and drug expenditures were selected to represent distributions of these variables drawn from real-world data sources—including the 2001 Census and provincial drug expenditure reports. Comparing the Fair PharmaCare model to the other nine provincial pharmacare models across Canada extended the analysis. Contrasted against the old pharmacare model in BC, Fair PharmaCare better protects against extremely high drug costs and better targets subsidies at low-income households. However, this is achieved at the expense of seniors predominantly, who will receive much less coverage for modest drug costs, than in the past. Compared to other provincial pharmacare models in Canada, Fair PharmaCare effectively protects against catastrophic drug costs. Universal models that employ income based maximum contribution limits best protect against catastrophic drug costs, while less comprehensive models in Atlantic Canada, and premium-based models in Quebec and Alberta, provide poorer protection.

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