prescriptions

April 15, 2002

Shifting Costs, Creating Problems

There is a problem world wide with the rapid growth in the cost of drugs. There is a particular problem in BC with double digit increases in the cost of the Pharmacare program. The problem is not made any less by shifting it from government onto seniors. Is an 85 year old victim of dementia in a good position to second guess whether she should fill her doctor's prescription? Sensible government policy should be directed at countering the enormous drug promotion campaigns that pharmaceutical companies direct at doctors. Seniors do suffer from over prescribing. The fix is not in user fees but in preventing bad prescribing.

According to BC Stats, the province's total population was estimated to have increased by 1.2% between 2001 and 2002 but the population age 65 and over increased by 1.9%. It is reasonable to expect that prescriptions written for people age 65 and over would, therefore, increase by 1.9%. Data from the Ministry of Health, however, shows that the number of prescriptions written for those age 65 and over during the first three months of the calendar year decreased from 1,873,225 in 2001 to 1,859,329 in 2002 - a decrease of 0.7%. In other words, when population growth in taken into account, there is a gap of a minus 2.6%.

A 2.6% drop in prescriptions is a far cry from the 38% drop that made the news, but it is worthy of attention. The Quebec study, published in the Journal of the American Medical Association, found that the use of essential drugs decreased amongst the elderly by 9.1% with "serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons".

BC's Minister of Health should show some concern over these numbers. Instead government used what is becoming a common technique of having a backbencher abuse question period by asking the Minister to respond to the Vancouver Sun story.

V. Anderson: "There are reports today that the prescriptions bought by seniors across the province have gone down 38 percent in the last three months of this year. Some have suggested that this drop is due to the fact that government changes have come to the Pharmacare program. Would the Minister of Health Services respond to this concern?"

Hon. C. Hansen: "The information contained in some of the media reports is not accurate. If you look not at the claims submitted to the Pharmacare program but rather at the number of prescriptions issued in the province, as reflected in the PharmaNet data, it actually shows that for the first quarter of last year to the first quarter of this year, there was a change in the magnitude of 0.07 percent. There are as many prescriptions being filled the first quarter of this year as there were last year."

"What we did see was a significant increase in the number of prescriptions that were filled in December, which usually happens when there's a change in Pharmacare policy because of stockpiling that takes place. The articles today are really quite misleading in that there has been no decrease in the number of prescriptions filled in this province."

Hansen got the numbers wrong, the decrease was 0.7 percent (2.6% when population growth is considered) not 0.07 percent, but that is the least of his problems. The Minister of Health ought to have been briefed on the serious health consequences that follow increased user fees. The literature is full of far more studies than just the one done in Quebec. Any user of the Internet can access MedLine and search on prescriptions and copayment.

Rather than doing damage control on the last round of cuts as he plans the next and bigger round, the Minister of Health ought to develop policy based on sound science. Work with BC's doctors to reduce bad prescribing habits. That will not only lower the costs of Pharmacare but it will reduce other health costs as well. Unfortunately for BC's seniors, the BC government confuses cost shifting with cost saving.