Pharmacare Research

June 16, 2003

Upcoming - More Pharmacare Cuts, Less Research

According to a contract obtained through a freedom of information request, more policy changes might be "upcoming" for Pharmacare. Health Minister Collin Hansen appears to have been less than perfectly clear when he told the legislature that UBC would do research "to make sure that no senior and no British Columbian is negatively impacted in terms of the ability - based on their ability to pay - to get the medications that they need."

The Strategic Policy and Research branch of the Ministry of Health Planning has a standing research contract covering the period July 1, 2001 to March 31, 2006, with the Centre for Health Services and Policy Research (CHSPR) at UBC. In response to a freedom of information request for the research contract mentioned by Hansen, the document that was produced was an amendment to the standing contract. All the amendment provides with respect to Pharmacare reads as follows:

"CHSPR will begin to develop a framework and identify some key indicators necessary for assessing patterns of pharmaceutical use by residents of BC. The object will use Pharmacare data and therefore focus on patterns of use by the elderly. The project will focus on enhancing CHSPR's ability to measure key aspects of utilization such as exposure, frequency, and intensity of use, and where possible, develop categories of drugs that represent appropriate use, inappropriate use, and unproven use. The project will allow CHSPR to describe variations in population-based prescriptions use by the elderly. While it is expected that the project will provide relevant perspectives on patterns of pharmaceutical use, it will more importantly help CHSPR develop a framework to enhance future capacity to study patterns of pharmaceutical use and to enhance the Centre's future ability to evaluate upcoming policy changes in this area."

According to the Centre's website, its study will "undertake the comprehensive evaluation necessary to determine whether these policy reforms have their intended effects." Of course, it is the undesirable unintended effects that may be of the most interest.

The "upcoming policy changes" could involve more than what has been seen so far. Since the Ministry is forecasing further double digit increases in Pharmacare costs (15% in 2004-05 and 14% in 2005-06), don't be surprised to see more substantial reductions in the amount Pharmacare pays sometime after the 2005 election.

A study by Robyn Tamblyn and 13 others, published in the Journal of the American Medical Association (JAMA. 2001;285:421-429), analyzed the impact of higher user fees for Quebec's prescription drug program. They looked at a random sample of 93,500 elderly persons and examined "Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction." The study found a reduced use of essential drugs and an increase in serious adverse effects related to that decrease.

The document released under freedom of information refers to "Completion of CHSPR's reorganization, following the budget reduction of 45%, effective April 1, 2002, due to reductions in the Ministry of Health Planning." Cuts like that will have a negative impact on health policy research in BC.

The staff at the Centre for Health Studies and Policy Research are well respected and will no doubt make every effort to thoroughly evaluate the effects of the changes to Pharmacare. The Centre's website says that its research will take place over the next three years in collaboration with researchers from the Harvard Medical School and the University of Victoria. It is unlikely British Columbians will see any results from the research before the next election which will be held in less than two years.