Sicker Seniors

It is very likely that over a hundred thousand seniors have suffered reductions in their use of essential drugs and a higher rate of serious adverse events and emergency room visits associated with those reductions as a consequence of the implementation of so called Fair PharmaCare. The Campbell government cannot hide the research for another three years.

BC's "Fair PharmaCare Plan" started May 1, 2003. The government's website boasted that: "Under the new plan, up to 280,000 BC families will pay less than they did in the past." It didn't reveal how many families pay more than they did in the past but you can get an idea by subtracting that figure from the number who have received PharmaCare benefits in past years (814,424 in 2002). On October 22, 2003, Colin Hansen told the Legislature that: "We have already put in place a contract with officials at the University of British Columbia to make sure that this transition is properly monitored using PharmaNet data, to make sure that no senior and no British Columbian is negatively impacted in terms of their ability - based on their ability to pay - to get the medications that they need." The Auditor General recently released a highly critical audit of the PharmaCare program in which he quoted the Ministry's 2003/04 Annual Report as saying: "…any potential negative impacts of Fair PharmaCare are being monitored, and that preliminary evaluations indicate that drug use has not decreased in either the senior or non-senior groups since implementation." The Auditor General has confirmed (click for his letter) that he and his staff did not see the "preliminary evaluations" as they were not auditing the Annual Report, but merely quoting from it.

There are serious reasons to believe that the claim made in the Ministry's Annual Report, as quoted in the Auditor's report, is misleading. According to the Budget Transparency and Accountability Act, the Ministry's 2003/04 Annual Report had to be made available by August 31, 2004. That is just 3 months after the first full year of experience with the new plan. It is inconceivable that research studies could have been completed so quickly. The claim made by the Ministry refers to total utilization by groups of people, seniors and non-seniors. Of course some people, possibly those with improved coverage, obtained more drugs while others obtained fewer drugs. Aggregate utilization says nothing with respect to the claim Hansen made that the program was being monitored to make sure that no senior and no British Columbian is negatively impacted. The promise referred to individuals, not to aggregate group use of pharmaceuticals.

The Ministry of Health had a standing agreement with the Centre for Health Services and Policy Research (CHSPR) at UBC which it subsequently amended to monitor the transition to Fair Pharmacare. I have submitted a freedom of information request for the report that should have been the product of the contract Hansen referenced in 2002, although the Ministry has yet to acknowledge receipt of my March 22nd request. Despite time limits specified in the Act, it can take a year or more to beat information out of the Campbell government. It is particularly important to obtain the research reports on the effect of the change in PharmaCare because a study of a similar change in Quebec found: "increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions." That study, published in the Journal of the American Medical Association, wasn't based on glancing at aggregate drug use; it studied individual drug use by a random sample of 93,950 elderly persons and 55,333 adult welfare medication recipients 32 months before and 17 months after Quebec's 1996 introduction of a prescription coinsurance and deductible cost-sharing policy.

In 2002, British Columbians age 65 or over were eligible for one of two PharmaCare plans: regular Plan A where seniors paid a maximum of $25 towards the drug cost and dispensing fee per prescription, to a yearly maximum of $275, or Plan A1 for seniors in receipt of premium assistance where they paid a maximum of $10 towards the drug cost and dispensing fee per prescription, to a yearly maximum of $200. In 2002, 413,274 seniors received $339,815,837 in benefits from PharmaCare.

Under "Fair" PharmaCare the maximum amount paid and the initial deductible before any benefits are paid depends on income. Seniors with net annual family income of $40,000 don't receive any coverage until they've paid a deductible of $400, after which they receive 75% coverage until they've paid a total of $800. Deductibles and maximum self-payments increase as income increases. The challenge for the researchers is to follow the prescription drug use of a large random sample of families, whose benefits were reduced, before and after the 2003 policy change. The data exists for that study. Since it is now almost three years after the implementation of the policy change, it is likely that the study on the Quebec change could have been replicated in BC. According to the Ministry of Health's Annual Report, the Campbell government intends to keep the study secret until after the 2009 election. It is certain to face a challenge before the Freedom of Information and Protection of Privacy Commissioner if it follows that plan.