| dc.description.abstract | Introduction: The Canada Health Act (CHA) requires provincial/territorial governments to publicly fund prescription drugs when delivered in the hospital. This coverage does not continue once individuals are discharged under the terms of the CHA. Governments do provide additional public coverage for drugs outside of the hospital for specific groups. The Ontario Drug Benefit Program (ODB) was implemented in 1974 to provide public funding for prescription drugs for seniors 65 years and older.
Methodology: The data collection for this case study is based on a scoping review (peer review and grey literature) and semi-structured interviews. Relevant documents were identified from the Ontario government’s websites, professional associations, and searches with Medline, PubMed, Econlit and Ovid. Ten physicians working in a Durham region primary care clinic in Ontario were interviewed to determine their views on the ODB program. An iterative approach was used to analyze the data and resulted in the identification of several different themes related to both the benefits and challenges of the ODB for physicians and their patients.
Results: Physician views were concentrated on transparency regarding the ODB’s decision making process for inclusion/exclusion on the ODB formulary, the need for timely information when brand name drugs are replaced with generic drugs (i.e., communication about and information on the generic), and on the challenges of completing ODB forms to request coverage for non-formulary drugs. Concerns were raised about the potential negative side effects of the replacement drugs for their patients. While it was recognized that generic drugs are less costly, this saving needs to be balanced with the costs associated with the impact the replacement drug may have on patient outcomes. Procedures to request public funding for prescription drugs not covered under the ODB program need to be streamlined to ensure patients have timely access to the appropriate drug within the publicly funded program (i.e. the Exceptional Access Program). The primary care physicians did also express that they were pleased with the fact that Ontario had such a program to offer to the senior population as they are the population suffering with the most co-morbidities.
Discussion/Conclusion: The implementation of a national pharmacare program in Canada has the potential to reduce costs and increase access. Results from this study suggest that certain challenges exist in obtaining the most appropriate drugs for individual patients. Challenges exist that impact the quality of care and costs associated with procedural requirements. Other lessons learned from this study suggest the importance of including physicians when making policy based decisions in healthcare because they are the gatekeepers of medicine. | en |
