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The impact of out-of-pocket costs within the BC PharmaCare program

Examining the impact of out-of-pocket patient costs in the BC PharmaCare program on prescription drug use, use of other health services, and health outcomes

The Challenge

The Fair PharmaCare program provides universal public drug coverage to British Columbians based on their net income. Households must pay out-of-pocket for their prescription drugs until they reach an income-based deductible, after which they are eligible for financial assistance.

The overall design of PharmaCare has remained essentially unchanged for more than a decade, despite growing knowledge across Canada that income-based approaches to coverage can impact prescription medication use among some populations, such as lower-income Canadians.

When patients don’t fill their prescriptions – or if they don’t take the recommended dose – it can affect their health outcomes and their use of other health services.

This project will help inform the ongoing debate about the role income-based deductibles should play in public drug plans.

Our Approach

British Columbia maintains extensive health care databases on the province’s four millions residents. By linking different data variables together, this project will create a population-level picture of how Pharmacare policies affect health behaviours and outcomes.

Using sophisticated observational research methods, the project will use the unique features of the Fair PharmaCare program to identify whether income cut-off level has an impact on drug use, adherence, health outcomes and the use of other health care services in BC.

This project has significant potential for influencing policy both within and outside of BC. Understanding the role of deductibles in influencing drug use and health outcomes may provide useful evidence to inform policy decisions.

The leader of this project is Dr. Michael Law, Canada Research Chair in Access to Medicines, University of British Columbia.