Ottawa, December 11, 2024 — A new study assessing provincial and territorial variations in reimbursement criteria of drug coverage for patients covered by Canada's public pharmacare programs for two common cardiovascular conditions revealed significant inequities and inadequacies in access to medications and treatment.
The article, published in the Canadian Journal of Cardiology and authored by Dr. Morgane Laverdure and Dr. Derek So of the University of Ottawa Heart Institute, exposes the complexities of the Canadian drug review process and makes a case for a unified framework to improve the present infrastructure, moving towards ensuring the best care possible for patients with cardiovascular disease.
Canada has been praised for its universal healthcare system and low drug prices, yet it is the only country with universal healthcare that does not provide global coverage for prescription medications. Only a third of Canadians are eligible for publicly funded drug plans. Current Canadian drug review decisions are complex, and coverage decisions vary widely across the country. Reimbursement decisions are often discordant with Canadian guidelines, resulting in an inability to provide guideline-recommended cardiovascular evidence-based care.
"Can the Present Canadian Health Care System Provide Evidence-Based Pharmacare? Consideration of Two Important Cardiovascular Clinical Contexts" compared all provincial and territorial drug formulary reimbursement criteria for medications recommended to treat heart failure with a reduced ejection fraction and antiplatelet therapies in acute coronary syndromes, two common cardiovascular conditions, based on the most recently updated Canadian Cardiovascular Society (CCS) guidelines. The study assessed whether reimbursement criteria were concordant with listing recommendations from the Canadian Agency for Drugs and Technology in Health (CADTH) and with CCS cardiovascular therapy guidelines.
"Our study showed that the Canadian Agency for Drugs and Technology in Health recommendations were only followed 33% of the time in the 24 medications reviewed, and that almost a quarter of reimbursement approvals (23%) were discordant with Canadian guidelines,” said co-lead investigator Dr. Morgane Laverdure, chief cardiology resident in the Division of Cardiology at the University of Ottawa Heart Institute. “Furthermore, novel drugs disproportionately carried the highest discordance with evidence. No systematic process exists for formulary updates based on new evidence, changes in guidelines, or drug pricing."
Among the study’s key findings...
- There is substantial redundancy with multiple tiers of agencies in drug approval processes across provinces and territories.
- Despite the initial common Health Technology Assessment in all provinces but Quebec, there are significant interprovincial variations in final drug reimbursement approvals.
- There are no protocols in place in any province to permit timely updates of formularies to account for novel evidence in cardiac drugs or change in pricing.
- The Non-Insured Health Benefit federal plan and the Quebec plan, the only one not relying on CADTH’s recommendations, were the two plans most concordant with current CCS and its affiliate societies’ guidelines and best evidence.
"The current system leads to significant inequities, with Canadians residing in different provinces having varied access to different evidence-based medications and treatment. While solutions are being explored, the limited and inconsistent provincial drug formularies may compromise the health of many Canadians, especially for the most vulnerable groups relying on publicly funded drug plans,” said co-lead investigator of the study, Dr. Derek So, a cardiologist and clinical investigator in the Division of Cardiology at the University of Ottawa Heart Institute.
"The situation of fragmented pharmacare within the same country is not unique to Canada. Indeed, several other countries such as Sweden and Norway have a similarly decentralized healthcare system with strong regional control over services. The findings of our study, as well as the potential solutions explored, can therefore be of interest for other international jurisdictions," adds Dr. Laverdure.
Additional information
- Read the complete news release published by Elsevier.
- Read “Can the Present Canadian Health Care System Provide Evidence-Based Pharmacare? Consideration of Two Important Cardiovascular Clinical Contexts," by Drs. Laverdure, So, et al.
- Read the accompanying editorial, "Bureaucratic Dissonance and Inertia: Barriers to the Effective and Equitable Implementation of Cardiovascular Guideline-Directed Medical Therapy in Canada," by Dr. Jafna Cox, a professor at Dalhousie University and cardiologist in the Division of Cardiology at Queen Elizabeth II Health Sciences Centre in Halifax, NS.
Media contact
Leigh B. Morris
Communications Officer
University of Ottawa Heart Institute
613-316-6409 (cell)
lmorris@ottawaheart.ca