Health Economics and Technology Assessment Rounds VII

The NOAHE Health Economics and Technology Assessment Rounds are presented by the Institute of Health Economics, the University of Calgary Health Economics Group and HTA Unit, and the University of Alberta Health Economics Unit. Their aim is to advance health economics research and support evidence-based health policy, to improve the health outcomes of Canadians.

Round Objectives

  • To present research on topics of relevance to Health Economists, trainees, and policymakers across Alberta.
  • To bring experts in Health Economics to Alberta to present cutting-edge research.
  • To encourage collaboration and discourse between Alberta Health economists and policymakers.

Please note that the views expressed in this series and other deliverables associated with NOAHE are not necessarily representative of any particular organization involved.

Public prescription drug plans across provinces and territories: A national environmental scan and public policy analysis in Alberta

Presented by Dr. Reed Beall and Jane Fletcher, University of Calgary
Date: June 19, 2024
12:00 - 1:00 PM MT

Cardiovascular disease, cancer, respiratory diseases, and diabetes are leading causes of death in Canada. Medications can improve outcomes, but due to financial and other barriers, adherence is suboptimal, leading to avoidable consequences for public health. Disparities in public medication coverage vary significantly by province and affect prevalence of cost-related non-adherence.

We conducted an environmental scan to gather details on existing public medication coverage plans across Canadian provinces and territories. Using provincial and territorial websites, data was collected on each drug plan type, cost-sharing structure, plan details, eligibility requirements, and products covered. Plan summaries were then reviewed by administrators from 8 provinces and territories to confirm accuracy. Semi-structured qualitative interviews with administrators were used to identify themes in the perceived strengths and weakness of plans that were common across those provinces. The scan found that coverage structures varied widely, and included the use of premiums, deductibles, or copayments. Plans included flat rates or those calculated by income or drug costs. Common challenges across provinces/territories based on directed content analysis of transcripts included coverage for high-cost drugs, rare diseases, aging populations, and low-income working people without insurance. Administrators also identified challenges and advantages to different plan types, including administrative, economic, equity, political, and feasibility factors.

Following the environment scan, we assembled a team of policy analysts, actors and experts, and patient partners to follow the six steps of a traditional public policy analysis: problem identification; determining evaluation criteria; identifying and assessing policy options; selecting the preferred policy option; and designing implementation and monitoring. The analysts then independently scored each option collected in the scan according to the six decision criteria recommended by the National Collaborating Centre for Healthy Public Policy based on available evidence, namely: effectiveness, unintended effects, equity, cost, feasibility, and acceptability. The results of this policy analysis are expected to inform provincial decision-makers and public insurance providers of potential options to improve drug coverage for working-age Albertans who currently have inadequate coverage.

Presenter Biographies

Reed F. Beall is a population health researcher who works largely with medicine patent, regulatory, and utilization data to investigate the long-term impacts of national and international policy decisions which aim to balance incentives between equitable drug innovation and equitable drug access. He is an Assistant Professor in Healthcare Policy in the Department of Community Health Sciences within the Cumming School of Medicine and at the O’Brien Institute for Public Health at the University of Calgary. He also serves as affiliated faculty for the Program on Regulation, Therapeutics, and the Law (PORTAL) based within the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham and Women’s Hospital and Harvard Medical School. He has been invited to provide testimony on his research to the trilateral technical symposium of the World Health Organization, the World Intellectual Property Organization, and the World Trade Organization, as well as to the United Nations Secretary-General's High-Level Panel on Access to Medicines. Dr. Beall’s work has been published in Value in Health, Nature Biotechnology, Health Affairs, and Health Policy, among others

Jane Fletcher is a PhD student at the University of Calgary in the Department of Community Health Sciences, focusing on Health Services Research, and was the 2023-2024 NOAHE fellow. Her research is centred around medication access for people facing financial and other barriers, as well as determining other factors around medication non-adherence. 

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