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Swallowing the costs

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B.C.’s is the only province with a "nominally universal drug program," according to Health Canada, "although for the under 65 population the deductibles are (deliberately) set high enough that there are few beneficiaries, and the coverage for those over 65, which was once first-dollar, now includes a co-payment."

It’s called "reference-based pricing" – although drugs may have a different chemical composition and mode of action, if they are used to treat the same condition they are assigned to the same reference class. Doctor’s are encouraged to use the lowest cost drug in that reference class that would be effective, although they can make exceptions if it’s medically necessary.

Bill C-91, however, is catching up with us by making fewer generic choices available to doctors.

On Nov. 3, the provincial government announced that it would create a panel to seek a cost-effective alternative to B.C. Pharmacare’s reference drug-pricing program, which is already the most cost-effective program of its kind in Canada.

Nobody knows what this alternative might look like, although nobody has ruled out the possibility that non-essential drug costs would be off-loaded onto patients, or that deductibles will increase. With no generic alternatives available for many conditions, doctor’s will have no choice but to prescribe brand names.

In October, the B.C. government removed six drug groups from Pharmacare coverage, including anabolic steroids, growth hormones, Flavoxate (used to treat individuals with involuntary urine loss), Nasal corticosteroids (and other drugs used to treat seasonal allergies), Vancomycin (used to treat diarrhea caused by antibiotics), and all topical antifungal skin preparations used to treat conditions like athlete’s foot and ringworm.