In British Columbia, patients aged 65 years and older are required to pay dispensing fees of their prescription drugs up to an annual maximum of $200, beyond which all of their drug costs are covered for the rest of the year.
Aslam Anis and colleagues wondered whether this policy could be detrimental. They identified almost 3000 patients with a severe chronic illness (rheumatoid arthritis) in British Columbia and looked at their patterns of physician visits, filling of prescriptions and hospital admissions during the cost-sharing period (before the annual maximum of $200 had been reached) and during the "free" period (when all drug costs were covered to the end of the year) in each of 4 years. The authors found that there were 0.38 more physician visits per month and 0.50 fewer prescriptions filled per month during the cost-sharing period than during the free period. In addition, among patients who were admitted to the hospital, there were 0.013 more admissions per month during the cost-sharing period than during the free period.
In an accompanying commentary, Robyn Tamblyn points out that, although the federal government's national drug strategy goes beyond many prior policy reforms in addressing the challenges in optimizing the cost-effective use of prescription drugs, it ignores the fundamental inequity between the provinces. She adds that the results reported by Anis and colleagues probably underestimate the true effects, because only patients who could afford to pay the annual maximum amount were included in the study.
1335 When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions -- A.H. Anis, D.P. Guh, D. Lacaille, C.A. Marra, A.A. Rashidi, X. Li, J.M. Esdaile
http://www.cmaj.ca/misc/press/pg1335.pdf
1343 Prescription drug coverage: An essential service or a fringe benefit? -- R.M. Tamblyn
http://www.cmaj.ca/misc/press/pg1343.pdf
Journal
Canadian Medical Association Journal