Author
Nigel S B Rawson, Ph.D.
Introduction
A national pharmacare scheme similar to the system used to control pharmaceutical costs in New Zealand has been suggested for Canada. While the New Zealand system has reduced costs, it also restricts access to important medicines. The objective of this analysis is to compare the comprehensiveness of Canadian provincial public drug plan benefit lists with the New Zealand national formulary by examining the listing status of a range of existing and recently approved drugs for a wide variety of disorders.
Methods
Canadian provincial drug benefit listing information obtained from online resources and direct enquiries was compared with New Zealand listings in nine drug classes?anti-infective agents, cardiovascular drugs, gastrointestinal drugs, musculoskeletal agents, nervous system drugs, oral hypoglycemic drugs, respiratory system drugs, and recently approved oncology and rare disorder drugs?current at the end of July 2016. Mortality and hospital discharge data for selected health conditions were also examined.
Results
Of 248 drugs in the analysis, 90% were approved for marketing in Canada compared with only 74% in New Zealand. The discrepancy in marketing approval between the two countries resulted in the benefit listing rates for anti-retrovirals, angiotensin receptor blockers, statins, proton pump inhibitors, non-steroidal anti-inflammatory drugs and oral hypoglycemic drugs in New Zealand being reasonably high (≥67%), but the number of drugs with benefit listing as a percentage of the total number of drugs in the class being less than 60%. Benefit listing and overall rates for histamine-2 receptor antagonists and recently approved oncology and rare disease drugs were much lower in New Zealand than in Canada. Mortality rates for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease, musculoskeletal conditions and peptic ulcer in 2011 were more than 30% higher in New Zealand than in Canada.
Discussion
The results of this analysis demonstrate that several drugs recently approved in Canada are not approved in New Zealand and many drugs approved in New Zealand in the past are no longer available. As a result, fewer products were insured in most drug classes in New Zealand than in many Canadian provinces. In general, Canadian physicians have greater prescribing choice than their New Zealand counterparts to ensure that the most effective and best tolerated product is available for each patient. The adoption of a scheme to control drug costs in Canada that is similar to the New Zealand system would lead to less choice of new effective and safe drugs and the potential for poorer health outcomes. Although a majority of Canadians may favour for the concept of a national pharmacare program, it is likely that they believe such a program would lead to access to more products for more patients, not universal coverage of a limited range of mainly low-cost medicines. Canadians should be careful about what they wish for.
