Author
Dr. Brett J Skinner, Ph.D.
Introduction
On March 15, 2013 Quebec’s ministry of health announced changes to its reimbursement policy for proton pump inhibitor (PPI) drugs covered under the public prescription drug insurance plan le régime public d’assurance médicaments (RGAM) du Québec, effective October 1, 2013. The new policy sets the maximum price payable (MPP) for all PPI drugs at $.55 per unit and will financially penalize patients who don’t switch to PPI drugs that are priced under the MPP. It follows a study by the Institut national d’excellence en santé et en services sociaux (INESSS) that deemed all PPI drugs to be therapeutically equivalent though they are bio-chemically different products. INESSS projected that RGAM will save between $32 million and $41 million annually from the policy change.
Objective
In 2003, British Columbia implemented a policy for PPI drugs, which like Quebec, financially incentivized patients to make a medically unnecessary switch from their prescribed PPI to a cheaper bio-chemically different PPI product. Skinner, Gray and Attara (2009) evaluated the economic impact from BC’s policy for PPIs. The purpose of this study is to extrapolate the outcomes observed in BC from 2003 to 2005 to Quebec in 2014 to 2016, projecting the potential impact on total health system costs from therapeutic substitution of PPI drugs in Quebec.
Data
Data were obtained from the findings of Skinner, Gray and Attara (2009). The most recent data on the size of Quebec’s population of PPI users as of 2012 was obtained from INESSS (2013). Supplementary health spending data was obtained from the Canadian Institute for Health Information (CIHI) (2012).
Results
According to INESSS, of the 681,644 PPI patients insured by RGAM, 196,023 patients will face a financial incentive for therapeutic substitution because of the MPP. Assuming Quebec’s experience in its first 3 years after implementation of the MPP (2014 to 2016) will be proportionally similar to BC’s actual experience (2003 to 2005), the expected potential total net health system costs associated with therapeutic substitution of PPIs could reach an estimated $49.8 million. If the policy achieves 100% compliance among the group of patients affected by the financial incentive to switch PPI drugs, net costs could reach up to $162 million. Under both scenarios, the estimated costs are net of any price savings associated with the MPP for this group of patients.
Conclusions
Like BC, Quebec’s therapeutic substitution policy for PPI drugs is designed to encourage patients to switch for non-medical reasons from their prescribed medication to a cheaper drug product that is not bio-chemically equivalent. If Quebec’s experience turns out to be similar to BC’s experience, it should be expected to result in significant additional net health system costs from increased utilization of PPI drugs, physician services and hospital services.
