Posted on Apr 26, 2016

Seniors Drug Policies

Once again, thank you to everyone who came out to the Seniors Drug Policies Public Consultation at the Terwillegar Community Recreation Centre. I heard a lot of good feedback, and a lot of weights being dropped on the floor above us.

If you missed this event and want to submit your feedback to my constituency office, here are the questions:

1. Separate programs:
Alberta Health, as administered by Alberta Blue Cross, provides different forms of coverage for people in different situations instead of universal coverage.

Persons over 65 qualify for premium-free Seniors Coverage. Persons who do not have access through a workplace for a group plan (including unemployed persons) may subscribe to Non-Group Coverage, which has premiums. Alberta Health also offers specialized programs like the Outpatient Cancer Drug Benefit Program and the Specialized High Cost Drug Program.

Should seniors be covered under a universal program or under their own specialized program? Why?

2. Benefit list and cost-benefit analysis:
Alberta Health appoints an Expert Committee on Drug Evaluation and Therapeutics, which receives technical advice from Blue Cross in the production of the province’s Drug Benefit List. The Minister of Health has final approval of this list. The Alberta Drug Benefit List defines which drugs and therapeutics are covered by Alberta government-sponsored drug programs.

Alberta Health’s purchasing policy uses a cost-benefit analysis, which directly impacts the Expert Committee’s recommendations. While pursuing cost effectiveness saves the government money, it means that less effective drugs may be recommended over more effective drugs if they are considerably less expensive.

Consequently, Alberta’s benefit list is smaller than other Canadian provinces. Some drugs that are costly but effective are not available for coverage. At the same time, public drug costs to the system are reduced.

Should the government use a cost-benefit analysis when deciding which drugs to purchase? If so, to what degree should it be applied? If no, why?

3. Paying for medication:
Currently, seniors covered under Alberta Health’s Coverage for Seniors drug program pay a deductible of 30%, up to a maximum of $25, for each prescription covered under the benefit list. Drugs that are not on the benefit list must be paid for by the patient or a private health insurance provider.

There are numerous precedents for how patients pay for medication across the world. Some include:

  • A per-prescription fixed fee system. Our current system uses a fixed fee system whereby a senior pays a maximum of $25 to fill a prescription.
  • A percentage-based fee system. Japan uses a model whereby seniors pay 15% of the medication’s cost.
  • An income-based system reduces public drug costs, but operates on the insurance model of paying deductibles. This can make it difficult for lower-income seniors to purchase their medication.
  • A free prescription system. All medications prescribed by a doctor are covered by the government. This would incur the most public expense. However, it has precedent in that seniors, like other patients, do not pay for physician services in Alberta.

Should seniors pay for their medication? If so, what payment model should be used?

4. Appeals:
At the moment seniors are not involved in determining which drugs are listed for benefits. After the Alberta Drug Benefit List is released, there is no process for appealing their benefit list decisions. It currently takes around 740 days for Alberta Health to list a new drug product. Generics of existing medication take roughly 80-90 days to be approved.

This means that a patient whose medication is no longer listed or who has been prescribed a medication newer than the current Alberta Drug Benefit List has no recourse for action.

Should there be a mechanism for individual appeals as an exception to the benefit list? Should generics be exempt from this waiting period?

5. Responsibility:
As people get older, they require more drug therapy. At the same time, as people get older, their bodies cannot handle medication as well. In order to stay healthy, then, the patient needs their medication monitored.

How should the system work to protect the patient? Should it be through their pharmacist? family physician (ideally within a primary care network)?

6. Other Advice for the Government:
What do you feel is fundamentally wrong with Alberta’s seniors drug benefit program? What primary issues can you identify for future discussion?