Position Statement: Reimbursement Access to Medications
The Better Pharmacare Coalition believes that timely and accessible coverage of pharmaceuticals and health products are important components of a patient’s treatment plan. Drug policy must focus on providing the best care for patients. If managed properly, the use of "the right drug, at the right time for the right patient" can have a significantly positive impact on improving health outcomes and reducing health system costs. Successful and effective pharmaceutical policy must incorporate the following principles and approaches:
Patient Access and Choice (Therapeutic Options)
- Issues of affordability and ability to pay must not impede patient access to required medications.
- Physicians are best suited to making decisions about the treatment needs of their patients as they fully understand the disease history and the clinical implications of treatment. For this reason, physicians should have the option to prevent switching of prescribed medications by pharmacists.
- A policy must be established to ensure that patients who are being successfully treated on a medication are not forced to switch medications.
- Mechanisms for formulary exceptions and/or special authorization should be timely and efficient, allowing patients to gain access to clinically important medications that will provide optimal treatment benefits.
- Drug review decisions must incorporate a broad range of relevant experts, including specialist physicians who treat patients living with disease the drug is intended to treat, as well as taking into consideration the uniqueness of disease experience.
- Decisions about drug safety are an integral and ongoing part of the review process, and must incorporate all relevant stakeholders, including specialist physicians, epidemiologists and patients.
- Decisions about the cost effectiveness of medications must include an examination of the full economic impact across the whole health system as well as those areas of government significantly impacted by indirect health care costs.
- Pharmaceutical policy development, including drug review decisions, must be accessible and open to the general public, patients and all physicians.
- The development, implementation and evaluation of pharmaceutical policy must include meaningful and formal processes for involving informed patients, specialty physicians and, when appropriate, members of the public.
- Drug pricing must be in line with other provincial and territorial jurisdictions and must respect the balance between best price and patient needs. Savings accrued through improved pricing and purchasing policies should be reinvested into the BC PharmaCare program in order to provide better imbursement coverage for new, improved medications.
- Patient access to publicly funded medications should not be restricted by policies that limit pharmaceutical purchasing to sole product suppliers (sole tendering) across an entire class of chemically different drugs. Instead, purchasing policies for drugs that have been shown to be chemically identical (such as generics) should be incorporated as a way to reduce costs, while not limiting access and increasing risk to patients.
- Pharmaceutical policy should not be based solely on cost “containment” as such policies restrict access to needed medications, thereby impeding appropriate and effective care, and increasing financial, human and social costs.
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