Improving Access to Medicines in Canada and Abroad

Project number: 
Approval date: 
Thursday, March 21, 2019
Principal Investigator: 
University of British Columbia (UBC)
Funding Agency: 
Canada Foundation for Innovation (CFI)
Datasets requested: 
Births (BC Vital Statistics Agency)
Deaths (BC Vital Statistics Agency)
Medical Services Plan (BC Ministry of Health)
Hospital Separations (BC Ministry of Health)
Consolidation registry (Ministry of Health)
consolidation - census geocodes
Consolidation - demographic (Ministry of Health)
Research objective: 

17-030A: Project 1 - Deductibles
17-030B: Project 2 - OAT
17-030C: Project 3 - Primary Nonadherence

Overarching Theme: Same policy issues (e.g. social/economic, primary health services, or health policy)
The projects for this program of research all fall under the theme of studies on health policy issues related to access to medicines in Canada. The first three projects proposed under this program are a direct fit with this theme:

1.Estimating the Prevalence of Primary Non-adherence in British Columbia
This project aims to evaluate primary non-adherence in British Columbia, as well as the characteristics of patients who engage in this behaviour. Primary non-adherence refers to people who get a prescription from a physician but then never fill it at a pharmacy. This falls under the theme of health policy issues related to access to medicines as primary non-adherence is the first point at which patients can not access medicines.

2. Opioid Agonist Therapy under the PharmaCare Psychiatric Medications Plan: Trends in Use, Persistence, and Unintended Consequences
This project is the evaluation of a pharmaceutical policy change in British Columbia that added Opioid Agonist Therapy to the Psychiatric Medications Plan (Plan G). This change was designed to reduce barriers to accessing these medicines. This falls under the theme of health policy issues related to access to medicines as it is a policy evaluation of a change intended to increase access to medicines.

3. The Impact of Lowering Deductibles within the BC PharmCare Program
This project evaluates the policy change on Jan 1, 2019 to lower deductibles within the BC PharmaCare plan. The aim of this change is to reduce barriers of access to medicines for lower income households in British Columbia. This falls under the theme of health policy issues related to access to medicines as it is a policy evaluation of a change intended to increase medicine access.

Program Objectives:
My program of research focuses on whether or not people who need prescription drugs can access them, what factorsin particular costplay a role, and what policy changes might alleviate any identified gaps in access to necessary medicines. This research is important to the quality of health care provided, how health systems can manage their costs, and ultimately the health outcomes that patients experience. I place a heavy emphasis on the policy-relevance of my research and work closely with decision-makers as a result. This allows my findings to be quickly translated into improvements to health care systems. Projects within this program will fall within the theme of access to medicines in Canada.

Despite universal coverage for physician and hospital services, coverage for other services is much more of a patchwork. In particular, access to medicines remains an issue for millions of Canadians. For example, I have previously shown that approximately 1.7 million Canadians cannot afford their prescription medications. My proposed program of research will build on current knowledge through several sub-projects.

Example Project: Estimating the Prevalence of Primary Non-adherence in British Columbia:
Prior Canadian research has shown that 30% of prescriptions that are written for seniors and those on social assistance are not filledalso known as primary non-adherence. Despite this striking prevalence, we do not have a good understanding of either the causes or consequences of this behaviour. My work will utilize linked data between a primary care electronic medical record system and BCs PharmaNet database, which contains information on all drug dispensing in the province. I will use this unique dataset to quantify primary non-adherence in BC in the general population.

Canadian policy experiments and evaluations are another aspect of my work on access to medicines. A core component of my program uses administrative health data to assess the impact of policy changes on medicine access. I plan to lead a series of both policymaker-initiated and investigator-initiated evaluations. Over the past several years, I have worked in very close partnership with the BC Ministry of Health to conduct studies that have influenced three areas of pharmaceutical policy: the impact of Fair Pharmacare deductibles, pharmacist medication reviews, and blood glucose test strip coverage. In conjunction with the Ministry of Health, we currently have 7 active projects of mutual interest that are in various stages of completion. Of those projects, I plan to conduct 5 under the auspices of this data approval. This portion of my work would benefit greatly from programmatic data access, as it will facilitate the quick turn-around that is often necessary to influence policy.

Page last revised: July 14, 2020