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Drug Reimbursement Policies in Canada—Need for Improved Access to Critical Therapies

Director of Pharmaco-economics and Pharmaco-epidemiology Research Unit, Centre Hospitalier de L'Université de Montréal, Montréal, Quebec, Canada

Alan Bell, MD MCFP

Active Staff, Department of Family and Community Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada

David J Bougher, BSP MHSA

Principal Consultant, D Bougher Consulting, Edmonton, Alberta, Canada

Jafna L Cox, MD FRCPC FACC

Professor, Departments of Medicine and of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada

Alexander GG Turpie, MD FRCP FRCPC FACC

Professor, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario

Reprints: Dr. LeLorier, Pharmaco-economics and Pharmaco-epidemiology Research Unit, Centre Hospitalier de L'Université de Montréal, CRCHUM—Pavillon Masson, 3850 Saint-Urbain, Montréal, QC, Canada H2W 1T8, fax 514/412-7174, massicoa{at}umontreal.ca

Public drug programs in Canada are increasingly implementing cost management strategies. A multidisciplinary review of these strategies—specifically, the special authorization (SA) process—found that implementation of the SA practice is costly and causes inequity in access, underutilization, and delays in treatment for urgently required therapies, all potentially leading to negative health outcomes. We present potential solutions and a set of recommendations for decision-makers to base reimbursement decisions on the best clinical evidence, eliminate regional variability in access, ensure timely access to urgently required treatments, and monitor the impact of reimbursement policies on health outcomes.

Key Words: health outcomes, health policy, medications, reimbursement

Published Online, May 13, 2008. www.theannals.com, DOI 10.1345/aph.1K373