barbara walman - pharmacare in canada today
TRANSCRIPT
PharmaCare 2020
Barbara Walman
Assistant Deputy Minister
Pharmaceutical Services Division
2
Outline
Welcome BC PharmaCare Program
Quick overview Current State & Trends Observations ~
3
BC PharmaCare
BC PharmaCare Program
Primarily a publically funded drug insurance program Prescription drugs and designated medical supplies
2011/12 820,000 beneficiaries Approximately 30 million claims Almost $1 billion in benefits
2011/12 budget = $1.140 billion
4
5
Plan B4.7%
Plan C30.5%
Plan D0.1%
Plan F0.5%Plan G
2.6%
Plan I58.9%
Plan P1.8%
Plan S0.9%
11/12 Total PharmaCare Expenditure by Plan (Millions)
6
Fair PharmaCare Fair PharmaCare provides coverage for eligible prescription drug
and medical supply costs based on a family’s net income. Families pay 100% of costs until they reach their annual deductible,
at which time PharmaCare begins paying 70% of costs and the beneficiary the other 30% as a co-payment. There is no deductible for lower income families.
When the family maximum is reached (2% to 4% of net income), PharmaCare covers 100% of eligible costs.
All BC families are encouraged to register for Fair PharmaCare since families who do not register are assigned an annual default deductible/family maximum of $10,000 per family member.
As of January 1, 2013, 1.2M families were registered under the plan.
7
Other PharmaCare Plans Plan B – permanent residents of licensed residential care facilities Plan C – individuals receiving BC income assistance Plan D – patients with cystic fibrosis Plan F – disabled children registered in the At Home Program Plan G – patients for whom the cost of psychiatric medication is a
significant barrier to treatment Plan M –medication management services provided by pharmacies Plan P – patients who wish to receive palliative care at home Plan S – nicotine replacement therapies under the Smoking
Cessation Program Plan X – anti-retroviral drugs provided through the BC Centre for
Excellence in HIV/AIDS
8
Highlights (examples): Pharmaceutical Services Act ~ proclaimed in May/12
New pricing regulation specific to generic drugs Research/Developing an EDRD Framework Improvement of the drug review process Do Bugs Need Drugs? (education) Provincial Academic Detailing PharmaNet Modernization project
Includes ePrescribing
BC Trends: Total Claims Expenditures (All Plans: B, C, D, F, G, I, P, and S)
FY 07/08 FY 10/11 FY 11/124 Yr %
Chg1 Yr %
Chg
Total Claims (millions)24.08 28.03 29.77 24% 6%
Beneficiaries (millions) 0.79 0.79 0.82 3% 3%
Ingredient Cost Paid ($M) $690.55 $784.36 $767.47 11% -2%
Professional + Capitation Fees Paid ($M) $171.20 $187.94 $215.29 26% 15%
Total Amount Paid ($M) $861.75 $972.30 $982.76 14% 1%
9
BC PharmaCare Total Annual Expenditure
2005
/2006
2006
/2007
2007
/2008
2008
/2009
2009
/2010
2010
/2011
2011
/2012
$0
$200
$400
$600
$800
$1,000
$1,200
$867$913
$947$989
$1,032$1,093 $1,109
Total Annual Expenditure
Mil
lion
s ($
)
10
11
CIHI - Changing Look of the Health Care System
60%
9%
9%
9%
13%
1975
Hospitals and Physicians Drugs Other Professionals Other InstitutionsOther Expenditures
SourceNational Health Expenditure Database, CIHI.
44%
16%
11%
11%
19%
2012
The Challenge We Face
12
$8.7$9.7 $10.2 $10.5 $10.6
$11.4$12.1
$13.0 $13.3$13.9
$14.6$15.6
$16.2$16.8 $17.3
$8.5
$9.6
$10.4 $10.4 $10.8
$11.7 $12.1
$13.2
$13.9
$14.6
$15.4$16.3
$17.0$17.6
$18.1
38.1% 39.0%40.6% 41.6%
43.0% 43.2% 43.0% 44.2% 43.9% 44.5%45.6%
46.5% 47.8%49.3% 49.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
5
10
15
20
00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15
% o
f CRF
Billi
on$
Ministry Actuals Ministry Estimates
Provincial Government Health Expenditure estimates/health function CRF Health Function as % of total CRF
Note: 2011/12 CRF Total adjusted for Reimbursement of HST Transition Funding ; 44.5% if not adjusted
Health Care Sustainability/Affordability
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
0
10
20
30
40
50
60
70
13
$ B
illio
ns
Base Expenditure
General Price Inflation
Pop Growth
Utilization
Health-related Inflation
Holding at 8.4% of GDP
At 8.4%+0.05% points
Pop Aging
Source: HMB2011_122, HSP, Ministry of Health
BC public health expenditure was estimated at 8.4% of GDP in 2010. It has grown an average of 0.09 percentage points (as a % of GDP) since 1981.
At 8.4%+0.09% points
14
The Current System
1. Health promotion and disease prevention
2. A province wide system of integrated primary and community care
3. High quality and accessible hospital care
Improved innovation, productivity and efficiency across the system
The Innovation and Change Agenda
15
16
Observations ~ Questions
New ADM~
WOW!
&
REALLY?
17
Statement: Drugs are the 2nd highest cost in Health Care. Cost control ~ “move the dial” = drug reform
Generic: lower and lower prices as a % of brand Low Cost Alternative/Referenced Priced programs Product Listing Agreements with Manufacturers Pan-Canadian Alliance(s): Top 6 generics~ 18% brand Formulary management:
Product listing decisions are evidence base & cost effective Driving more and more product through Special Authority
18
Continued: Expensive Drugs for Rare Diseases
“willingness to pay” research underway Developing a framework to help decision making
New, newer, newest…. Personalized medicine Subsequent entry biologics Orphan drugs Catastrophic illnesses
Drug shortages Working with jurisdictions to track and manage
19
COMPLEXITY ~ from a public plan perspective Supply chain~
Very, very complex business model Manufacturing ↔ Wholesale ↔ Pharmacy Includes rebates, incentives, clinical services,
mark-ups, business practices, etc.
☼ On top of business model: We need to define government’s role ~ In supply chain In pharmacy/business With pharmacists
20
INTEGRATION ~ How do we integrate effective, efficient and safe
drug use into the primary health care continuum? Need to move from a cost driven model to an outcome
focussed model Educate prescribers, other healthcare professionals,
patients and public on: the optimal use of drugs to achieve improved health outcomes in a fiscally responsible manner
21
Ability ~
Affordability Sustainability Accessibility Accountability
There are many opportunities for us to work together on these key principles ~ for improved health outcomes for Canadians.
22
Thank you.
23