British Columbia, more than any other province, has managed to keep its drug spending in check.
Per capita drug spending in the province was $660 last year, compared to $910 in New Brunswick - an astounding difference.
Variations and increases in drug spending are related, in part, to demographics and socioeconomic factors - and British Columbians are slightly younger and somewhat healthier than residents of more drug-consuming provinces - but public policies also have a tremendous influence.
While prescription drugs are not covered under the provisions of medicare, every province covers, to some extent, the drug costs of seniors, children and those on social assistance programs.
On average, less than half of drug costs are picked up by state-run plans, ranging from a low of 32 per cent in New Brunswick to a high of 53 per cent in Manitoba. Public-sector spending per person on prescription drugs ranges from a low of $241 in British Columbia to a high of $389 in Quebec.
These differences depend largely on what is on a provincial formulary - a list that lays out which drugs are covered (or in some cases reimbursed).
Quebec, which is home to the head offices of most brand-name pharmaceutical companies, has a reputation for approving virtually everything, and that is reflected in the cost of its plan. British Columbia, on the other hand, has some of the most sound and reasoned drug policies in the country and they don't always sit well with Big Pharma.
The provincial pharmacare program owes some of its efficiency and cost-effectiveness to an electronic record-keeping system. (What exactly are other provinces waiting for to embrace electronic health records?)
British Columbia has a policy of reference pricing - meaning pharmacare pays only for the cheapest drug that works, even if it's a generic. That is because many older, cheaper medicines work just as well as highly hyped and far more costly "me too" drugs that offer no additional benefit.
British Columbia was the leading proponent of the Common Drug Review, a national body (all provinces except Quebec) that reviews new drugs and recommends their inclusion or exclusion on formularies.
Still, while British Columbia is leading the pack, Health Minister George Abbott wondered if it could do better, so late last year he appointed the Pharmaceutical Task Force. After all, $900-million a year on pharmacare is a major expense for the province.
Last week, the industry-dominated group issued its report. The recommendations were, for the most part, reasonable, if predictable: speed up approvals, get more public input, fix the ridiculous reimbursement policies for pharmacists and negotiate prices differently with generic manufacturers (while brand-name drug prices are regulated, generic ones are not).
But one recommendation in the report stands out as mean-spirited and unjustified: a call to abolish the Therapeutics Initiative. It is made all the more puzzling by another recommendation that says if the initiative is maintained, its scope should be limited but its funding expanded.
A little background and context is in order.
Established in 1994 to "provide physicians and pharmacists with up-to-date, evidence-based, practical information on rational drug therapy," the Therapeutics Initiative has slowly grown into a gem of Canadian public policy.
For the most part, the initiative does its work - a mixture of technical reviews and education - quietly and efficiently. For the most part, only policy wonks know it exists.
Still, with funding of about $1-million a year from the B.C. Ministry of Health, it saves pharmacare about $12-million annually - a pretty good return on investment.
But there is no doubt the initiative, which depends on the work of a few dozen scientists, physicians and pharmacists, has left some noses out of joint with its groundbreaking work. Notably, it warned that the painkiller Vioxx appeared to increase heart problems and offered little additional benefit than traditional painkillers long before the drug became an international scandal.
The group has also influenced what is on British Columbia's formulary and what doctors prescribe - almost always for the better.
The task force, in its report, acknowledges that the Therapeutics Initiative conducts excellent therapeutic evaluation of drugs but wants it to cease having a say in formulary decisions and public education because it is "narrow, insular and resistant to meaningful stakeholder engagement."
This is utterly nonsensical.
By virtue of the expertise required to do drug reviews, membership in the group will be limited, and the pool gets even smaller because the initiative insists on members free of conflicts of interest in a field where such conflicts are rampant.
Are the drug reviews done by the initiative a little slow? Is the process a bit insular? Perhaps. But safety is far more important than rushing another drug to market. And sound scientific advice is more important than token public input, particularly given the pervasive marketing of drugs.
In our health system, there are not nearly enough individuals or organizations with the insight to cry out: "The Emperor has no clothes." The Therapeutics Initiative has done so many a time and the people of British Columbia are healthier, wealthier and wiser as a result.