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Older people are at higher risk for threatening drug interactions because have multiple chronic diseases, so they take more drugs.Getty Images/iStockphoto

British Columbia is expanding a drug program that provides patients with cheaper medications to treat the same illness, but critics say seniors and low-income people will be forced to pay out of pocket if they can't switch to alternatives.

As of Dec. 1, the Reference Drug Program will include three new categories of drugs: some that treat high blood pressure and heart disease, others for stomach-acid issues, and statins to help lower cholesterol levels.

Cheaper categories of other drugs for high blood pressure and heart disease have also been added to the program, along with another class of medications for stomach-acid conditions.

Nitrates for people suffering from heart disease and a class of drugs that treat pain and reduce inflammation are already part of the program.

Cheryl Koehn, who speaks for the advocacy group Arthritis Consumer Experts, said two of the new drug categories added to the program will affect thousands of arthritis patients who end up taking medication to counteract stomach problems caused by other drugs.

Koehn said that while she has a private drug plan that covers the cost of the rheumatoid arthritis medications she's taken for years, people who remain on higher-priced drugs will have to pay the difference between those that are cheaper.

Newly diagnosed patients who start on a cheaper drug may be better off than patients who are switched to a cheaper medication after effective treatment on a particular drug, she said.

About 56,000 patients with complex medical needs will automatically retain coverage of their current medications, the Health Ministry said, adding that patients would be switched to cheaper drugs that are equally safe and effective.

Health Minister Terry Lake said doctors can apply for full coverage of drugs after patients have tried the cheapest alternative.

He said the Reference Drug Program, which began in 1995, saves the province up to $9 million a year that can be used to pay for new drugs.

"As we are looking at things like hepatitis C drugs that are coming onstream we have to be able to accommodate these new treatments that are quite expensive."

The Health Ministry said Saskatchewan, Nova Scotia, Quebec, and Newfoundland and Labrador have variations of the program.

However, a spokesman for the Health Ministry in Saskatchewan said the province's policy covers only one class of drugs that treat stomach-acid conditions. He said most people take a generic version of the drug anyway because it would be under the maximum amount of $1.51 a capsule, so the savings of the program established in 2004 are negligible.

Koehn said immediate savings in drug costs may be offset by patients who were previously stable visiting emergency rooms and doctors' offices when they don't take a new drug for any number of reasons, including cost.

"To reach into patients' pockets and say you're going to pay the difference is the lowest common denominator for a policy solution," she said.

Pharmacists and doctors will have the next six months to transition to the expanded program, said Bryce Wong, a pharmacist and spokesman for the British Columbia Pharmacy Association.

"The hope is that if the patient did have to change a medication it wouldn't have any negative effect on their health outcomes," Wong said.

This content appears as provided to The Globe by the originating wire service. It has not been edited by Globe staff.

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