Table 1:
Summary of parameters chosen for the economic models of the cost of adding universal public coverage of an essential medicines list to the existing complement of public drug plans in Canada*
| Parameter | Explanation | Base-case scenario | Best-case scenario | Worst-case scenario |
|---|---|---|---|---|
| Direct change in the use of the essential medicines | Increased accessibility of essential medicines to Canadians who are currently uninsured or underinsured34 | 30% increase in utilization | 12% increase in utilization | 39% increase in utilization |
| Indirect change in the use of the essential medicines | Expected product substitutions among patients currently filling prescriptions for drugs similar to the essential medicines35 | Average of 37% of such patients switch | Average of 66% of such patients switch | Average of 7% of such patients switch |
| Changes in prices of generic versions of the essential medicines | Expected reductions achieved with tendering and other generic pricing tools, gauged on the basis of prices in comparable single-payer systems: United States (US Department of Veterans Affairs), Sweden and New Zealand36,37 | Median comparator prices | Best comparator prices | Worst comparator prices |
| Changes in net prices of brand-name essential medicines | Expected price reductions achieved with universal application of negotiated rebates, gauged on the basis of published estimates of prices and rebates, and average net price information for the US Department of Veterans Affairs38–40 | 15% lower net prices | 20% lower net prices | 10% lower net prices |
| Changes in prices of drugs not on the essential medicines list | Expected changes in the price of drugs not on the essential medicines list | No change | No change | No change |
| Standard co-payment per prescription for the essential medicines | Expected co-payment for standard beneficiaries, set as a maximum dispensing fee that could be lowered if pharmacies competed on price to patient | $11 or less, depending on pharmacy | $11 or less, depending on pharmacy | $11 or less, depending on pharmacy |
| Percentage of prescriptions filled by patients exempted from co-payments for essential medicines | Expected co-payment exemptions for vulnerable populations (e.g., older people, low-income people, children) as a share of all prescriptions filled for the essential medicines | 30% | 30% | 30% |
| Other changes in existing public drug plans in Canada | Expected changes in public coverage of drugs not on the essential medicines list | None | None | None |
| Patient savings from shopping at pharmacies with lower dispensing fees | Expected patient savings arising from pharmacies competing for business by lowering dispensing fees | Not included in estimates | Not included in estimates | Not included in estimates |
| Indirect reduction in government cost of extended health benefits for public sector employees | Expected government savings from reduced cost of private insurance for public sector employees, which would be equal to about 20% of total private sector savings41 | Not included as government savings in estimates | Not included as government savings in estimates | Not included as government savings in estimates |
| Health care system savings from increased adherence to essential medications | Expected savings to the broader health care system resulting from increased adherence to essential medicines6–9 | Not included in estimates | Not included in estimates | Not included in estimates |
*
Complete details concerning the rationale and data sources for model parameters are provided in Appendix 2 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.161082/-/DC1).