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Breadth, Depth and Agreement Among Provincial Drug Formularies in Canada

Breadth, Depth and Agreement Among Provincial Drug Formularies in Canada

Healthcare Policy, Volume 4, Issue 4, p.e162-e184 (2009)
Journal Article
Summary

Background: Using conventional concordance statistics, previous studies suggest there is significant variation in drug coverage across provinces. The objective of our study was to further investigate the notion of widely varying provincial formularies using conventional and new measures. 
 
Methods: We searched for drug listings on December 2006 formularies for the general 'pharmacare' programs in all but the smallest Canadian province. A province's formulary was characterized in terms of the unweighted share of all available drugs that it listed ('breadth of coverage') and by the same shares with each drug weighted by its national retail sales ('depth of coverage'). Agreement between formularies was measured using such weighted and unweighted concordance statistics.
 
Results: Provincial formularies listed between 55% and 73% of the 796 drugs analysed. When formulary listings were weighted by national expenditures, coverage exceeded 86% in all provinces studied. Coverage was relatively consistent across provinces for all but three of the leading therapeutic categories: anti-migraine drugs, anti-dementia drugs and sedatives.
 
Conclusion: While variations in coverage for specific drug classes and drug products remain important areas for investigation and policy consideration, Canada is currently operating with a significant "implicit national formulary" by way of the fact that provincial formularies independently yet mutually list most of the top selling medicines in the marketplace.