title: The unintended (and costly) effects due to the introduction of an unrestricted reimbursement policy for atypical antipsychotic medications in a Canadian public prescription drug program: 1996/97 to 2005/06.
abstract: BACKGROUND
  Due to the increasing costs of pharmaceuticals, drug benefit programs often implement various policies that limit availability of drugs. These policies can have unforeseen consequences.
  
  
  OBJECTIVE
  To examine the utilization and expenditures for antipsychotic medications in a provincial government community-based drug program over a 10-year period when atypical antipsychotics were introduced and multiple reimbursement policy changes with respect to these agents were employed.
  
  
  METHODS
  Retrospective analysis of the Newfoundland and Labrador Prescription Drug Program (NLPDP) claims database from 1996/97 to 2005/06. Antipsychotic medication utilization and expenditure were measured and effects of changes in reimbursement policies examined. Excess expenditure was measured by subtracting the actual from modelled expenditure under different policies.
  
  
  RESULTS
  Between 1996/97 and 2005/06, the number of prescriptions for antipsychotic medications increased by 75% and expenditures by more than 720% to $7.2 million (peaking at $7.9 million in 2003/04), with atypical agents making up 96% of the total. Expenditure for antipsychotic medications grew by an annual average rate of 26.3%. At the same time, the number of people enrolled in the drug program declined by an annual average rate of 1.13%. The total excess amount of money spent was $266,195 per 1,000 beneficiaries during unlimited access to atypical agents.
  
  
  CONCLUSIONS
  There has been a substantial, unintentional, increase in the prescribing of atypical antipsychotics each year in Newfoundland and Labrador over the 10 years, likely due to off-label use following the unrestricted and partial restrictive access policies for these medications. Perhaps restricted access for recognized usage should be enforced.
authors.affiliation: Program for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada. oreilld@mcmaster.ca
authors.forename: Daria J
authors.initials: DJ
authors.lastname: O'Reilly
authors.forename: Ron A
authors.initials: RA
authors.lastname: Goeree
authors.forename: Jean-Eric
authors.initials: JE
authors.lastname: Tarride
authors.forename: Collen
authors.initials: C
authors.lastname: James
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Parfrey
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D016208:Databases, Factual; D016527:Drug Costs / Q000639:trends; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends; D007356:Insurance, Pharmaceutical Services / Q000191:economics* / Q000639:trends; D009523:Newfoundland and Labrador; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents