title: Stitching the gaps in the Canadian public drug coverage patchwork?: a review of provincial pharmacare policy changes from 2000 to 2010.
abstract: OBJECTIVE
  To describe recent changes and identify emergent trends in public drug benefit policies in Canada from 2000 to 2010.
  
  
  METHODS
  For each province, we tracked pharmacare design (namely eligibility, premiums, and patient cost-sharing) over time for three beneficiary groups: social assistance recipients, seniors, and the general non-senior population. We assess which plan designs are emerging as a national standard, where the gaps in public coverage remain, and implications for progress towards national pharmacare.
  
  
  RESULTS
  Expansion of public drug coverage has been limited. For social assistance recipients, first-dollar coverage is the standard. Seniors coverage remains varied, though means testing of eligibility or cost-sharing is common. Seniors benefits were significantly expanded in only one province. As of 2010, six provinces have embraced age irrelevant catastrophic income-based coverage, in some, resulting in the elimination of seniors drug benefits.
  
  
  CONCLUSIONS
  Universal income-based catastrophic coverage appears to be emerging as an implicit national standard for provincial pharmacare. However, due to the variation and high level of patient cost-sharing required under these programs, convergence on this model does not equate to substantial progress towards expanding coverage or reducing interprovincial disparities. Leverage of federal spending power to promote standards for public drug coverage is necessary to uniformly protect Canadians against high drug costs.
authors: Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada. jdaw@chspr.ubc.ca
authors: Jamie R
authors: JR
authors: Daw
authors: Steven G
authors: SG
authors: Morgan
mesh_terms: D002170:Canada; D017047:Cost Sharing / Q000191:economics; D016527:Drug Costs; D004608:Eligibility Determination / Q000191:economics; D006291:Health Policy / Q000191:economics; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000639:trends*; D055553:Prescription Drugs / Q000191:economics*; D012041:Regional Medical Programs / Q000191:economics; D012946:Social Welfare / Q000191:economics
chemical_list: D055553:Prescription Drugs