title: Public Drug Coverage and Its Impact on Triptan Use Across Canada: A Population-Based Study.
abstract: BACKGROUND
  Public drug coverage for triptan medications varies across jurisdictions in Canada, which may lead to differences in usage patterns and patient risk for medication overuse headache.
  
  
  METHODS
  We conducted a population-based, cross-sectional analysis of publicly funded triptan use in seven provinces across Canada from January 1, 2012 to December 31, 2012. All patients who had filled at least one prescription for a triptan during the study period were included. We defined quantity limits of 6, 12, and 18 triptan units per month to assess the prevalence of high volumes of triptan use, which may place patients at risk for medication overuse headaches, and compared this prevalence between provinces with different funding restrictions.
  
  
  RESULTS
  We identified 14,085 publicly funded users of triptans in 2012 in the seven provinces studied, 82.5% of whom were aged less than 65 years (N = 11,631). The prevalence of triptan use ranged substantially by province, from 0.04% in Ontario to a maximum of 1.0% in Manitoba (P < .001). Furthermore, the percentage of patients in each province using more than 6, 12, or 18 units per month differed significantly between provinces (P < .001). In particular, the percentage of patients treated with more than 6 units per month ranged from as low as 2.1% in Saskatchewan to 43.8% in Ontario.
  
  
  CONCLUSIONS
  Differing public drug reimbursement criteria for triptans may be one contributing factor that has led to our observation of considerable variation in both prevalence of triptan prescribing and potential overuse of these medications. We offer that monthly quantity limits may be considered as a tool to decrease risks for medication overuse headache.
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Amadio
authors.affiliation: Canadian Institute for Health Information, Toronto, ON, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lee
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Yao
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Ximena
authors.initials: X
authors.lastname: Camacho
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.|The Leslie Dan Faculty of Pharmacy, Toronto, ON, Canada.|Keenan Research Centre of The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Knowles
authors.affiliation: Department of Medicine (Neurology), Women's College Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Lay
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.|Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Canadian Institute for Health Information, Toronto, ON, Canada.
authors.forename: Jordan
authors.initials: J
authors.lastname: Hunt
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.|The Leslie Dan Faculty of Pharmacy, Toronto, ON, Canada.|Keenan Research Centre of The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000191:economics; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008297:Male; D050316:Medical Order Entry Systems / Q000191:economics; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods; D014363:Tryptamines / Q000191:economics / Q000627:therapeutic use*; D019472:Universal Health Insurance / Q000191:economics
chemical_list: D014363:Tryptamines
keywords: medication overuse headache; migraine; public drug coverage; triptan