Cost shifting and timeliness of drug formulary decisions in Atlantic Canada

Context: Our objectives were to investigate the timeliness of formulary decision-making in Atlantic Canada, including the Common Drug Review (CDR) process and the adoption of positive CDR recommendations by Atlantic Canadian provincial public drug plans, and to determine the degree of cost shifting to private payers. Methods: Dates of formulary listing decisions from Atlantic Canadian provincial drug plan formularies and utilization analyses from Medavie Blue Cross were used to calculate the timeliness of decisions and cost shifting from public payers to a private payer. Results: The median time period between the issuance of a positive CDR recommendation and the addition of a drug to an Atlantic Canadian provincial drug plan was 26.7 weeks (<T = 19.1). Cost shifting to employer-sponsored health plans provided by Medavie Blue Cross was minimal. Discussion: There is significant variation in the timing of provincial drug formulary listings among the four Atlantic Canadian provinces and the uptake of CDR recommendations. Conclusion: Atlantic Canadian provincial governments should support the mandate of the CDR by aiming for a more timely consideration of recommendations.