Grant: Travel Awards - Institute Community Support

Background: Drug cost in Quebec can vary between publicly and privately insured patients because the pharmacist's fee is determined freely by the pharmacy owner for the privately insured patients and fixed for the publicly insured patients. Therefore, some studies showed that drug cost is higher for privately insured patients versus publicly insured patients due to higher pharmacist's fee. Objective: This study aimed to assess the difference in drug cost between persons covered with private and public drug insurance. Methods: To compare the difference in drug cost of Quebecers when insured by the RPAM and a private drug insurance, we used prescriptions from reMed (an administrative database of Quebecers insured by the RPAM and private insurances). We matched 3766 pairs of prescriptions bought by 1386 patients between January 1st 2015 and September 14th 2017. Each pair of filled prescriptions had the same drug, DIN, quantity, pharmacy and had to be bought twice within three months: once while the patient was insured by the RPAM and once while she/he was insured by a private drug insurance. Results: More than 65% of the patients in our sample were between 40 and 65 years old. More than 59 % of the patients were covered by a private drug insurance before changing to the RPAM and more than 59 % of the patients contributed 2 prescriptions or more to the analysis. We observed that privately insured patients had to pay CAD$7.54 (25.7%); (95% CI 7.03-8.05) more for their medication than did publicly insured patients. This study estimated that this mean CAD$7.54 excess paid by privately insured patients represent an excess of approximately 973 million CAD in one year at the province level. Conclusion: This study showed that on average drug cost is higher for privately insured Quebecers. Knowing that adherence is affected by drug cost, these results will be useful to help public health authorities to make informed decisions about drug insurance policies.