ABSTRACT
Objectives: In Canada, basic primary health coverage for physician and hospital services is provided without cost-sharing, while drug insurance is provided through a patchwork system of public and private plans that often have substantial cost-sharing, resulting in important inequities. The COVID-19 pandemic has further exposed the limit of Canada's drug insurance systems, as mass layoffs have resulted in millions losing employment-based drug coverage. Method(s): We conducted a systematic review to examine the association of prescription drug insurance and cost-sharing with drug use, health services use, and health, in Canada. We searched four electronic databases, two grey literature databases, five specialty journals and two working paper repositories. At least two reviewers independently screened articles for inclusion, extracted characteristics, and assessed risk of bias. Result(s): Results from 37 studies consistently demonstrated that the expansion and/or provision of drug insurance were associated with higher drug use, while increases in and higher levels of cost-sharing were associated with lower drug use. Although many studies found statistically significant associations between drug insurance or cost-sharing and health services use, the magnitudes of these associations were small and unlikely clinically meaningful. Among five studies that examined the association of drug insurance and cost-sharing with health, one found a statistically significant and clinically meaningful association. Lastly, we found little evidence that socioeconomic status or sex were effect modifiers;however, some evidence suggested that health modified the association between drug insurance and cost-sharing with drug use. Conclusion(s): Increased cost-sharing is likely to affect the use of essential and nonessential drugs. Universal pharmacare without cost-sharing may reduce health inequities as it may increase drug use among lower-income relative to higher-income populations. These findings may inform drug insurance policy in Canada, as well as other jurisdictions. Copyright © 2022