Variability in prescription medication coverage for children and youth across Canada: A scoping review.

BACKGROUND: Prescription medication coverage in Canada is provided by at least 14 public drug plans and thousands of private insurance plans. Previous literature suggests that public plan coverage varies, and little is known about private drug plans. OBJECTIVE: Undertake a scoping review of recent literature evaluating coverage of prescription medication for children and youth under 25 across Canada. METHODS: Bibliographic databases (Embase, CINAHL, Web of Science, Medline) and gray literature sources were screened. Papers published between January 2005 and July 2021, focusing on prescription medication coverage for Canadians under 25 years were identified. RESULTS: Of 562 titles and abstracts, 9 reports met our criteria. One report estimates 3.3% of children and youth in 10 provinces are uninsured (i.e. not eligible), with non-enrollment for those eligible for public plans ranging from 12% to 49%. Minimal information on private drug plan coverage was identified. Demographic- or income-based public drug plans report coverage in 12 of 14 jurisdictions. Those covered by a demographic- or income-based plan have access to jurisdictional formularies. 3 of 14 public plans report no cost sharing for children. CONCLUSION: There is less variability in who and what is covered and more in how much is covered (i.e., details of cost sharing). More research is needed to adequately understand the gaps in coverage and its impact on children and youth.

Physician and patient willingness to pay for electronic cardiovascular disease management.

OBJECTIVES: Cardiovascular disease (CVD) is an important target for electronic decision support. We examined the potential sustainability of an electronic CVD management program using a discrete choice experiment (DCE). Our objective was to estimate physician and patient willingness-to-pay (WTP) for the current and enhanced programs. METHODS: Focus groups, expert input and literature searches decided the attributes to be evaluated for the physician and patient DCEs, which were carried out using a Web-based program. Hierarchical Bayes analysis estimated preference coefficients for each respondent and latent class analysis segmented each sample. Simulations were used to estimate WTP for each of the attributes individually and for an enhanced vascular management system. RESULTS: 144 participants (70 physicians, 74 patients) completed the DCE. Overall, access speed to updated records and monthly payments for a nurse coordinator were the main determinants of physician choices. Two distinctly different segments of physicians were identified - one very sensitive to monthly subscription fee and speed of updating the tracker with new patient data and the other very sensitive to the monthly cost of the nurse coordinator and government billing incentives. Patient choices were most significantly influenced by the yearly subscription cost. The estimated physician WTP was slightly above the estimated threshold for sustainability while the patient WTP was below. CONCLUSION: Current willingness to pay for electronic cardiovascular disease management should encourage innovation to provide economies of scale in program development, delivery and maintenance to meet sustainability thresholds.