The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis.

BACKGROUND: In 2018, Ontario implemented a pharmacare program (Ontario Health Insurance Plan Plus [OHIP+]) to provide children and youth younger than 25 years with full coverage for prescription medications in the provincial formulary. We aimed to assess the use of public drug plans and costs of publicly covered prescriptions before and after the program's implementation and modification. METHODS: We conducted a population-based, interrupted time-series analysis using data on prescription drug claims, from the Canadian Institute for Health Information's National Prescription Drug Utilization Information System, for people younger than 25 years from January 2016 to October 2019 in Ontario, using British Columbia as the control. We assessed changes in the level and trend of publicly covered prescriptions and expenditures after the introduction of OHIP+ in January 2018 and after program modifications in April 2019. We also assessed plan use and expenditures for publicly covered prescriptions for diabetes and asthma. RESULTS: Publicly covered prescriptions in Ontario increased by 290%, from 756 per 1000 people before OHIP+ to 2952 per 1000 (p < 0.001) after its implementation. After program modification, prescriptions decreased by 52% to 1421 per 1000 (p < 0.001). Similarly, total public drug expenditures increased by 254%, from $379 million in 2017 to $839 million in 2018, then reduced by 49% to $204 million in 2019. Monthly public plan expenditures increased by $115.94 (95% confidence interval [CI] $100.93 to $130.94) post-OHIP+ implementation and decreased by $99.97 (95% CI -$119.79 to -$80.15) per person per month after April 2019. INTERPRETATION: Adopting OHIP+ increased use of public drug plans and expenditures for publicly funded prescription medicines, and the program modification was associated with decreases in both outcomes. This study's findings can inform the national pharmacare debate; future research should investigate associations with health outcomes.

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.

A 15-year study of the impact of community antiretroviral therapy coverage on HIV incidence in Kenyan female sex workers.

OBJECTIVE: To test the hypothesis that increasing community antiretroviral therapy (ART) coverage would be associated with lower HIV incidence in female sex workers (FSWs) in Mombasa District, Kenya. DESIGN: Prospective cohort study. METHODS: From 1998 to 2012, HIV-negative FSWs were asked to return monthly for an interview regarding risk behavior and testing for sexually transmitted infections including HIV. We evaluated the association between community ART coverage and FSW's risk of becoming HIV infected using Cox proportional hazards models adjusted for potential confounding factors. RESULTS: One thousand, four hundred and four FSWs contributed 4335 woman-years of follow-up, with 145 acquiring HIV infection (incidence 3.35/100 woman-years). The ART rollout began in 2003. By 2012, an estimated 52% of HIV-positive individuals were receiving treatment. Community ART coverage was inversely associated with HIV incidence (adjusted hazard ratio 0.77; 95% confidence interval 0.61-0.98; P = 0.03), suggesting that each 10% increase in coverage was associated with a 23% reduction in FSWs' risk of HIV acquisition. Community ART coverage had no impact on herpes simplex virus type-2 incidence (adjusted hazard ratio 0.97; 95% confidence interval 0.79-1.20; P = 0.8). CONCLUSION: Increasing general population ART coverage was associated with lower HIV incidence in FSWs. The association with HIV incidence, but not herpes simplex virus type-2 incidence, suggests that the effect of community ART coverage may be specific to HIV. Interventions such as preexposure prophylaxis and antiretroviral-containing microbicides have produced disappointing results in HIV prevention trials with FSWs. These results suggest that FSWs' risk of acquiring HIV infection might be reduced through the indirect approach of increasing ART coverage in the community.