Public Drug Plan Coverage for Children Across Canada: A Portrait of Too Many Colours

A spate of reports scrutinizing the healthcare system in recent years (Health Canada 1997; Kirby 2002; Romanow 2002) have brought new life to the discussion concerning a national pharmacare program. A program that would ensure access to and affordability of needed medications, particularly for vulnerable populations, has repeatedly been cited as a priority by policy makers as well as stakeholder groups. This goal has yet to be realized, and the debate regarding what constitutes optimal pharmaceutical policy in Canada continues. Currently in Canada, payment for prescription medicines is financed by a combination of public and private sources. In 2001, public plans, consisting of provincial and territorial drug programs, accounted for 46% of total prescription drug spending in Canada (Canadian Institute for Health Information 2004). Persons aged 65 and older accounted for 65% of the $4.44 billion spent on public drug programs in 2001. In contrast, persons aged 14 and under accounted for 2.1% (Health Canada 2001). While provincial policy makers agree on the importance of providing medication benefits to seniors, there is no agreement on the need to provide the same benefits to other vulnerable populations, including Canada’s 7.5 million children. Thus, the low public spending on pharmaceutical benefits for children may reflect a lack of programs to meet children’s needs. A number of reports have exposed differences in provincial drug plan characteristics related to eligibility, cost-sharing and listed benefits (Canadian Institute for Health Information 2004; Health Canada 2000; Jacobs and Bachynsky 2000; Grootendorst 2002; Narine and Sen 1997; Currie and Nielson 1999; Willison et al. 1998; Morgan 2004). However, none has focused on access to benefits for the paediatric population. The primary objective of this study was to determine the extent of medication coverage for children in publicly administered programs in each province across Canada. This study also investigated the proportion of new drugs added to each provincial formulary in 2003 that included indications for paediatric conditions or allowed prescribing for children.