Improving Affordable Access to Prescription Drugs in Prince Edward Island

I. Overview

The Government of Prince Edward Island (PEI) has been working with the Government of Canada since August 11, 2021 on a demonstration project to provide PEI residents better access and more affordable prescription drug choices. The agreement, signed in March 2022, provides $35 million in funding to PEI over 4 years (2021-22 to 2024-25).

PEI's drug formulary is not as extensive as other provinces and territories, and residents face high co-pays and deductible amounts in some of its current drug programs. The Improving Affordable Access to Prescription Drugs Demonstration Project (the Project) includes initiatives designed to make it easier for PEI residents to access and afford medications. This Implementation Plan describes activities over the next three years. Activities will occur in stages with time to measure results and impact and allow for changes to be made when necessary.

The $35M represents a first step towards supporting improved affordability and accessibility for PEI residents. These funds, while significant, will not be able to support all program and formulary changes that residents may be seeking to address their health care needs; however, this funding represents an opportunity to make improvements and explore future developments.

The Government of Canada may use the learnings from this Project to inform ongoing work to advance national universal pharmacare.

This Implementation Plan is flexible to allow for adjustments to activities over time. PEI will monitor changes to its prescription drug coverage and will measure the impacts as progress is made.

More information on the PEI Pharmacare programs is available at PEI Pharmacare | Government of Prince Edward Island.

II. Areas of Activity

The Project will be carried out under three areas of activity:

• Planning and Stakeholder Engagement
  • Design and planning
  • Stakeholder engagement
• Improvements to Drug Formulary
  • Expanding drug formulary
  • Simplifying formulary access
  • Modernizing formulary management
• Improvements to Drug Plans
  • Expanding drug program coverage
  • Simplifying drug program access
  • Reducing drug costs for residents

Planning and Stakeholder Engagement

Initiative Design and Planning

To guide decision making, a governance structure has been established under the direction of the Minister of Health and Wellness which includes a project team, a technical oversight committee, and a steering committee reporting to the Deputy Minister of Health and Wellness and the Chief Executive Officer of Health PEI.

A scan of prescription drug coverage across multiple provinces has revealed a diverse array of drug formularies and drug plans. This work has identified opportunities to improve access and affordability of prescription drugs for residents of PEI for consideration.

Stakeholder Engagement

PEI is committed to stakeholder engagement to ensure the needs, opinions, and concerns of stakeholders are heard and considered. Members of the public/residents, experts in the field/Health Care providers, and other stakeholders will have opportunity to provide input on the drug programs and formulary. Stakeholder engagement is key to ensuring that those who are most vulnerable are heard.

Stakeholder engagement will help inform priorities, opportunities and potential changes and the manner in which they will be implemented. Supporting communications including public announcements, website updates, and bulletins are planned to ensure that stakeholders are informed as changes are implemented throughout the Project.

Improvements to Drug Formulary

The PEI drug formulary is a list of drugs and products approved for coverage for eligible residents through the provincial public drug programs.

Most products in the formulary are available without restrictions (open benefit) while some can only be accessed under specific conditions (special authorization). Formulary decisions are based on recommendations from the Provincial Drugs and Therapeutics Committee, informed by national review and negotiation processes. Other factors considered include drug plan mandates, jurisdictional priorities, budget impact, and system capacity.

1) Expanding Drug Formulary

PEI will identify drugs that could be added to its formulary to align it more closely with formularies available across the Atlantic region. This alignment may include the adding of medications or devices, expanding prescribing indications, and updating prescribing criteria.

PEI will also examine the differences between PEI and the rest of the Atlantic region along therapeutic streams ranging from specialty cancer medications to products used in the treatment of chronic conditions such as diabetes and heart disease. PEI will identify and implement changes to increase coverage of new and existing medications for eligible residents.

2) Simplifying Formulary Access

PEI will work to reduce paperwork for prescribers and to make the system more user friendly, for both healthcare providers and residents. This will reduce administrative burden and improve timely access to necessary medications for residents.

PEI will examine opportunities for alignment with other provinces by providing open access to certain medications such as those used for women's health, Parkinson's disease, mental health, and treating infections.

3) Modernizing Formulary Management

PEI will work to improve formulary management processes. This may include an evaluation of processes when considering new drugs to list and gaining a better understanding of the impact of delays in listing medications.

Improvements to Drug Plans

PEI manages 29 public drug programs that vary in terms of list of drugs available, client eligibility, and have a variety of copays and deductibles depending on age, disease state, and/or income. Understanding multiple programs may be challenging to some residents.

Ongoing analysis is identifying areas where PEI's public drug plans could provide more comprehensive coverage, be easier to access, and be more affordable for residents. Improvements to drug plans may include expanding programs, simplifying programs, and reducing out-of-pocket costs for residents. PEI will work toward understanding what funding model would deliver a comprehensive, equitable, and inclusive public drug program that is affordable and sustainable over time.

1) Expanding Drug Program Coverage

Based on the results of regional scans and stakeholder engagement, PEI will identify changes that could be made to improve the coverage offered through its public drug plans.

For example, PEI may review the criteria for income testing and streamline income testing requirements across programs. An evaluation of program costs may be considered to better understand the impact of costs for residents. PEI may consider programs available in other provinces to better understand how similar programs could benefit PEI residents.

2) Simplifying Drug Programs

PEI's 29 different drug programs can be challenging for patients, caregivers and families, and health care providers to navigate. Residents may be eligible to access multiple programs, with varying copays or deductibles, at the same time, which can be confusing to residents and the health care system alike. Under this stream of work, PEI will look for opportunities to simplify and streamline drug programs to minimize the burden on residents and the professionals who care for them.

3) Reducing Drug Program Costs

Many families face financial burdens from medication cost. High copays or deductibles may prevent residents from accessing necessary medications, leading to complications and more intensive or expensive treatments. PEI will review copays and deductibles and consider strategies to make costs more affordable. PEI will review copays in the high cost drug program to determine if the income-based parameters are reflective of the current PEI economy and will review deductible levels in the catastrophic drug program to understand the impact on residents.

III. Funding

PEI estimates that $32M will be used to cover costs of improvements to the drug formulary and drug plans. The remaining $3M will be used for knowledge development, stakeholder engagement, and staffing.

IV. Performance measurement and expected results

PEI will consider the needs of groups who may experience challenges in prescription drug access (for example, women, seniors, Indigenous Peoples, individuals with low-income status, and other visible minorities) throughout the design and implementation of the Project. As many of PEI's drug plans have as few as 10 to 500 users, in order to protect privacy, collection of data disaggregated by sex, age, race, or other identities will only be feasible in select circumstances.

V. Key Learnings

This Project represents an opportunity to inform national pharmacare or public drug plan enhancements in other jurisdictions. PEI will work with Health Canada to monitor and share key learnings. A final public report for this initiative will include a summary of the key learnings, such as: understanding the impacts of formulary and program changes on program uptake and adherence to therapy, and best practices to engage health system stakeholders so that changes to the drug plans reflect the needs of residents.