Introduction to the Pricing Doc
In Canada, , annual public drug program spending was $17.2 billion in 2022.1 Much of this spending goes to treating chronic conditions managed by family physicians, like diabetes and cardiovascular disease, and high-cost medications used by a minority of Canadians.
Generic medications constitute about 79% of public drug claims but only 27% of spending. In contrast, brand-name medications and biologics represent 21% of claims but account for 73% of the costs. Of the top 20 drug classes by public spending, only statins and proton pump inhibitors are used by more than 10% of the population, while the top three classes (biologics, hepatitis C and macular degeneration medications) are each used by less than 1% of the population.
Canada has the fourth highest per capita spending on biologics in the OECD, with biosimilar use rates lagging behind peers.2 However, in Canada, biosimilar usage has improved, with spending on biosimilars rising from 2.4% in 2018 to 13.7% in 2022. For biologics with available biosimilars, biosimilar spending accounts for about 50% of overall spending.1
Evidence shows similar clinical outcomes for patients starting on biosimilar, originator biologics, or switching from originator to biosimilar.3 British Columbia’s biosimilar program is notably successful among Canadian provinces4, with no increased health services spending post-switching.5 Switching over 40,000 BC patients from originators to biosimilars has saved the province 732 million dollars in 5 years.6
A national formulary focused on cost-effective, evidence-based drug utilization could mitigate the impact of pharmaceutical industry marketing on prescribing patterns. New Zealand’s rigorous national formulary system emphasizes clinical outcomes and cost-effectiveness.7 A study comparing Ontario and New Zealand found that adopting a similar system could save Ontario over $370 million annually for three medication classes (statins, PPIs, and ACE inhibitors).8 Canada is the only OECD nation with universal health insurance but no national pharmacare program; implementing one could save approximately $4 billion annually in prescription drug costs.9
We are pleased to update our Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta. We encourage prescribers to consider costs and coverage when treating chronic conditions and choosing between therapeutically similar medications.
In addition to considering lowest cost alternatives, other ways of decreasing drug costs include:
- Extending long term prescriptions to maximum length (i.e., 90 – 100 days)
- Splitting medications (especially when most medications have similar costs for different doses)
- Using combination products (where available)
- Programs like Maximal Allowable Cost (MAC) pricing and biosimilar initiatives
- Alberta MAC Pricing and Biosimilar Initiative
Alberta Maximum Allowable Cost (MAC) Pricing and Biosimilar Initiative
The Maximum Allowable Cost (MAC) pricing program limits the amount paid by the government of Alberta for publicly funded drug plans. Currently in Alberta, ACE inhibitors, ARBs, CCBs, statins and PPIs are subject to MAC pricing. For information about the Alberta MAC program, please visit the MAC pricing page.
About This Document
Generic Names Versus Brand Names
In this document, costs listed are primarily for the generic product (with generic name bolded) as provincial drug plans will generally only pay for the lowest cost formulation. Brand name prices (with brand name bolded) are for products still under patent protection. We also provide information on coverage by Alberta Blue Cross (BC) and Indigenous Affairs (IA) formularies and which products require Special Authorization (SA). Medications that are not covered (NC) are paid for entirely by your patients.
The prices, rounded to the nearest $5, represent the entire retail cost of the prescription filled at a community pharmacy in Alberta, including markups and dispensing fee. This does not reflect what a patient would pay if covered under a drug plan, but rather the cost to an individual without coverage, or to the health system. The reported price reflects the maximum allowable dispensing fee charged under provincial regulations. Some pharmacies may charge less than that, but this tool allows for relative cost comparisons between medications in the same class or for treating the same condition. This list is updated annually by the authors, with the cost updated monthly by Alberta Blue Cross.
For jurisdictions outside of Alberta, please consult similar pricing documents (Manitoba, Newfoundland and Labrador). We encourage other provinces without similar documents to compile a similar document.
Please contact your local pharmacist for information on medications not included that you routinely use in your practice.
Please forward any feedback, including cases where knowledge of medication cost or coverage made a difference to your patients or practice to: mkolber@ualberta.ca or tony.nickonchuk@ahs.ca.
Sincerely
Mike Kolber, Tony Nickonchuk, Stacey Jardine, and Tina Korownyk
July 2024
References:
1CIHIs Prescribed Drug Spending in Canada, 2019. Available at https://www.cihi.ca/sites/default/files/document/pdex-report-2019-en-web.pdf. Accessed June 26, 2020.
2Stewart M, Ryan B. Ecology of health care in Canada. Can Fam Physician 2015; 61:449-53.
3Prescription medication use by Canadians aged 6 to 79. Statistics Canada. 2014. Available at: http://www.statcan.gc.ca/pub/82-003-x/2014006/article/14032-eng.htm. Accessed November 23, 2015.
4Patented Medicine Prices Review Board. Biosimilars in Canada: Current Environment and Future Opportunity. April 2019. Available at http://www.pmprb-cepmb.gc.ca/CMFiles/News%20and%20Events/Speeches/biosimilars-april2019-en.pdf. Accessed June 26, 2020.
5Perry D, Ton J, Kolber M. Tools for Practice: It’s all in the details…or is it? Biosimilars versus biologics for inflammatory conditions. Available at https://gomainpro.ca/wp-content/uploads/tools-for-practice/1559165324_1558969328_tfp236biosimilarsfv.pdf. Accessed July 7, 2020.
6Gomes T, McCormack D, SA Kitchen et al. Projected impact of biosimilar substitution policies on drug use and costs in Ontario, Canada: a cross-sectional time series analysis. CMAJ Open 2021 November 23. DOI:10.9778/cmajo.20210091
7McClean AR, Law MR, Harrison M et al. Uptake of biosimilar drugs in Canada: analysis of provincial policies and usage data. CMAJ 2022 April 19;194:E556-60. doi: 10.1503/cmaj.211478
8Fisher A, Kim JD, Dormuth CR. Mandatory nonmedical switching from originator to biosimilar infliximab in patients with inflammatory arthritis and psoriasis in British Columbia: a cohort study. CMAJ Open 2022 February 15. DOI:10.9778/cmajo.20200319
9Zafar A. CBC News January 29, 2017. Generic drug industry agrees to cut prices up to 40% in 5-year deal with provinces Available at: http://www.cbc.ca/news/health/generic-drug-prices-1.4509073. Accessed June 26, 2020.
10Kelley LT, Tenbensel T, Johnson A. Ontario and New Zealand pharmaceuticals: Cost and coverage. Health Policy 2018;13(4):23-34.
11Wolfson MC, Morgan SG. How to pay for national pharmacare. CMAJ 2018; 190: E1384-8. doi: 10.1503/cmaj.180897