COMPARISON OF DRUG BENEFITS PROVIDED BY VETERANS AFFAIRS CANADA AND THE CANADIAN FORCES HEALTH SERVICES GROUP
Main Article Content
Keywords
Drug Benefit Plans, Formularies, Military, Veterans
Abstract
Background
Drug benefits are provided at public expense to all actively serving Canadian Armed Forces (CAF) personnel, with ongoing drug coverage offered by Veterans Affairs Canada (VAC) for selected conditions following termination of employment. Differences in drug coverage between these programs could introduce risks for treatment disruption.
Objectives
Work was undertaken to establish a process that would allow systematic comparison of the entire VAC and CAF formularies, and to identify and explain discordant listings in 14 therapeutic categories that pose risk of adverse outcomes with sudden treatment interruption.
Methods
Lists of medications were created for each program, including regular benefit and restricted use drugs, using files obtained from the claims processor in January 2015. Products were coded using the Anatomic Therapeutic-Chemical (ATC) system. Degree of alignment within therapeutic categories was assessed based on the percentage of fifth-level ATCs covered in common. Discordantly listed drugs in 14 categories of concern were reviewed to identify similarities in product characteristics.
Results
A total of 1124 medications were identified in 80 therapeutic categories. Coverage of medications was identical in 11 categories, and overall, almost three-quarters of identified drugs (73.4%, n = 825) were covered by both plans. Many discordant listings reflected known differences in the programs’ operating procedures. A number of discrepancies were also identified in newer therapeutic categories.
Conclusions
There is significant overlap in the medications covered by the CAF and VAC drug benefit programs. Application of the ATC coding system allowed for discrepancies to be readily identified across the entire formulary, and in specific therapeutic categories of concern.
Drug benefits are provided at public expense to all actively serving Canadian Armed Forces (CAF) personnel, with ongoing drug coverage offered by Veterans Affairs Canada (VAC) for selected conditions following termination of employment. Differences in drug coverage between these programs could introduce risks for treatment disruption.
Objectives
Work was undertaken to establish a process that would allow systematic comparison of the entire VAC and CAF formularies, and to identify and explain discordant listings in 14 therapeutic categories that pose risk of adverse outcomes with sudden treatment interruption.
Methods
Lists of medications were created for each program, including regular benefit and restricted use drugs, using files obtained from the claims processor in January 2015. Products were coded using the Anatomic Therapeutic-Chemical (ATC) system. Degree of alignment within therapeutic categories was assessed based on the percentage of fifth-level ATCs covered in common. Discordantly listed drugs in 14 categories of concern were reviewed to identify similarities in product characteristics.
Results
A total of 1124 medications were identified in 80 therapeutic categories. Coverage of medications was identical in 11 categories, and overall, almost three-quarters of identified drugs (73.4%, n = 825) were covered by both plans. Many discordant listings reflected known differences in the programs’ operating procedures. A number of discrepancies were also identified in newer therapeutic categories.
Conclusions
There is significant overlap in the medications covered by the CAF and VAC drug benefit programs. Application of the ATC coding system allowed for discrepancies to be readily identified across the entire formulary, and in specific therapeutic categories of concern.
References
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2. Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med 2004;140:533–6.
3. Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 2005;80(12):1094–9.
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8. Coulter A, Entwistle VA, Eccles A, Ryan S, et al.Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015;3(3):CD010523.
9. Brewster M. At least 2,250 veterans are homeless, according to groundbreaking analysis. The Canadian Press.Updated 6 Jan 2016. Available at: http://www.cbc.ca/news/politics/2250-canadian-veterans-homeless-1.3390674.
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11. Office of the Department of National Defence and Canadian Armed Forces Ombudsman, Government of Canada. Simplifying the service delivery model for medically releasing members of the Canadian armed forces. Posted 28 Sept 2016 at: http://www.om-budsman.forces.gc.ca/en/ombudsman-reports-stats-in-vestigations-new-service-delivery-model/new-ser-vice-deliverymodel.page#ex.
12. House of Commons Standing Committee on Veterans Affairs, Government of Canada. Continuum of transition services. Posted at: http://www.parl.gc.ca/HousePubli-cations/Publication.aspx?DocId58049069&Language5E&Mode51&Parl541&Ses52&File527.
13. Office of the Auditor General, Government of Canada.2012 Report of the Auditor General of Canada, Chapter4: Transition of Ill and Injured Military Personnel to Civilian Life. Posted at: http://www.oag-bvg.gc.ca/internet/English/parl_oag_201210_04_e_37348.html.
14. Schafheutle E. Personalised chronic care planning showed limited but promising effects on physical and psychological health and self-management capabilities. Evid Based Med 2015;20(5):172.
15. Grenier S, Ma J, Pratt JP. Transition of drug benefit coverage for medically releasing personnel serving in the CAF. Abstract P142, 6th Annual Military and Veteran Health Research Forum, Quebec City, 23-25 Nov 2015.Available at: https://cimvhr.ca/forum/CIMVHR-Forum-Abstracts-2015.pdf.
16. Veterans Affairs Canada, Government of Canada. Minister Hehr reaffirms Government of Canada’s commitment to supporting medically releasing members of the Canadian Armed Forces. Posted 28 Sept 2016 at:http://news.gc.ca/web/article en.do;jsessionid=2abd6a5cd52adaa5c02e9ee3b80f67dbe9709bc8d28a125b611a757aac678462.e34Rc3iMbx8Oai0Tbx0SaxuRb3n0?mthd=index&crtr.page=1&nid=1130669.
17. Department of National Defence, Government of Canada. Minister’s Message regarding the Departmental Performance Report for Fiscal Year 2015-2016. Posted at: http://www.forces.gc.ca/en/about-reports-pubs-departmental-performance/2016-ministers-message.page.
18. Government of Canada, Department of National Defence. Spectrum of Care: Medical and Dental Benefits and Services. (Reviewed May 2013) http://www.forces.gc.ca/en/caf-community-health-services-benefits-drug-coverage/index.page.
19. Government of Canada, Veterans Affairs Canada. Healthcare Benefits (Treatment Benefits). Revised 21 Dec 2014 at: http://www.veterans.gc.ca/eng/services/health/treatment-benefits.
20. Morgan S, Hanley G, Raymond C, Blais R. Breadth, depth and agreement among provincial formularies in Canada. Healthcare Pol 2009;4(4):e162–84.
21. Anis AH, Guh D, Wang XH. A dog’s breakfast: prescription drug coverage varies widely across Canada. Med Care 2001;39(4):315–26.
22. Grégoire JP, MacNeil P, Skilton K, Moisan J et al. Inter-provincial variation in government drug formularies. Can J Public Health 2001;92(4):307–12.
23. MacDonald K, Potvin K. Interprovincial variation in access to publicly funded pharmaceuticals: a review based on the WHO Anatomical Therapeutic Chemical classification system. Can Pharm J 2004;137(7):29–34.
24. Sermet C, Andrieu V, Godman B, Van Ganse E, et al.Ongoing pharmaceutical reforms in France: implications for key stakeholder groups. Appl Health Econ Health Pol 2010;8(1):7–24.
25. Elshaug AG, Watt AM, Moss JR, Hiller JE. Policy Perspectives on the Obsolescence of Health Technologies in Canada, Discussion Paper. Canadian Agency for Drugs and Technology in Health, Health Technology Strategy Policy Forum. (October 2009) Available at: https://www.cadth.ca/media/pdf/Obsolescence%20of%20Health%20Technologies%20in%20Canada_Policy_Forum_e.pdf.
26. Glassman PA, Tanielian T, Harris K, Suarez A, et al. Provider perceptions of pharmacy management: lessons from the military health system. Med Care 2004;42(4):361–6.
27. Shrank WH, Ettner SL, Glassman P, Asch SM. A bitter pill: formulary variability and the challenge to prescribing physicians. J Am Board Fam Pract 2004;17(6):401–7.
28. Morgan SG, Martin D, Gagnon MA, Mintzes B, et al. Pharmacare 2020, Summary of Recommendations: Moving from Principles to Policies. (15 July 2015) Available at: http://pharmacare2020.ca/assets/pdf/Moving_From_Principles_To_Policies.pdf.
29. Stanbrook MB. Canada can afford universal pharmacare– no more excuses. CMAJ 2015;187(7):475.
30. Laupacis A, Anderson G, O’Brien B. Drug policy: making effective drugs available without bankrupting the healthcare system. Healthc Pap 2002;3(1):12–30.
2. Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med 2004;140:533–6.
3. Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 2005;80(12):1094–9.
4. Veterans Affairs Health Care, U.S. Department of veterans affairs. Common challenges during re-adjustment. Prepared 11 Feb 2011. Available at: http://www.mentalhealth.va.gov/communityproviders/docs/readjustment.pdf.
5. Morin R. The difficult transition from military to civilian life. pew research center social & demographic trends. Prepared 8 December 2011. Available at: http://www.pewsocialtrends.org/2011/12/08/the-difficult-transition-from-military-to-civilian-life/.
6. VanTil L, Macintosh S, Thompson J, MacLean MB, et al. Fast facts on veterans’ transition experiences.J Mil Veteran Fam H 2015;1(1):7–8.
7. Thompson JM, MacLean MB, Van Til L, Sudom K, et al. Survey on transition to civilian life: report on regular force veterans. Research Directorate, Veterans Affairs Canada, Charlottetown, and Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa. 4 January 2011:103.
8. Coulter A, Entwistle VA, Eccles A, Ryan S, et al.Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015;3(3):CD010523.
9. Brewster M. At least 2,250 veterans are homeless, according to groundbreaking analysis. The Canadian Press.Updated 6 Jan 2016. Available at: http://www.cbc.ca/news/politics/2250-canadian-veterans-homeless-1.3390674.
10. The Canadian Press. At least 2,250 of Canada’s veterans are homeless due to alcoholism, drugs and mental health, study finds. Posted 5 Jan 2016 at: http://news.nationalpost.com/news/canada/at-least-2250-of-canadas-veterans-are-homeless-due-to-alcoholism-drugs-and-mental-health-study-finds.
11. Office of the Department of National Defence and Canadian Armed Forces Ombudsman, Government of Canada. Simplifying the service delivery model for medically releasing members of the Canadian armed forces. Posted 28 Sept 2016 at: http://www.om-budsman.forces.gc.ca/en/ombudsman-reports-stats-in-vestigations-new-service-delivery-model/new-ser-vice-deliverymodel.page#ex.
12. House of Commons Standing Committee on Veterans Affairs, Government of Canada. Continuum of transition services. Posted at: http://www.parl.gc.ca/HousePubli-cations/Publication.aspx?DocId58049069&Language5E&Mode51&Parl541&Ses52&File527.
13. Office of the Auditor General, Government of Canada.2012 Report of the Auditor General of Canada, Chapter4: Transition of Ill and Injured Military Personnel to Civilian Life. Posted at: http://www.oag-bvg.gc.ca/internet/English/parl_oag_201210_04_e_37348.html.
14. Schafheutle E. Personalised chronic care planning showed limited but promising effects on physical and psychological health and self-management capabilities. Evid Based Med 2015;20(5):172.
15. Grenier S, Ma J, Pratt JP. Transition of drug benefit coverage for medically releasing personnel serving in the CAF. Abstract P142, 6th Annual Military and Veteran Health Research Forum, Quebec City, 23-25 Nov 2015.Available at: https://cimvhr.ca/forum/CIMVHR-Forum-Abstracts-2015.pdf.
16. Veterans Affairs Canada, Government of Canada. Minister Hehr reaffirms Government of Canada’s commitment to supporting medically releasing members of the Canadian Armed Forces. Posted 28 Sept 2016 at:http://news.gc.ca/web/article en.do;jsessionid=2abd6a5cd52adaa5c02e9ee3b80f67dbe9709bc8d28a125b611a757aac678462.e34Rc3iMbx8Oai0Tbx0SaxuRb3n0?mthd=index&crtr.page=1&nid=1130669.
17. Department of National Defence, Government of Canada. Minister’s Message regarding the Departmental Performance Report for Fiscal Year 2015-2016. Posted at: http://www.forces.gc.ca/en/about-reports-pubs-departmental-performance/2016-ministers-message.page.
18. Government of Canada, Department of National Defence. Spectrum of Care: Medical and Dental Benefits and Services. (Reviewed May 2013) http://www.forces.gc.ca/en/caf-community-health-services-benefits-drug-coverage/index.page.
19. Government of Canada, Veterans Affairs Canada. Healthcare Benefits (Treatment Benefits). Revised 21 Dec 2014 at: http://www.veterans.gc.ca/eng/services/health/treatment-benefits.
20. Morgan S, Hanley G, Raymond C, Blais R. Breadth, depth and agreement among provincial formularies in Canada. Healthcare Pol 2009;4(4):e162–84.
21. Anis AH, Guh D, Wang XH. A dog’s breakfast: prescription drug coverage varies widely across Canada. Med Care 2001;39(4):315–26.
22. Grégoire JP, MacNeil P, Skilton K, Moisan J et al. Inter-provincial variation in government drug formularies. Can J Public Health 2001;92(4):307–12.
23. MacDonald K, Potvin K. Interprovincial variation in access to publicly funded pharmaceuticals: a review based on the WHO Anatomical Therapeutic Chemical classification system. Can Pharm J 2004;137(7):29–34.
24. Sermet C, Andrieu V, Godman B, Van Ganse E, et al.Ongoing pharmaceutical reforms in France: implications for key stakeholder groups. Appl Health Econ Health Pol 2010;8(1):7–24.
25. Elshaug AG, Watt AM, Moss JR, Hiller JE. Policy Perspectives on the Obsolescence of Health Technologies in Canada, Discussion Paper. Canadian Agency for Drugs and Technology in Health, Health Technology Strategy Policy Forum. (October 2009) Available at: https://www.cadth.ca/media/pdf/Obsolescence%20of%20Health%20Technologies%20in%20Canada_Policy_Forum_e.pdf.
26. Glassman PA, Tanielian T, Harris K, Suarez A, et al. Provider perceptions of pharmacy management: lessons from the military health system. Med Care 2004;42(4):361–6.
27. Shrank WH, Ettner SL, Glassman P, Asch SM. A bitter pill: formulary variability and the challenge to prescribing physicians. J Am Board Fam Pract 2004;17(6):401–7.
28. Morgan SG, Martin D, Gagnon MA, Mintzes B, et al. Pharmacare 2020, Summary of Recommendations: Moving from Principles to Policies. (15 July 2015) Available at: http://pharmacare2020.ca/assets/pdf/Moving_From_Principles_To_Policies.pdf.
29. Stanbrook MB. Canada can afford universal pharmacare– no more excuses. CMAJ 2015;187(7):475.
30. Laupacis A, Anderson G, O’Brien B. Drug policy: making effective drugs available without bankrupting the healthcare system. Healthc Pap 2002;3(1):12–30.