Overview of Formulary Management Practices of Publicly Funded Provincial and Territorial Drug Plans

Each federal, provincial, and territorial (FPT) public drug plan provides access to prescription medications for specific populations. FPTs rely on guidance from health technology assessment agencies such as Canada's Drug Agency; however, reimbursement decisions for individual medications follow different local processes. This Environmental Scan sought to compare these reimbursement decision-making processes (e.g., drug review processes, decision-making principles and/or frameworks, decision-making committee structures).

Decision-making processes were evaluated for all provinces as well as for Yukon and the Non-Insured Health Benefits (NIHB) program. Decision-making processes were stratified for oncology versus non-oncology medications as well as for Canada's Drug Agency review–eligible versus Canada's Drug Agency review–ineligible products.

There were 2 models of decision-making processes with a geographic divide: local expert committees reviewing all new drug submissions (Western model) versus reviewing only drug submissions out of scope for Canada's Drug Agency (Eastern model). If decision-making processes were to be harmonized across FPTs, there would need to be a balance between local autonomy versus centralization.