Evaluating Utilization Patterns, Financial Impact, and Access Delay Caused by Reimbursement Criteria on Public Drug Plans for Primary Care Topical Treatments in Canada: Case Study With HP/TAZ Combination for Plaque Psoriasis

OBJECTIVES: Psoriasis is a chronic auto-immune skin disorder that can have substantial implications on quality of life. Provincial reimbursement criteria aim to control utilization and reduce costs; however, they can also hinder timely access to therapies and impose a provincial administrative burden. This study aims to assess the financial impact of removing reimbursement criteria through the case study of HP/TAZ, a topical combination treatment for plaque psoriasis, over one year, in Alberta.

METHODS: Units and costs were collected from IQVIA PharmaStat and Delta PA and listing status were retrieved from provincial formularies for 2023 in Alberta, Manitoba, Ontario and Saskatchewan. HP/TAZ market shares in these provinces were calculated to have a reference point in provinces where HP/TAZ is listed as full benefit. Annual public Alberta drug costs without criteria for HP/TAZ were estimated and compared to the current scenario to determine the financial impact. A literature search and survey, sent to Alberta dermatologists, were used to estimate the administrative costs and burden (access delays) of the criteria and then compared with the cost of transferring HP/TAZ to a full benefit listing.

RESULTS: HP/TAZ is used 5.4 times more in Ontario, a province without criteria, compared to Alberta, which has criteria. For the base-case scenario, the additional drug costs resulting from criterion removal surpassed the criterion’s administrative costs by $9,484.02. According to clinical expert opinion, the access delays averaged 10 days.

CONCLUSIONS: HP/TAZ reimbursement criterion removal would increase the cost minimally for Alberta within the current environment. Should a PLA be in place allowing a discount greater or equal to 10% on HP/TAZ drug price, this could make the removal of its criteria a cost-saving alternative for Alberta while optimizing patient access. The findings and recommendations could contribute to informed decision-making to improve access and the utilization of topical treatments in Canada.