QUEBEC–Is Quebec’s universal drug insurance plan a success or failure? It depends who you ask. Media and critics in the opposition government are demanding drastic changes to the costly three-year-old drug plan, designed to provide everyone in Quebec with some form of drug cost assistance.

The plan, launched as a cost- saver, is actually running $210 million over budget. But that’s not necessarily a bad thing, say pharmacy groups who insist that behind the higher drug costs are savings to the healthcare system. And an independent research group conducting periodic reviews of the program says that although the plan has not yet reached its goal of accessible, universal coverage, the province should invest even more funds to ensure that it is effective in reducing overall health costs.

The plan, which came into full scale practice in January 1997, was introduced as a means of extending drug coverage to the more than one million Quebecers who did not have private or public drug insurance. It was also supposed to save the government $200 million on prescription drugs by collecting premiums and deductables from people who formerly received free drugs.

In a report released in November 1999, a group of independent researchers found that the universal drug insurance plan is facing a cost overrun of $210 million. The province will spend slightly more than $1 billion on subsidizing prescription drugs in the 1999-2000 fiscal year, an increase of 20% from the previous year.

But the description of those costs as excessive is disputed by members of the pharmacy community in the province. “It’s not a cost overrun, but a shift in costs from the hospital network to the drug insurance plan budget,” says Norman Cadieux, president of the Association Quebecoise des Pharmaciens Proprietaires. The province increased community-based health care and tightened the criteria for hospital treatment and stays in 1997, the same year in which it adopted the new drug plan.

“Patients who used to be treated in hospitals are now being treated in the community with the increase in ambulatory care,” says Cadieux. “Their drugs used to be administered in the hospital by a hospital pharmacist. Now, they receive their medication by a pharmacist in the community, so the funds come from another budget.”

Quebec’s healthcare budget is divided into two parts: the hospital network, the bulk of which represents salaries of hospital workers, and the drug insurance budget, which includes the costs of medications, as well as remuneration of physicians.

Researchers also found in 1998 that the new system was causing the poor and elderly to go without medication or try to use less medicine in order to save money. Under the previous drug program, welfare recipients received free medication, and seniors paid $2 per prescription, up to a $100 annual maximum. Now, users of the plan pay an annual $175 fee and then pay 25% of the cost of their prescriptions. A monthly cap exists for low income Quebecers.

“We believe the co-payment system should be improved,” says Robert Perreault, a health researcher and advisor with the public health department at the Montreal health board, and a member of the evaluative research group.

The group also suggests that rather than simply infusing cash into the drug insurance plan, or increasing the premiums, Quebec should adopt a comprehensive strategy to slow the growth of costs in the plan.

One of their recommendations is a province-wide computerized tracking system to prevent possible errors in physician prescribing that can lead to dangerous drug interactions. Those drug interactions often lead to hospitalization of patients.

“Spending about $10 million to put the system in place would lead to about $110 million in annual savings,” says Perreault.