BC Physicians Express Concern Over BC PharmaCare's Diabetes Drug Coverage Change

VANCOUVER, Feb 3, 2015 /CNW/ - Results from a recent survey of British Columbia doctors by the Canadian Heart Research Centre showed that the majority of surveyed physicians expressed concern about BC PharmaCare's change to coverage for diabetes medications. The survey results further showed physicians felt such changes may lead to a negative impact on patient care and to increased costs to the provincial healthcare system.

Eighty five per cent of surveyed doctors expressed that drug substitution on economic grounds alone cannot be considered in the interest of the individual patient.

The majority of the doctors responding to the survey indicated that this change may have a direct impact on patient care and may result in extra work and costs. About half of the responders indicated that patients may stop taking their medication due to the coverage change which may in turn result in the loss of glycemic control. Sixty nine per cent of physicians felt, that at a minimum, patients who are well controlled on sitagliptin (Januvia®) or sitagliptin/metformin fixed dose combination (Janumet®) should have been excluded from the coverage change.

Forty eight per cent of survey respondents have experienced or are anticipating that the change to coverage will result in at least two extra patient visits per week with thirty five per cent experiencing or anticipating at least two extra lab tests per week.         

"BC physicians have clearly indicated their concerns about the impact of this decision on the care of their patients as well as the process adopted by BC Pharmacare in undertaking this change," said Dr. Keith Dawson, BC Voice Steering Committee Member, Professor Emeritus of Medicine, Division of Endocrinology at the University of British Columbia. "Physicians frequently commented that they would very much welcome being involved in the decision making process since they identify themselves as among the stakeholders most impacted by this coverage change and that they would, at a minimum, like to understand the rationale to this decision making process."

Sixty one per cent of survey respondents disagreed with BC PharmaCare's coverage change with only 9% agreeing. A further 68% of physicians believe that this coverage change to DPP-4 inhibitors sets a negative precedent.  Seventy four per cent of responders agreed that there may be differences amongst the DPP-4 inhibitors that have not been demonstrated in clinical trials to date, noted Dr. Dawson. He continued, "Without studied adverse side effects to this medication, we like to understand the rationale behind this decision more fully." 

Sixty nine per cent of the physicians were aware of the coverage changes to the DPP-4 inhibitors by BC PharmaCare, but 88% of responders who were aware of the coverage changes were not consulted, either directly or indirectly, by BC PharmaCare in advance of the changes taking effect and were also not aware of which organizations were consulted as part of this decision making process. Interestingly, 85% of all responders believe that physicians should have been involved in the decision making process for this coverage change primarily given the potential implication on their practice, while two per cent believed that BC PharmaCare is better suited for making these type of decisions.

In August 2014, BC PharmaCare announced it would no longer cover sitagliptin (Januvia®) a DPP-4 inhibitor and the fixed dose combination of sitagliptin and metformin (Janumet® / Janumet XR®). All patients currently taking these medications are required to transition to one of the other two DPP-4 inhibitors that are covered by BC Pharmacare by February 5, 2015.  DPP-4 inhibitors are an oral antihyperglycemic medication, prescribed alone or in combination with other medications, for patients with Type 2 diabetes.

Methodology
The survey was conducted online between November and December 2014. It was completed by 332 physicians in BC, with 86% being primary care physicians and 64% identifying a group practice as their main patient care setting.   

The contributing physicians are experienced and busy clinicians, with 49% practicing for more than 20 years, 74% managing between 50 and 200 patients per week and 64% providing care for more than 100 patients with diabetes in their practice.

The BC Voice Survey initiative was developed by a steering committee of eight physician experts, five of whom practice in BC.

The full results of the BC Voice Survey may be viewed at www.bcvoice.ca

About the Canadian Heart Research Centre
The Canadian Heart Research Centre is a federally incorporated not-for-profit, full service academic organization with a sustained mission to be a national leader in the design, conduct and management of clinical trials, quality enhancement research initiatives and innovative physician educational programs devised to narrow the care and treatment gaps, improve physicians' adherence to clinical practice guideline recommendations in the treatment and prevention of cardiovascular and metabolic diseases and their risk factors in Canada and the U.S.

The CHRC has over 20 years of experience in integrating evidence based recommendations into clinical practice, which has resulted in measurable and sustainable behavior change at the point of care.  It has established long standing relationships and a vast network of collaborators from thought leaders, universities and academic institutions to CME content experts and health care professionals across specialties.

This initiative was made possible through the support of Merck Canada Inc.  The opinions expressed in this material are those of the authors and do not necessarily reflect the views of Merck Canada Inc.

SOURCE Canadian Heart Research Centre

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