Analysis of FPT Formulary Harmonization: Specialty Care Medications

A previous study demonstrated a high degree of similarity in listing status for primary care drugs across Canada but excluded drugs for specialty care. Assessing formulary harmonization for specialty care medications is critical given that these medications represent a high proportion of overall drug spending. This analysis sought to evaluate formulary harmonization for specialty care medications by assessing listing status and reimbursement criteria for a select sample of drugs.

Listing status was similar for federal, provincial, and territorial governments (FPTs) at 81.5%, which was comparable to previous findings for primary care medications. An assessment of a sample of 12 medications ($4.1 billion spend in 2019) found that reimbursement criteria were largely comparable across FPTs; however, variations in restrictions were found depending on therapeutic subgroup. FPTs trade off restriction in listing status for restriction in reimbursement criteria as part of the formulary management strategy, which may impact future initiatives for harmonization.