The auditor general has recommended Veterans Affairs Canada tighten up and update its drugs benefits program and policies, actions which VAC says have already begun.
The auditor general examined the program for the 2013-14 and 2014-15 fiscal years, looking at evidence used to make decisions, strategies to keep costs in line, and monitoring of prescriptions. It found the department wanting on each front. In 2014-15, the drug benefits program served about 51,000 veterans at a cost of about $80 million.
A review of decisions by the committee that oversees adding or removing and tightening or broadening access found many decisions that were not supported by evidence. For instance, in 2014, the department decided to limit medical marijuana coverage to 10 grams per day, but the auditor general found no evidence to support the decision, and noted the department had documentation from Health Canada that more than five grams per day increases health risks.
The report recommends VAC specify the type of evidence and how it is considered to facilitate decisions about which drugs it will pay for, and how much it will pay. It also recommends timely updating of the drug benefits list.
VAC replied that it hired a national pharmaceutical advisor in 2015 and is developing a framework for making evidence-based decisions.
In response to a recommendation that cost-saving strategies be periodically reviewed, VAC said it is studying strategies used by other drug plans and working with other government departments and partners also interested in reining in drug costs.
The report noted medical marijuana was the highest-cost item under the drug benefits program, and although VAC had identified payment limits as a means to control costs when access was broadened, it did not establish them. Consequently, costs rose to $14 per gram from $5 to $6. VAC estimates marijuana claims in 2016-17 could cost up to $25 million; the number of veterans with marijuana claims increased to 1,320 at the end of 2015, from 112 in 2013-14.
Finally, the report criticized VAC’s monitoring of drug utilization, saying better oversight could increase the department’s ability to keep the list of drugs covered more in line with contemporary usage patterns and help manage costs.