Related Experiment Video
Updated: Jun 13, 2026
11:17
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Breadth, Depth and Agreement among Provincial Formularies in Canada
Steve Morgan1, Gillian Hanley, Colette Raymond
1Associate Professor & Associate Director, Centre for Health Services and Policy Research, School of Population & Public Health, University of British Columbia, Vancouver, BC.
Healthcare Policy = Politiques De Sante
|May 4, 2010
Summary
Canadian provincial drug formularies largely agree on top-selling medications, suggesting an implicit national formulary despite low inter-rater reliability scores for formulary listings.
Area of Science:
- Health Services Research
- Pharmaceutical Policy
- Drug Utilization
Background:
- Significant variation in Canadian provincial drug coverage exists, with low inter-rater reliability scores for formulary listings.
- Previous studies suggest these variations may be driven by minor drugs or legitimate therapeutic differences.
Purpose of the Study:
- To assess the appropriateness of conventional methods for measuring formulary concordance.
- To test if variations are due to disagreement over low-market-share drugs.
- To explore if coverage patterns indicate legitimate provincial differences.
Main Methods:
- Analysis of December 2006 formulary listings for Canadian provincial general pharmacare programs.
- Characterization of formularies by simple drug percentage and sales-weighted drug percentage.
- Measurement of agreement using Kappa statistics and coverage-agreement metrics.
Main Results:
- Weighted formulary coverage exceeded 86% across provinces, with 77% of retail spending covered by drugs listed on all nine formularies.
- Inter-rater reliability (Kappa statistics) indicated low to moderate agreement.
- Coverage consistency varied across therapeutic categories, notably in anti-migraine, anti-dementia, and sedative drugs.
Conclusions:
- Despite apparent variations, an implicit national formulary exists in Canada.
- Provincial formularies collectively list most top-selling drugs, indicating substantial de facto national concordance.
- Further investigation into specific drug class variations is warranted for policy considerations.
Related Concept Videos
01:27Pharmaceutical Alternatives: Polymorphic Form-Related and Particle Size-Related Therapeutic Nonequivalence
Changes in polymorphic forms can significantly influence the bioavailability of poorly soluble drugs. Although the FDA defines pharmaceutical equivalence based on having the same active ingredient, dosage form, and route of administration, it does not automatically disqualify products with different polymorphic forms. This means two products with different polymorphs can still be deemed pharmaceutically equivalent. However, polymorphic differences can affect properties like wettability,...
01:26Pharmaceutical Equivalents
As defined by regulatory standards, pharmaceutical equivalents require generic drug products to have identical dosage forms and chemically identical active pharmaceutical ingredients (APIs). They must adhere to compendial or applicable standards for potency, content uniformity, disintegration times, and dissolution rates. In the case of modified-release dosage forms, variations in drug content are permissible as long as the delivered amount remains consistent with the innovator drug product.
01:24Dosage Regimen: Individualization
Individualization in dosing regimens is the customization of medication doses for individual patients. Its necessity arises from the goal of maximizing therapeutic benefits while minimizing risks. This approach is pivotal because human responses to drugs can vary widely; what is effective for one person may be inadequate or excessive for another. Interpatient (intersubject) variability refers to differences in drug responses between individuals, while intrapatient (intrasubject) variability...
01:16Bioequivalence: Overview
Pharmaceutical equivalents, by definition, are drug products with the same active ingredient in the same quantities, encapsulated in identical dosage forms, and intended for the same administration routes. These pharmaceutical equivalents are deemed bioequivalent if the bioavailability of the active entity in the drug preparations is similar. Moreover, pharmaceutical equivalents demonstrating bioequivalence are also regarded as therapeutically equivalent. This means that when used as directed,...
01:28Drug Products: Biologics, Biosimilars and Interchangeables
Biologics, derived from living sources such as humans, animals, or microorganisms, represent a significant category of pharmaceuticals. These complex molecules, developed through advanced biotechnological methods or purified from natural sources, include essential medical treatments like insulin and growth hormones. The complexity of biologics arises from their large molecular structures and the intricate processes required for their production, making them distinct from conventional...
01:02Prescription, Nonprescription and Orphan Drugs
Prescription drugs require a prescription from a medical practitioner and can only be obtained from a pharmacy. They have many applications, including treating pain, anxiety, and hypertension.
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...