Financial advantage or barrier when deprescribing for seniors: A 'case based' analysis

Deprescribing has several barriers, including financial implications; the purpose of this study is to determine the financial impact of deprescribing on the pharmacy, public payer (government), and the patient, across Canadian provinces and territories.

A case was developed to reflect a typical senior in Canada. Eight different deprescribing scenarios were studied financially before and after each intervention. Detailed drug costs were obtained from the government plans covered in each province or territory, and were used to calculate the annual average pharmacy margin and total government and patient share.

Before deprescribing, the patient share for the regimen ranged between $1511.47 (Quebec) and $4342.75 (British Columbia) per year. The scenario with the greatest cost saving to the patient and greatest loss to the pharmacy was switching to a lower cost medication from liraglutide to prefilled detemir, with highest savings in patient share of $3699.95 and highest loss in pharmacy margin of $473.84 in Alberta.

There is a range in costs and coverage for medications across Canada. The scenarios demonstrated a small impact on the pharmacy's gross margin, in some cases a significant financial impact on patient costs, but minimal impact to government. Deprescribing initiatives and policies should include financial considerations for pharmacies and patients.