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Emergency contraception subsidy in Canada: a comparative policy analysis.
Sabrina C Lee1,2, Wendy V Norman3,4
1Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
BMC Health Services Research
|September 1, 2022
Summary
Access to emergency contraception (EC) in Canada is limited by cost. While ulipristal acetate (UPA-EC) is more effective than levonorgestrel (LNG-EC), most provinces only subsidize LNG-EC, creating a gap between evidence and policy.
Area of Science:
- Public Health
- Pharmacoeconomics
- Health Policy
Background:
- Cost remains a significant barrier to accessing emergency contraception (EC) in Canada.
- Ulipristal acetate EC (UPA-EC) offers superior clinical effectiveness and cost-effectiveness compared to the standard levonorgestrel EC (LNG-EC).
- Provincial drug formularies and decision-making processes for EC subsidization were analyzed.
Purpose of the Study:
- To analyze provincial emergency contraception (EC) subsidization policies in Canada.
- To examine the decision-making processes influencing EC formulary inclusion.
- To identify gaps between current EC policies and emerging clinical evidence.
Main Methods:
- Documentary analysis of publicly available provincial drug formularies.
- Semi-structured interviews with key informants involved in policymaking.
- Qualitative exploration of the rationale behind formulary decisions.
Main Results:
- Only Quebec subsidizes ulipristal acetate EC (UPA-EC); all ten provinces subsidize levonorgestrel EC (LNG-EC).
- Provincial EC subsidization policies do not consistently reflect the latest clinical evidence favoring UPA-EC.
- Evidence is considered in policymaking, with formulary decisions reached through interdisciplinary consensus.
Conclusions:
- A notable discrepancy exists between current Canadian provincial EC subsidization policies and the most recent scientific evidence.
- Existing institutional structures influence policy development, impacting the adoption of evolving evidence.
- Enhancing interdisciplinary collaboration may foster the implementation of more evidence-based EC policies.
Keywords:
CanadaEmergency contraceptionEvidence-based policyHealth policyUlipristal acetateUniversal subsidyMore Related Videos
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