In response to BC PharmaCare’s recent changes to the coverage of DPP-4 inhibitors, the Canadian Heart Research Centre (CHRC), a non-profit academic research organization and its expert steering committee conducted an online survey to gain insight and assess the potential impact of this decision on physicians’ practice and patient care.
Approximately 4,500 Specialist and Primary Care physicians practicing in British Columbia were invited via email (300) and the rest via fax by the CHRC to complete the survey anonymously through a secure online platform. Between November and December 2014, 332 physicians completed the survey, with 86% being primary care physicians and 65% identifying a group practice as their main patient care setting.
The contributing physicians are experienced and busy clinicians, with 48% practicing for >20 years, 74% managing between 50 and 200 patients per week and 60% providing care for >100 patients with diabetes in their practice.
Sixty nine per cent of the physicians were aware of the coverage changes to the DPP-4 inhibitors by BC PharmaCare, but 88% of responders who were aware of the coverage changes were not consulted, either directly or indirectly, by BC PharmaCare in advance of the changes taking effect and were not aware of which organizations were consulted as part of this decision making process. Interestingly, 85% of all responders believe that physicians should have been involved in the decision making process for this coverage change primarily given the potential implication on their practice, while 2% believed that BC PharmaCare is better suited for making these type of decisions.
Perceived Impact on Practice and Patient Care:
Physicians expressed significant concerns about the impact of this decision on their practice with 97% believing that physicians will be subject to the most additional work as a result of the coverage change.
43% of responders have noted/are expecting at least 2 extra patient visits per week as a result of the change and 13% have noted/are expecting at least 5 extra visits per week. Similarly, 35% have noted/are anticipating at least 2 extra lab tests per week and 14% at least 5 extra lab tests per week.
62% of physicians had to explain the coverage change to affected patients, with 56% of these physicians estimating that a minimum of 5 minutes are required for the discussion and 11% estimating 10 minutes or more. According to the survey participants, the most common patient reactions were frustration (30%), unease or anxiety (29%) and confusion (25%). About half of the responders indicated that patients may stop taking their medication which may result in the loss of glycemic control. Sixty nine per cent of physicians felt, that at a minimum, patients who are well controlled on sitagliptin (Januvia®) or sitagliptin/metformin fixed dose combination (Janumet®) should have been excluded from the coverage change. Only about 17% of the physicians were not concerned with having to change the DPP-4 inhibitor therapy in patients who are currently controlled on sitagliptin (Januvia®) or sitagliptin/metformin fixed dose combination (Janumet®) and are affected by the coverage change.
Fifty two per cent of responders believed that BC PharmaCare should conduct therapeutic reviews and formulary rationalization policies which result in the removal of existing therapies in order to reduce drug costs, but 95% thought that all relevant costs to the healthcare system should be taken into account and not only the drug acquisition cost.
The majority of physicians (61%) disagreed with BC PharmaCare’s coverage change with only 9% agreeing. A further 68% of physicians believed that the coverage change to DPP-4 inhibitors sets a negative precedent. Seventy four per cent of responders agreed that there may be differences amongst the DPP-4 inhibitors that have not been demonstrated in clinical trials to date.
A frequent comment reported to the survey was that physicians would very much welcome being involved in the decision making process since they identify themselves as the stakeholders most impacted by this coverage change and that they would, at a minimum, like to understand the rationale to this decision making process.
Overall, 85% of physicians believe that without an evidence base to support it, drug substitution on economic grounds alone cannot be considered in the interest of the individual patient.
Should you have any questions, or require any assistance, please do not hesitate to contact the Canadian Heart Research Centre at 1-800-725-6585 ext. 229 or via email at email@example.com
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