Veterans Affairs Canada is not adequately managing the drug component of the Health Care Benefits of former Canadian soldiers under its care, according to the most recent review conducted by the Auditor General’s Office.
The department did not have the proper process for making evidence-based decisions related to its drug benefits list nor did it have the procedure to make sure its Formulary Review Committee systematically reviewed appropriate evidence to support decisions about changes to the drug benefits list.
“We reviewed 32 Committee decisions and found that for 17 of them, the Department could not provide evidence that it had appropriately considered veterans’ needs, current health practices and policies, clinical research, and cost-effectiveness,” according to the report released by Auditor General Michael Ferguson. “We also found that no timelines had been established for updating the drug benefits list with the Committee’s decisions.”
The Government of Canada provides prescription drug coverage for about 1.1 million Canadians who are members of eligible groups. These include First Nations people living on or off reserves, Inuit, some new immigrants, members of the military and the RCMP, some veterans, and inmates in federal penitentiaries.
Information provided by departments responsible for the programs indicated that during the 2013-2014 fiscal year, the federal government spent about $501 million to provide drug benefits to these eligible groups.
Veterans Affairs Canada’s Health Care Benefit Program provides drugs to eligible veterans. Some of these veterans have complex health issues and mental health conditions. Approximately 36 per cent of the recipients is over the age of 80.
During the 2014-2015 fiscal year, the Health Care Benefits Program covered drug expenses of 51,000 veterans at a cost of $80 million.
The auditor general found that the cost-effectiveness strategies used by Veterans Affairs Canada “did not use all the information at its disposal” in order to determine and document which drugs it should cover.
While the department monitored the use of some higher-risk drug, it failed to come up with an approach that could detect trends important to the well-being of veterans under the program.
For instance, the department did not analyze the use of drugs not available on the drug benefits list but accessible to eligible veterans on a case-by-case basis.
In failing to conduct such analysis, the department limited its ability to identify which drugs are routinely approved and which ones could be added to the drug benefit list.
Veterans Affairs Canada also did not have a well-defined approach that would prevent the inappropriate use of drugs.
For example, the department manages the only publicly funded plan that covers marijuana for medical purposes, but it does not monitor trends that may suggest high-risk use.
A proper monitoring mechanism could help the department flag potential drug-related problems at the time of dispensing, the auditor general’s report said.