OPINIONS

After hospital costs, drug costs are thesecond largest component of health-care spending, accounting for 18 % of the Canadian health budget.1 To control an-nual budget increases of 10%, public drug programs have implemented strate-gies limiting patients ’ access to certain medications. While it is clear that costs must be contained, formulary decisions are not consistent2,3 and are often made based on varying evaluations of effec-tiveness, demographics, self-interest, government priorities, and patient advo-cacy.4,5 Differing reimbursement restric-tions cause inconsistency of care and can lead to untoward consequences.6 In light of these concerns, 5 physicians and reimburse-ment experts assembled to review collective experience re-lated to the impact of restricted access and to develop a set of recommendations to address limitations of the current system. This article reports the group’s findings