Three Essays on the Ethics and Effects of Public Policy on the Price-Accessibility of Pharmaceuticals

Abstract

Pharmaceuticals have become, arguably, one of the fastest changing forms of health care. Advancements in pharmaceuticals are constantly bringing better treatments to illnesses previously untreatable. These advancements, however, come with a hefty price tag: In many countries they also represent the fastest growing source of health care expenditures. Innovative drugs often come to the market with high prices, and the prices of existing drugs can creep up if they are not reined in. These high prices can threaten patient access to the pharmaceuticals they need. Fortunately, there is a lot public policy can do, if it is designed to interact well with clinical, economic, and commercial factors, to safeguard this access.

This thesis contains three studies on the effects of public policy on the price-accessibility of pharmaceuticals. Its objectives are as follows: 1) To develop the definitions of a fair pricing of pharmaceuticals in terms of price-accessibility, 2) to present two case studies where public policy changes pharmaceutical prices and affects their utilization, and 3) discuss the significance of these case study policies on access to these drugs.

This thesis contributes to the existing body of literature by developing new theoretical models about what constitutes fair pricing of pharmaceuticals and about the relationships between the main parties responsible for making pharmaceuticals accessible to the people who need them. A new evaluation of the policy that delisted high-strength opioids from public formularies in Ontario is also presented with new regression models that allow the analysis of the effects of the policy across sociodemographic categories. Finally, this thesis also contains the first empirical analysis of OHIP plus, the policy that extended the public drug benefits to all individuals under 25 years of age; in this case, with the focus on oral chemotherapy drugs for cancer.