Coverage of drug costs: reference-based pricing.

Since 1985, British Columbia has used reference-based pricing (RBP) as a basis for reimbursement of the cost of an increasing number of drugs. Under this policy the costs of certain drugs are reimbursed at a level determined by the price of the lowest priced drug of equal efficacy in the same category. A recent position paper of the Canadian Cardiovascular Society has roundly criticized this policy. The principal grounds for criticism are that the policy is not 'evidenced based', that it is ineffective in that it does not lower health care costs, and that it contravenes the principals of equity and accessibility. These claims were examined and determined to be ill founded. Because the British Columbia experiment seems to be a reasonable approach to restraining drug costs it should be continued and monitored closely. In this way, real evidence of the impact of RBP on health and health care costs in the context of the Canadian health care system can be obtained.