Reference-based pricing
=======================

* Lutchmie Narine
* Mahil Senathirajah
* Tina Smith

**[The authors respond:]** 

One of the ways to move beyond partisan discussion about the BC Reference Drug Program is to begin looking at the objective evidence of the program's effectiveness, as we did in our article.1 Although we are pleased that our study has drawn interest and comment from those involved in the development of the program, it is unfortunate that the comments were directed at clarifying perceived misstatements that in our view are not present in the article.

Bob Nakagawa and Rick Hudson question our comparison of the BC reference pricing policy with those in Europe, citing differences between the policies. A careful reading of our article will reveal that we are aware of these differences and so did not attempt to make any correlations beyond indicating that jurisdictions in Europe experimented with this form of policy before BC and reporting that as in Europe the initial effect of the BC program has been a decline in annual drug expenditures. We devoted a paragraph to listing how the BC program differed from others, and in particular we indicated the existence of "an option for special authority approval, which provides full coverage for a more expensive drug if the prescribing physician can justify its use."

Nakagawa and Hudson indicate that we stated that the BC program targets generic equivalents. At no point did we make such a statement. If this were so, our analysis and presentation of data would have highlighted generic equivalents. We did indicate in the article that reference-based pricing may be most applicable to a limited segment of the pharmaceutical market that includes therapeutic categories containing generic equivalents. This statement was made as part of a general discussion about why reference-based pricing policies may not substantially slow the growth of pharmaceutical expenditures in the long term and did not refer to the BC program specifically.

## Reference

1.  1. Narine L, Senathirajah M, Smith T. Evaluating reference-based pricing: initial findings and prospects. CMAJ 1999;161(3):286-8.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjEvMy8yODYiO3M6NDoiYXRvbSI7czoyMToiL2NtYWovMTYyLzEvMTQuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)