Impact of Provincial Pharmacare Coverage for Direct Oral Anticoagulants on Long-Term Anticoagulation for Unprovoked Venous Thromboembolism.

BACKGROUND

Unprovoked venous thromboembolism (VTE) has a high risk of recurrence, typically warranting indefinite anticoagulation. Direct-acting oral anticoagulants (DOACs) have several advantages over warfarin and are thus recommended preferentially for long-term use. Until January 2024 in Nova Scotia, DOAC use beyond 6 months was often cost-prohibitive due to limited provincial funding.

OBJECTIVE

To evaluate the impact of drug coverage on duration of anticoagulation for unprovoked VTE in Nova Scotia.

METHODS

A retrospective chart review was completed for patients with unprovoked VTE seen in the Halifax Thrombosis Clinic between 2018 and 2020. Patients were grouped by anticoagulant class, type of insurance (private, provincial, or neither), and anticoagulation continuation or noncontinuation beyond 6 months. The primary outcome was the difference in anticoagulation use at 6 months according to type of insurance based on χ2 testing.

RESULTS

The chart review identified 1016 patients seen during the study period, of whom 222 were included in the analysis. No significant difference in treatment duration was found among patients with private insurance, those covered under provincial pharmacare, and those with no insurance (mean duration 14.47, 12.39, and 13.89 months, respectively; p = 0.25). Scores for the Charlson comorbidity index and patient age did not significantly affect treatment duration. Patients with private insurance were more likely to receive a prescription for DOACs (p = 0.015 relative to provincial pharmacare, p < 0.001 relative to no insurance).

CONCLUSIONS

This study showed no statistically significant difference among types of insurance in terms of duration of anticoagulation after unprovoked VTE. However, patients with private insurance were more likely to use DOACs than warfarin. Since this study was completed, Nova Scotia Pharmacare now covers DOACs, but coverage remains limited in many other provinces. The results of this study may serve as evidence to lobby for extended DOAC funding in other provinces as a way to enhance care.