1. Impact Evaluation of the BC Smoking Cessation Program 2016 CADTH Symposium Elaine Chong, Anne Nguyen, Shelley Canitz, HealthLink BC, Product Distribution Centre, Kelly Uyeno, Eric Lun

2. Speaker Disclosure I have no actual or potential conflict of interest in relation to this topic or presentation. 2

3. Agenda Background Program Evaluation Operational Improvement BC Stats Survey 2016 Program Refresh Discussion and Questions 3

4. Background Program launch September 2011  No-cost nicotine replacement therapy products (NRTs) Phone registration through HealthLink BC at 8-1-1 Choice of pharmacy pick-up or free mail delivery  PharmaCare coverage of bupropion or varenicline By prescription only, and dispensed at pharmacy Annual coverage up to 12 consecutive weeks 4

5. Background Broad reach > 25% of BC smokers = 187,000 patients Substantial investment Total expenditure for NRTs and prescription drug coverage (to March 2015): $38.2 million 5

6. Program Evaluation How well was the Program working? How can processes be improved? Operational review  Focus was to characterize and determine registration preferences, accessibility, and interest in behavioural support  No operational changes for prescription drugs 6

7. Update – NRT Registration Goals of registration component:  Accessible (24/7/365) method  Clinical interface for the Program (“safety net”)  Behavioural therapy support (QuitNow Services) Results: success in meeting intended goals Clinical interface and behaviour therapy support not used/needed as Program matured Ongoing staffing constraints 7

8. Update – NRT Distribution Goals of distribution component:  Choice of two timely and flexible mechanisms Results: success in meeting intended goals Majority choose pharmacy distribution  Consistent across all health authorities  Pharmacy-only distribution model acceptable as per previous conversations NRT supply and pharmacy distribution are stable 8

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10. Operational Improvements Streamline operations – simplify registration process and maintain pharmacy distribution model only 10

11. 11 Operational Improvements

12. New: Declaration Form (required for each dispense) Purpose:  Self-declaration as a smoker  Affirmation of pharmacist obligations NRTs dispensed Update patient address and phone number Update PharmaNet record Records subject to PharmaCare audit  Future program evaluation 12

13. Operational Improvements New: Request-for-Proposals for NRT Products Last RFP from summer 2011 (Habitrol®, Thrive®) Current contract will expire RFP launched and completed in Fall 2015  Nicoderm® patch  Nicorette® gum, lozenge, inhaler Transition phase provided 13

14. Program Evaluation Did the Program help British Columbians quit smoking? BC Stats Survey  Focus was to characterize and determine the impact of the Program (NRT component)  Future evaluation to include prescription drugs 14

15. BC Stats Survey Central statistical agency of BC  Inform decision making and policy development  British Columbia Statistics Act, R.S.B.C. 1996, C. 439 Survey conducted in early 2015  Assess Program impact on 3,000 NRT recipients  Results posted on the PharmaCare website: http://www2.gov.bc.ca/assets/gov/health/health-drug- coverage/pharmacare/smokingcessationevaluationrepor t.pdf http://www2.gov.bc.ca/assets/gov/health/health-drug- coverage/pharmacare/smokingcessationevaluationrepor t.pdf 15

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19. BC Stats Survey The Program is effective  27% quit smoking  76% were smoking less than before  71% made at least one quit attempt  52% remained smoke free for more than 30 days  65% strongly agreed or agreed that the Program helped them quit smoking 19

20. 2016 Program Simplified registration process  Registration through HealthLink BC discontinued  Pharmacy distribution only (self-declaration) New products  Nicoderm® patch  Nicorette® gum, lozenge, inhaler Collaboration with tobacco control programs in BC health authorities 20

21. Discussion and Questions 21