But GPs aren't ignorant. Like most doctors, he would have preferred an education program that encouraged appropriate, cost-effective prescribing rather than the firm fist of policy. Hudson agrees that would have been preferable but claims that education alone would not change prescribing behaviour enough to make a difference in the Pharmacare budget, especially when government efforts would be pitted against the overwhelming amount of information doctors receive from drug companies. When RBP was introduced, the PMAC and 7 drug firms sued the province, arguing that the health minister lacked authority to implement the scheme and that RBP contravened both doctors' confidentiality provisions and the Food and Drug Act. The arguments were rejected by both the BC Supreme Court and BC Court of Appeal.
Data indicate that the policy has had an impact.
Still, many critics claim that although RBP may save money by lowering drug costs, overall costs will increase because there will be more visits to physicians and more hospitalizations because of adverse reactions. Pharmacare has monitored sentinel illnesses before and after the introduction of RBP, using data on hospital deaths and discharges and records of services provided in hospital and for certain diagnostic codes. The data show that among seniors who switched nitrates because of RBP, hospitalization rates for syncope and myocardial infarction were unchanged. The average number of hospitalizations for syncope was 73.5 per week for the 2 years before the policy and 72.2 per week for the 6 months after nitrates were referenced. For heart attack the average rate was 73.1 hospitalizations per week before RBP was introduced, compared with 68.8 in the 5 months after its introduction.