Public Drug Coverage of Aripiprazole and Brexpiprazole for Major Depressive Disorder: A Canadian Environmental Scan

Background: There are approximately 5.4% of Canadians currently living with major depressive disorder (MDD). The Canadian Network for Mood and Anxiety Treatments 2023 Clinical Guidelines recommend partial dopamine agonist antipsychotics (i.e., aripiprazole and brexpiprazole) as first-line adjunctive therapy for difficult-to-treat depression (DTD). These medications are not covered for MDD in Saskatchewan.

Objectives: In order to advocate for the inclusion of aripiprazole and brexpiprazole on the Saskatchewan Drug Formulary, our project aims to assess and compare the public drug coverage of these medications for the treatment of MDD across all Canadian publicly funded drug plans.

Methods: All 13 publicly accessible Canadian formularies were comprehensively reviewed, and representatives from federal, provincial, and territorial health ministries were consulted to verify the information obtained from the public websites and to request additional information when needed.

Results: The environmental scan revealed that aripiprazole and brexpiprazole are fully covered for MDD across most publicly funded drug plans except for the Yukon, British Columbia, and Saskatchewan, and Québec (brexpiprazole only).

Conclusion: Aripiprazole and brexpiprazole should be listed as unrestricted benefits to ensure that there is no healthcare inequity to accessing first-line adjunctive pharmacotherapy for Saskatchewan residents with MDD.