One in ten Canadians cannot afford to take their prescription drugs as directed, according to an analysis by researchers from the University of British Columbia and the University of Toronto.
The study, published today in the CMAJ (Canadian Medical Association Journal) is the first to examine the relationship between drug insurance and the use of prescription drugs in Canada. Researchers from UBC’s Centre for Health Services and Policy Research reviewed data from 5,732 people who answered Statistics Canada’s Canadian Community Health Survey. They found that 9.6 per cent of Canadians who received a prescription reported not filling, failing to refill, or skipping doses for cost reasons. The phenomenon is particularly prevalent for Canadians who do not have drug insurance, with 26.5 per cent reporting not being able to afford their prescription drugs.
“Our results clearly demonstrate that cost-related problems in accessing prescription drugs are disproportionately borne by the poor, the sick and the uninsured,” says Michael Law, Assistant Professor at UBC’s School of Population and Public Health. “More than one in four Canadians without health insurance are forced, financially, to go without the prescription drugs they need.”
Prescription drugs fall outside the Canada Health Act, resulting in a “patchwork” of drug coverage that leaves two-thirds of Canadian households paying all or part of their prescription drug costs. The Canadian Institute for Health Information estimated these out-of-pocket payments totaled $4.6 billion in 2010.
The results of the UBC study show that individuals without drug insurance are 4.5 times more likely to avoid taking prescribed medications because of cost. Similarly, Canadians with low incomes are 3.3 times more likely to not use prescription drugs because they cannot afford them.
The study also shows that Canadians who reported fair or poor health status did not take their prescribed medications 2.6 times more often than those who reported good or excellent health; similarly, those with chronic conditions were 1.6 times more likely to not take their medicines as directed due to cost.
Provincially, those living in British Columbia were more than twice as likely to report not being able to afford their prescription drugs than those living in other large provinces. This is a cause for concern, says Law.
“The Canadian most likely to have problems affording their prescription drugs is in poor health, carries no drug insurance, and lives in British Columbia,” Law adds.
“As the Provincial Premiers meet in Victoria this week, they should consider expanding and improving public coverage for prescription drugs to reduce the influence of cost on whether or not Canadians can afford their prescription drugs.”
The study is available at http://www.cmaj.ca/content/early/2012/01/16/cmaj.111270.full.pdf+html.
Universal drug plan would save billions, UBC researchers say
Government plan could save billions of dollars while keeping drug costs affordable, study suggests
CBC News Posted: Mar 16, 2015 12:00 PM ET Last Updated: Mar 18, 2015 8:25 PM ET
A universal prescription drug plan could reduce total spending on medications in Canada by billions and cover everyone at an affordable price for taxpayers, health policy researchers say.
Canada is the only developed country with universal health insurance coverage that does not also offer universal prescription drug benefits.
About one in 10 Canadians say they can't afford to take their medications as prescribed, previous studies suggest.
In Monday's issue of the Canadian Medical Association Journal, researchers say the extra total cost to government of providing universal pharmacare could range as high as $5.4 billion a year, but would likely be about $1 billion, depending on exactly how much can be saved through bulk purchases of medications and other measures.
At the same time, it would save the private sector the $8.2 billion annually it spends on prescription drugs, mainly through employee health plans.
Saving 'billions of dollars'
"When we did the analysis, we were, at first, a little bit surprised," said study author Steven Morgan, a professor of health policy at the University of British Columbia in Vancouver. "Wow. Canada can really save billions of dollars by covering everybody for virtually every drug? And then we started to look deeper at the math, and it made perfect sense.
"You save about 10 per cent by getting better generic prices, you save about 10 per cent [on] brand name prices and you save an additional 10 per cent by encouraging more cost-effective prescribing," Morgan said, using conservative estimates. "Mine those three things together, you save 30 per cent of a very large budget. Therefore you're saving billions of dollars."
If Canada achieved "middle of the pack" spending as in comparable countries like Switzerland, Italy and Spain, and achieved the rates of generic drug use seen in some provincial drug plans, a universal public drug plan would reduce total spending on prescription drugs in Canada by $7.3 billion per year, the study's authors say.
Reducing health-care demands
Studies in the U.S. suggest that providing prescription medications for free to patients increases the chance they'll actually take the medicines they need and, in the long run, improves their health and reduces their demand on the health-care system, Morgan said.
Studies suggests one in 10 Canadians find it a financial strain to take medications as prescribed. (Fred Tanneau/AFP/Getty Images)
"Pharmacare is not unaffordable for taxpayers. Quite the opposite. It is unsustainable for taxpayers not to have a universal pharmacare system."
Health Minister Rona Ambrose wouldn't say whether she would favour a pharmacare program. She does think Canada can get a better deal by working together on a bulk purchasing system, instead of every province and territory buying drugs for their plans separately.
"We don't know who is paying what in one part of the country compared to the other sometimes, and I think to some extent we are getting ripped off," Ambrose said.
"Let's get together and start working on a bulk purchasing program that leads to the discussion around pharmacare."
Canada currently has one of the most expensive systems for purchasing prescription drugs in the world, Morgan said.
Bulk purchases, buying power
"Because we don't have universal coverage, we don't exercise the buying power that Canada could exercise in world markets for pharmaceuticals," Morgan said.
The study was possible because more detailed information about use and cost of different types of drugs by private health plans, public drug plans and out-of-pocket sources was published in the latest edition of the Canadian Rx Atlas, a compendium of drug-spending data.
The researchers pointed to three categories of potential savings:
- Increased use of generic drugs where appropriate.
- Lower generic drug prices such as through bulk purchases.
- Lower brand names through better price negotiations.
In 2013, the provinces and territories announced a jointdeal on six generic drug purchases.
Of drug costs in Canada, 36 per cent were funded through private insurance plans such as those provided by employers, four per cent came through compulsory social insurance such as workers' compensation funds and 22 per cent were funded out-of-pocket by patients between 1975 and 2013, according to the Canadian Institute for Health Information. The rest is mainly funded by public provincial plans.
Study co-author Danielle Martin, a family physician and vice-president of medical affairs and health systems solutions at Women's College Hospital in Toronto, is also a panellist on CBC-TV's The National and a volunteer member of the board of Canadian Doctors for Medicare.
With files from CBC's Kelly Crowe and Diane Paquette
NATIONAL DRUG COVERAGE IN CANADA?
A new study, conducted by the Angus Reid Institute, is the first to take a deep look at affordability and accessibility of prescription drugs in Canada. A significant, and apparently increasing number of Canadians are unable to afford the medicines being prescribed to them. The results can come as a surprise, given that many look to Canada’s advanced healthcare system as a model to emulate.
– Nearly a quarter of Canadians report that they, or someone in their household, did not take their prescribed medicines in the last 12 months because of cost.
– A third of Canadians say they have friends or family members who cannot afford to pay for their prescription medications.
– More than one-in-five Canadians say they have compensated by skipping doses, splitting pills, or simply not filling their prescriptions.
National drug coverage as a solution?
Over the past three weeks, these figures have contributed to the growing debate on whether Canada should implement a national drug coverage program. According to OECD health data, Canada has the second worst drug coverage amongst all OECD countries, followed by the U.S. that has the worst coverage.
The study by the Angus Reid Institute and public discussions on a Pharmacare program have sparked useful considerations on both sides of the debate. On one hand, there are clear benefits to a national drug plan. National drug coverage could ensure all Canadians have access to the drugs they need, and areport by the Mowat Center notes that a Pharmacare program could save $11.4 billion annually. The Angus Reid Institute study also shows strong public support for such a program: Nine-in-ten Canadians indicated support for this concept. But, they also expressed concerns on specific elements of the program.
There are two important cautionary notes expressed in public discussions:
1. What is the optimal vehicle by which such a program should run? There is skepticism on the program being run entirely at the federal level. Any national Pharmacare program will need to include a purchasing group that is capable of separating itself from inevitable politics of drug coverage, and there are models from the UK, New Zealand, France and Australia that Canada can look to.
2. There will need to be a strong focus on effectiveness of drugs. Decisions on funding should be based on performance of the drugs. In absence of evidence-based decisions, Canada could be left with an even more irrational and expensive drug coverage system.
A key take-home point from the Angus Reid survey is that the vast majority of Canadians believe that “Every Canadian – regardless of income – should have access to necessary prescription medicine” – a statement that goes to the very core philosophy of the Access Our Medicines initiative.
With the concept of national drug coverage now becoming a key election platform in Canada, it will undoubtedly continue to build momentum over the next few months. You can follow the discussions using #pharmacare on social media.
