One in 10 Canadians struggles to afford medications
Pay the bills or pay for medications? It doesn’t sound like a choice people with a publicly-funded health care system should be forced to make. While the sacrifices aren’t always so steep, a new study in the Canadian Medical Association Journal (CMAJ) warns that medication costs are a barrier for many Canadians — up to 10 per cent of our population, in fact.
Here’s the problem: prescription medications aren’t covered by the Canada Health Act, meaning most Canadians either pay for their medications out of their budget or rely on a private insurance plan — if they have one — to pay for part or all of the cost. Programs to help certain groups like seniors or people with certain inherited conditions vary by province and don’t cover everything.
What’s the damage? Previous studies have shown that roughly two thirds of Canadian families are paying out-of-pocket for all or part of their prescription drug costs — a total which topped $4.6 billion in 2010. Not everyone can afford the costs, and they could be putting their health at risk by not filling or re-filling a needed prescription or skipping doses into order to stretch their supply.
Until now, experts only had estimates of how common the problem is in Canada. Researchers from the University of British Columbia, University of Toronto and the Institute for Clinical Evaluative Sciences analyzed data from 5732 people who participated in the 2007 Canada Community Health Survey (CCHS).
All of the participants noted they had received one or more prescriptions, and were asked if cost was the reason they had problems filling a prescription, avoided refilling their prescription or tried to make a prescription last longer (i.e. by skipping doses). Researchers considered a positive answer to any of those questions as “cost-related nonadherence”. They then weighted the responses to represent the overall population.
The results? Drug affordability is a problem for 1 in 10 Canadians who need prescription medications — a cost-related nonadherence of 9.6 per cent. As you might expect, different parts of the country had different numbers. Quebec had the lowest rate at 7.2 per cent, followed by Alberta at 7.6 per cent. Saskatchewan and Manitoba along with Ontario all hovered around the national average, while the Atlantic provinces as a group were only two per cent over.
However, it was British Columbia where experts saw the greatest rate of cost-related nonadherence: 17 per cent. To be fair, respondents from this province also reported having a greater number of prescriptions than any other province.
Factors affecting affordability
While the study didn’t delve into why rates varied among provinces, researchers did uncover some trends including:
Income: It may not surprise you that the highest rate of cost-related nonadherence was among the lowest income group in Canada. Among households earning less than $20,000 a year, the rate was nearly double the national average at just over 20 per cent. Households earning $20,000 to $39,999 per year were next in line at 13.7 per cent, while households in the $40,000 to $59,999 or $60,000 to $79,999 were less than one percent over the average.
And if you think a higher income means no problems, researchers found that about 5 per cent — or 1 in 20 — of the $80,000+ income group reported cost-related nonadherence too.
Drug coverage: Again, no surprises here: people who had insurance coverage that included prescription medications were more likely to be able to afford them. Barely 7 per cent of this group reported cost-related nonadherence — compared to the 26.5 per cent of people who didn’t have private or public coverage.
Health status: The healthier people are, the more likely they are able to afford their prescriptions too. Respondents who rated their health as “fair or poor” had a cost-related nonadherence rate of about 20 per cent. To put this number in perspective, that’s twice as high as among the group who reported their health status as “good” (10 per cent) and almost three times as high as the “excellent or very good” (about 7 per cent).
Likewise, chronic conditions pay a major role. (After all, studies have shown that more than half of prescription drug costs are from long-term issues.) Respondents who reported having two or more chronic conditions were more likely to struggle with drug costs than people who only have one or who don’t suffer from any chronic conditions — though the difference wasn’t quite so dramatic (about 12 per cent versus 8 per cent.)