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.)

“We found cost-related nonadherence was most commonly reported by individuals who were poor, who reported worse health status, and who had multiple chronic conditions,” stated Dr. Michael Law, Centre for Health Services and Policy Research, University of British Columbia. 

Age: Any guesses which age group had the most issues with affordability? While age wasn’t noted as a major factor, older respondents had the advantage over their younger cohorts. Respondents in the 35-44 age group reported the highest rate of cost-related nonadherence, followed by the 45-64 cohort (11.4 per cent and 10.8 per cent respectively).

While you might expect people over age 65 to struggle with medication costs due to age-related chronic conditions, this group boasted a nonadherence rate of half the national average — just 4.8 per cent.
Researchers don’t go into the reasons why — provincial drug benefits for seniors could be a factor, for instance — but do note that people under age 65 are more likely to report cost-related nonadherence.

Overall, researchers note that these results are in line with previous estimates in Canada — and they’re below comparable data for the U.S.

What’s next?

Do these numbers accurately represent what’s going on in Canada today? As you’ve likely noticed, the Canadian Community Health Survey used was from 2007. We’re sure you’re also wondering how the recession impacted people’s ability to afford their medications. Likewise, other notable costs like equipment weren’t included.

We also don’t know if this issue had gotten better or worse because this is the first analysis of its kind, nor can experts dig down to the details. The sample size wasn’t big enough to provide specifics about subgroups — like which chronic conditions people have or costs for specific medications.

Researchers also note the possibility for error associated with self-reported data — some people may not know they qualified for private or public benefits. In short, there are many areas needing further investigation.

So what can we do in the meantime? Not much — experts don’t make any recommendations except to say the government can do something to tackle the biggest factor: insurance.

“Reducing cost-related nonadherence would likely improve health and reduce spending in other areas, such as admissions to hospital for acute care,” conclude the authors. “Of all the factors we found to be associated with cost-related nonadherence, insurance coverage is the most amenable to being addressed through changes in public policy.”

However, you probably noticed the part about potentially not being aware of benefits for which they qualify. One strategy we can take away from that point is to know what you’re entitled too. If you or someone you know faces challenges paying for medications, make sure you check into your province’s drug programs and any private or public insurance policies you have.

Read the study from the CMAJ here.

Note to our readers: the CMAJ article was been peer reviewed and researchers report the following competing interests: Michael Law has consulted for Health Canada on a related report on cost-related nonadherence to prescription drugs. Irfan Dhalla is a volunteer member of the board of Canadian Doctors for Medicare and a paid member of the Committee to Evaluate Drugs in Ontario. Steven Morgan has been a consultant to federal and provincial governments on matters related to pharmaceutical policy.

Photo © Aurélien Pottier

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