One in 10 Canadians are not able to adhere to their prescriptions due to the cost of prescription drugs, found Michael Law et al. in the Canadian Medical Association Journal. But more than just numbers, the study asked who are those one in 10 and found something truly troubling. The people in Canada who are the most unlikely to adhere to prescription medication due to cost are: those who do not have drug insurance (public or private), those who earn the lowest income ($20,000 or less), and those who are in the poorest health or have multiple conditions -- in other words, those who could benefit the most from pharmacare.
Our need for pharmacare
Two-thirds of Canadians pay out-of-pocket for prescription drugs each year, which totals $4.6 billion or 17.5 per cent of total spending on prescription drugs. Almost 10 per cent of Canadians reported not filling or renewing a prescription or trying to make a prescription last longer because of out-of-pocket expenses.
While 26.5 per cent of people who reported cost-related nonadherence to prescription drugs had no drug coverage, 6.8 per cent of Canadians who did have drug insurance reported cost-related nonadherence. This meant that lacking insurance was associated with a four-fold increase in the odds of cost-related nonadherence to prescription drugs. Not having drug insurance was the largest associated factor with cost-related nonadherence. This is also the area that the study's authors found to be the most amenable to being addressed through changes to public policy.
People who reported themselves as in fair or poor health were twice as likely to report cost-related nonadherence as self-reported healthy Canadians. As well, those who had multiple chronic conditions were 1.6 times more likely to report cost-related nonadherence than respondents who did not have chronic medical conditions.
The survey used by researchers asked people about their incomes. The lowest income range reported was less than $20,000 a year and this income bracket was the most associated with cost-related nonadherence. This could show that people living on a limited income are not able to afford out-of-pocket prescription drugs and are not being covered adequately, if at all, by public drug insurance. It could also mean that the deductible on some plans discourage people from filling or renewing their prescriptions. A high deductible was suggested by the authors as being a possible reason why British Columbians are more associated with cost-related nonadherence than people living in other provinces.
What this means for Canada and public health care
As many of you have likely put together already, being able to adhere to prescription drugs could improve health and lower admissions to hospitals and emergency rooms for acute care. It could also improve the health of Canadians.
For those looking for an economic argument in all of this, reducing cost-related nonadherence would give us a healthier work force. The age groups most highly associated with cost-related nonadherence is 35-44, followed by 45-64. Reducing ER and hospitals visits would also show significant savings in our health-care system. And implementing a pharmacare program in Canada would save all of us $10.7 billion a year! And not to forget, a pharmacare programme like medicare would attract companies to come to Canada because they would save money by not having to provide medical or drug coverage to their employees.
Canadians cherish medicare and regard it as part of our national identity. We see medicare as a way to care and look after one another, yet we've only implemented phase one of Tommy Douglas' universal health-care plan. Phase two, which includes pharmacare, is much needed. Law et al.'s paper shows us that there are large gaps in providing health care to Canadians because of ability to pay. We could close those gaps and save money doing it. Sounds like a win-win to me.
Take action by sending a letter to federal and provincial ministers today on the 2014 health care accord and the need for it to protect, strengthen and extend medicare: http://www.canadians.org/2014accord.
The report I refer to in this blog is available on the CMAJ website:
The effect of cost on adherence to prescription medications in Canada. Michael R. Law, Lucy Cheng, Irfan Dhalla, Deborah Heard, Steven Morgan. January 16th, 2012.