Intended for healthcare professionals


Cost keeps one in 10 Canadians from filling prescription

BMJ 2012; 344 doi: (Published 20 January 2012) Cite this as: BMJ 2012;344:e514
  1. Bob Roehr
  1. 1Washington, DC

The first analysis of cost related non-adherence has found that 9.6% of Canadians did not fill a new prescription, did not renew it once the drugs had been used, or that they spread out taking the pills because of the cost. The patterns of non-adherence along lines of income and insurance coverage mirrored those seen in similar studies in the United States.

The Canada Health Act requires provinces to provide universal public insurance for medically necessary hospital and doctor services, but it does not include the cover of outpatient prescription drugs.

Although private and public insurance cover for prescription drugs is available, “the typical employer sponsored plan will require you to pay 20% of the price of the drug out of pocket,” said Michael Law, lead author of the study and a health economist at the University of British Columbia.

Local and provincial insurance programmes for people on low incomes have high deductibles and often require one to spend 2-4% of income before qualifying.

As a result, Canadians paid Can$4.6bn (£2.9bn; €3.5bn; $4.5bn) out of pocket in 2010 for a variety of private insurance coverage and drug copayments. That is an estimated 17.5% of total spending on prescription drugs.

“If you get a prescription for a biologic drug for rheumatoid arthritis, your out of pocket charges could end up being literally thousands of dollars. So, even if you are wealthy, the cost in that range might be a barrier,” he told the BMJ.

The analysis drew upon 9404 telephone responses to the 2007 Canadian Community Health Survey and was published in the CMAJ.

Lack of insurance coverage for prescription drugs was associated with a fourfold increase in the odds ratio of cost related non-adherence (odds ratio 4.52), as was low household income compared with higher income (odds ratio 3.29). People with the lowest self-reported health status were most likely to report non-adherence. Some 35.6% of people with no insurance and low household income reported foregoing filling a prescription.

One surprise came in the analysis by province, or region where the available data were limited. People living in British Columbia were about twice as likely as other Canadians not to purchase medicines because of the cost.

Dr Law said part of the reason is that the cost of living is high in the province. He speculated that the province’s high deductible public drug plan and high level of debt per person might be contributing factors.

The study year, 2007, was near the peak of economic prosperity. He said, “There is no reason to think that the recession would have made things any easier for people.

“The burden is falling on exactly the people you would think that public insurance should help—the poor, the sick, the people who aren’t currently insured.” Dr Law said this supports the argument for extending the national law to mandate coverage of outpatient prescription drugs.


Cite this as: BMJ 2012;344:e514


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