One in 10 Canadians have problems affording medications they have been prescribed, and one in four people without drug insurance cannot afford to have their prescriptions filled, according to a study in CMAJ (Canadian Medical Association Journal).
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. Participants who received a prescription were asked if they had problems filling a prescription, avoided refilling a prescription or tried to make a prescription last longer because of the cost. A positive answer to any of the three questions was deemed to be cost-related nonadherence to prescription medication.
Although Canada has publicly funded health care for hospital and physician services, the country lacks universal drug coverage. Many Canadians do not have insurance for prescription drugs and must pay out-of-pocket for medications. Two-thirds of Canadian households incur these expenses each year, totaling $4.6 billion in 2010, or about 17.5% of total spending on prescription drugs.
According to the study, about 10% of Canadians who received one or more prescriptions had problems filling a prescription because of cost, with the highest rates of cost-related nonadherence in British Columbia (17%). Rates were higher for people with lower incomes and those with poorer health as well as for people without drug insurance.
"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. "Among those without drug insurance, cost-related nonadherence was reported by 26.5% compared with only 6.8% among those who reported having drug insurance."
Statistical projections indicate a 35.6% likelihood of nonadherence for uninsured low-income people compared with 3.6% for high-income insured people.
"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."
"We think these findings are timely, with the premiers' Council of the Federation meeting January 16, 2012 in Victoria, BC," adds Dr. Law. "The country's 13 provincial and territorial premiers should focus on how to address this disparity to improve access to prescription drugs for all Canadians."