A study carried out by the Canadian Medical Association Journal (CMAJ.ca) shows there are many Canadians who do not take their medical prescriptions because they cannot afford the cost of the medications.
The study was based on pooled data from Canadian Community Health Surveys carried out in 2015, 2016, 2018, 2019 and 2020 with more than 223,000 respondents, said the CMAJ report.
"We found that 4.9 per cent of respondents aged 12 years or older reported cost-related nonadherence," said the report.
Those who self-identified as female, belonging to a racial or ethnic minority group, — or bisexual, pansexual, or questioning — were more likely to report cost-related nonadherence.
The report was written by Nevena Rebić, Lucy Cheng, Michael R. Law, Jacquelyn J. Cragg, Lori A. Brotto and Mary A. De Vera representing physicians and researchers at the University of British Columbia faculty of pharmacy; Arthritis Research Canada; School of Population and Public Health at UBC; Centre for Advancing Health Outcomes at St. Paul’s Hospital, Vancouver, BC.
The authors wrote that their findings reveal inequities that disproportionally affect marginalized people at the intersections of sex, race, age, and disability, and vary by province.
"This foundational understanding of the state of cost-related nonadherence may be used to inform potential expansion of public drug coverage eligibility, premiums, and cost-sharing policies that address financial barriers to medication adherence," said the report.
The authors wrote that the cost of long-term prescriptions could result in significant hardship for many Canadians.
"Prescription medications are necessary for disease prevention and management, particularly for people with chronic conditions; however, they are not always taken as prescribed. The costs of long-term medication use may impose considerable economic hardship to patients and lead to suboptimal care choices.
“Cost-related nonadherence refers to skipping doses, reducing dosages, delaying refilling prescriptions, or not filling a prescription because of out-of-pocket costs," the report said.
The study revealed that the cost of medical visits and hospital care is covered in accordance with the Canada Health Act, it is not the same for prescription medications, which make up the second most expensive component of health care spending in Canada. Figures showed that prescriptions accounted for 13 per cent — $43 billion — of Canada's annual health care spending, said the report.
"In 2021, Canadian households paid an estimated $7.4 billion out-of-pocket for prescription medications, accounting for 17.3 per cent of total prescription drug expenditures, with out-of-pocket spending forecasted to continue to increase at a faster rate than other health expenditures," said the study.
For the interpretation of their findings, the authors wrote:
“Our study provides nationally representative estimates of the burden and predictors of cost-related medication nonadherence in Canada. We found that almost one in 20 respondents aged 12 years or older reported cost-related nonadherence and that females had 44 per cent higher odds of reporting cost-related nonadherence than males.”
In conclusion, the authors said their report can be used to inform eligibility for public drug coverage, premium amounts, and cost-sharing policies to reduce the need for private financing (i.e., private insurance, out-of-pocket costs), thereby addressing the financial barriers to prescription medication adherence in Canada.
A full text version of the report with footnotes is available here.