National Post (National Edition)
New study reveals potential areas we can improve access to medicine in Canada
As Health Canada undertakes a review of how patented prescription medications are priced in this country, one oft-cited justification for lowering the cost of medicines is that patients cannot afford them.
But a recent survey by Nanos Research found that cost is not the primary reason that Canadians don’t take their medications as prescribed. This is consistent with other recent survey findings of the McGill University Health Care in Canada survey.
The random survey of 4,445 Canadians found that 80 per cent had received a prescription over the previous six months. Of them, 93 per cent reported taking it as prescribed. Of the remaining respondents who reported not taking medication as prescribed, only seven per cent said it was because the medicine was too expensive or they couldn’t afford it.
“Our study found that cost is not a factor, and that more practical issues related to the medicine itself are more likely to be a reason for not taking a prescription,” says Nik Nanos, chair of Nanos Research.
Thy Dinh, Director of Health Economics and Policy at the Conference Board of Canada, contends the findings invite further investigation on two fronts. First, policymakers have to drill down into the reasons why medicines are unaffordable for some, since this remains an important health concern for the minority of Canadians who do not have coverage. “We need to dive into who is saying cost is an issue, and what specifically about the cost is an issue that we can try to address from a policy perspective?” says Dinh.
As she points out, the actual cost of the medication is only one component of affordability for patients — drug insurance plans’ design such as co-payments, deductibles and premiums may also be barriers for some patients.
Second, she says there is a legitimate concern that significantly lowering medicine prices will lead pharmaceutical companies to seek other countries with more favourable conditions than Canada to conduct clinical trials and bring their new medications to market. New medications may still make their way to Canadian patients, Dinh says, but it may take longer, and Canadians need to be among those consulted about just how long they’re willing to wait.
“If you make drastic decisions that negatively impact Canadians’ health, or the economy, or our ability to bring in new and innovative medicines, then certainly we need to think it through and determine where the appropriate compromise is,” she says.
Meanwhile, both Nanos and Dinh point out that the survey indicates areas where policies and practices could be improved right away in ways that are more strategic than simply changing medicine prices, but that could have a big impact on optimizing patient care.
The first is making sure patients know about public drug plans that could reduce their prescription costs. According to the survey, 54 per cent of Canadians who did not take their medications as prescribed also indicated they were unaware of public plans that help cover prescription medicine costs and three per cent were unsure, even seniors who, in the majority of provinces, are automatically enrolled into the public drug plan.
In addition to the Canadians who said they no longer needed the medication, one third cited no longer needing it and seven per cent forgot, while just under one quarter cited side effects or allergic reactions as the reason for not taking their medicine as prescribed.
“A key takeaway from this is that we should be worried when chronically-ill patients decide to be their own health practitioners in terms of whether they take, or don’t take, a medicine,” Nanos says. They should be consulting their physician.”
Better data collection on both filling prescriptions and adverse medication effects would not only improve patient outcomes, Dinh adds, but also provide valuable feedback to drug-makers.
“I think it speaks to better communication between physicians, pharmacists and patients. The entire health ecosystem can benefit from a more productive conversation.” The survey was commissioned by Innovative Medicines Canada and the Canadian Life and Health Insurance Association (CLHIA). Nanos conducted a random telephone survey of 4,445 Canadians 18 years and older between May 27 and June 10, 2017. The margin of error is +/- 1.4 percentage points, 19 times out of 20.