B.C. worst in Canada for drug affordability: study
B.C. residents are far more likely to face struggles with medication costs, especially drugs prescribed for mental-health conditions, according to a B.C.-led study published in the online journal CMAJ Open.
Analyzing the responses of 28,091 people who completed the 2016 Canadian community health survey, researchers from the University of B.C., Simon Fraser University and two Ontario institutions found that 5.5 per cent of respondents across Canada reported they couldn’t take their medications as prescribed because of costs. The proportion was highest in B.C., at 8.11 per cent.
Lead author Michael Law said there are two major factors that appear to work against B.C. residents. “First, and most obviously, the high deductibles in the public (Fair Pharmacare) drug plan means people face significant front-loaded charges to access medicines. Second, the high cost of living, relative to other parts of Canada, means people have less available funds to spend on prescription drugs.”
Deductibles in the B.C. Fair Pharmacare program are based on net-household income levels. Law said the actions the B.C. government announced last week to reduce or eliminate Pharmacare drug deductibles for those with household net incomes below $45,000 will help those who have the greatest challenges with drug affordability.
According to the Canadian Medical Association Journal study, those who struggle the most with costs are young adults, Aboriginals and South Asians, those who say their health is fair or poor, those with no drug-coverage plans and those whose household incomes are lowest.
“Yes, the changes to deductibles (which take effect next year) will make a difference in the ability of lower-income households in B.C. to afford their prescription drugs,” Law said. “The changes will make a substantial impact for households in the targeted income bands that need prescription drugs.”
In 2016, 23 per cent of B.C. respondents with incomes under $40,000 said they couldn’t afford one or more prescriptions, Law said. But under the B.C. government plan to eliminate deductibles for low-income earners, he expects up to 10 per cent more will be able to obtain their prescriptions.
Health Minister Adrian Dix said individuals with an income of $15,000 have been paying $300 a year while those earning up to $30,000 have spent $600 on deductibles. As of Jan. 1, 2019, they will no longer pay any deductibles, and copayments for drugs will be eliminated in families with a member older than 79 or with net incomes below $13,750.
The changes will cost the government $105 million over three years and will impact 240,000 families. It’s the first such change in 15 years and was the result of a collaborative effort between the NDP and Green party.
Law has co-authored previous studies showing that B.C. residents are more likely than those in other provinces to cite costs as the reason they haven’t filled prescriptions or have skipped doses of medications as recommended. He credits the Ministry of Health for paying attention to academic research and said it has also done its own “significant amount of internal analysis” on the topic.
“I think it’s great to see policy changes that consider the research evidence available,” Law said.
Since drugs are intended to heal or control health conditions, the negative consequences to non-adherence — not filling prescriptions or skipping doses — is chronic illness and even death. But there are other consequences too, the authors found, including more visits to doctors and hospitals. As well, those who struggle with medicine costs say they make trade-offs like spending less on heat and food to fill prescriptions. The study estimates that 730,000 Canadians spent less on food to afford medications, and 238,000 turned down their thermostats for the same reason.
While hospital and physician care are covered by public insurance schemes, prescription drugs are covered through a mix of employer, private and public insurance, and 22 per cent of total prescription-drug expenditures are out-of-pocket.
The study says many Canadians face substantial out-of-pocket charges for prescription drugs. It found 24 per cent of respondents said they used more health services — going to doctors more often, staying in hospitals longer or using emergency departments, if they couldn’t afford their medications. The authors acknowledge that a limitation of their study design is that it’s based on patient self-reports, which may be subject to bias.
The changes to deductibles … will make a substantial impact for households in the targeted income bands that need prescription drugs.