by Stacey J. Butler

Graphic design by Mimi Guo

Canada is often referred to as a country with ‘free healthcare’. The word ‘free’, however, is misleading. Canada is the only developed country with universal healthcare without prescription drug coverage, also known as ‘Pharmacare’.¹ Worse yet, Canadians pay more money for prescription medications than other high-income countries.² In a study of ten countries, Canada had the highest drug cost per capita ($824 CAD), while countries such as New Zealand ($365 CAD) had much lower costs.² Medications are vital to healthcare and the high cost in Canada is a socioeconomic barrier. 

Let’s calculate the cost of one of my medications: 

One month = $658 

One year: $658 x 12 months = $7,896

As a U of T graduate student, I am fortunate to have some medication coverage through student insurance, but this plan only covers 80% of the cost and has a $5,000 yearly maximum. Purchasing one of my medications drains my coverage before the school year is even over. I am left to pay thousands of dollars out-of-pocket unless I can somehow obtain additional coverage. I am not alone in this struggle–research suggests one in five Canadians struggle to afford their medications.¹ 

On January 1^st, 2018, it seemed like Ontario was taking the right step towards Pharmacare when they implemented OHIP+. The OHIP+ program covers the cost of prescription medications for all Canadians 24 and under without private coverage,³ however, it is still far from a universal program. Although OHIP+ boasts coverage for more than 5,000 drugs,³ many expensive medications and treatments for rarer diseases are not included or have approval restrictions.⁴ Furthermore, children are not eligible for OHIP+ if their parents have coverage through an employer. Families with private coverage and high prescription costs are left in the same position I am–scrambling to pay for their health out-of-pocket. These high costs can prevent Canadians’ ability to use the treatment at all, even if it has the potential to improve their quality of life. 

The Ontario Trillium Drug Benefit is similar to OHIP+,⁵ a program where the government covers drug costs for people without insurance, or with insufficient coverage. Although this sounds like a great solution in theory, the program requires individuals to pay a deductible based on their income. Similarly to OHIP+, it does not cover all medications. Many medications for chronic diseases are omitted and requests for exceptional access are regularly denied. My own medications are among the many denied, regardless of solid evidence proving their efficacy. Being unable to afford medications leaves patients in a difficult situation, especially those without the financial means to pay out-of-pocket. Patients are left asking the question, “How much money is my health really worth?”. It is a question that no one should ask themselves. 

When patients are unable to afford medications, they either decline treatment entirely or may take the medication less often, which is referred to as ‘non-adherence’.  A Canadian survey revealed 8% of Canadians receiving a prescription did not adhere to it due to cost.⁶ Non-adherence to medications for cost-related reasons is a dual-edged sword. It saves the individual money in the short term but can end up costing the government and potentially the individual more money in the long term. Medication is less effective when not taken as prescribed, usually resulting in the condition being uncontrolled or worsening in severity. This domino effect can ultimately cost the government a significant sum if it increases healthcare use and hospitalizations. The individual can also end up losing more money if they need to miss work due to illness, not to mention that their overall health and quality of life will also suffer. 

Although it is difficult to estimate the exact cost of non-adherence, there is clearly a significant economic impact.⁷ Researchers are compiling evidence to prove that eliminating the financial barrier to access medications can lower healthcare-related costs. A recent initiative led by Dr. Nav Persaud at the University of Toronto studied the benefit of providing free medications to patients through a program called ‘CLEAN Meds’ (Carefully seLected and Easy Accessible at No charge Medications) .⁸ Their study found that patients who received free medications had better adherence and reduced healthcare costs compared to patients who obtained their medications through usual access.⁸ 

Pharmacare can potentially improve medication adherence and health outcomes while also saving the government and taxpayer dollars. However, despite all the potential benefits of Pharmacare, it will be costly to implement. For this reason, it is a highly politicized issue. A 2019 report by the Advisory Council for Pharmacare at Health Canada estimated a cost of 15.3 billion dollars per year to cover prescription medications for all Canadians.¹ This is a large sum but a significant investment in preventative healthcare. With an aging population and chronic diseases on the rise, preventative healthcare is exactly where I feel our money should be spent.

References

1. Health Canada. A Prescription for Canada: Achieving Pharmacare for All. Ottawa, ON; 2019.
2. Morgan SG, Leopold C, Wagner AK. Drivers of expenditure on primary care prescription drugs in 10 high-income countries with universal health coverage. Cmaj. 2017;189(23):E794–9. 
3. Ontario Ministry of Health and Long-Term Care. OHIP+: Children and Youth Pharmacare [Internet]. Drugs and Devices. https://www.health.gov.on.ca/en/pro/programs/drugs/ohipplus/
4. Migneault J. Cystic fibrosis drug “a relief” for family in North Bay, Ont., but restrictions on cost coverage remain. CBC News. 2021 Oct 4
5. Ontario Ministry of Health. Get help with high prescription drug costs [Internet]. Available from: https://www.ontario.ca/page/get-help-high-prescription-drug-costs
6. Law MR, Cheng L, Kolhatkar A, et al. The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey. CMAJ Open. 2018;6(1):E63–70. 
7. Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open. 2018;8(1):1–13. 8.
8. Persaud N, Bedard M, Boozary A, et al. Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial. PLoS Medicine. 2021;18(5):1–14.