Cost of medicine stops BC'ers more than rest of Canadians

British Columbians indicating they couldn't afford prescriptions near double the national average: UBC study.

British Columbians are more likely than other Canadians to cite cost as the reason they've failed to take a medicine they've been prescribed, says a report by UBC researchers.

"Not having insurance coverage for prescription drugs, being in poor health, having a low household income, being under the age of 65 years and living in British Columbia" were all associated with what the researchers termed "cost-related nonadherence," in the report published in the Canadian Medical Association Journal today.

The release comes as B.C. Premier Christy Clark hosts her counterparts from across Canada in Victoria to discuss the future of health care, with a focus ahead of the meetings on funding and the federal government's plans to stop setting national standards.

Researchers from the University of B.C.'s Centre for Health Services and Policy Research, Michael Law, Lucy Cheng, Irfan Dhalla, Deborah Heard and Steven Morgan, wrote the study "The effect of cost on adherence to prescription medications in Canada" using data from Statistics Canada's 2007 Community Health Survey.

They found that on average one in 10 of the Canadians surveyed said that due to cost they had failed to fill a prescription or not taken a drug in the year before the survey. The number was one in six for people in B.C. and one out of four for people without drug insurance.

Omission from medicare

"Drugs have really become a core component of the treatment of disease and it's puzzling why they aren't included in medicare," said UBC's Law in an interview. "Prescription drugs are the most glaring omission from medicare today."

The Canada Health Act requires provinces to provide universal public insurance so that all medically necessary hospital services and doctors' fees are covered. Drugs for people outside the hospital, which Law said was a small part of medical expenses when medicare began in the 1960s, are not.

And while the 2004 Health Accord between the federal and provincial governments included much prescription drug content, there's been little progress made since then, said Law.

The result is that Canada has a patchwork of public and private plans that leaves many people uninsured, he said.

Two-thirds of Canadian households spend money out of their own pockets for drugs each year, the report noted. That adds up, it said. "These payments totaled $4.6 billion in 2010, or about 17.5 per cent of total spending on prescription drugs."

The study does not say which drugs people aren't taking, though it noted the majority of prescription drug spending in Canada is for things like heart medications that are intended for long-term use.

BC coverage good: ministry

"People in B.C., dramatically more than people in other jurisdicitons, are not taking the drugs they need because of cost," said New Democratic Party leader Adrian Dix. "It reflects a good amount of what we've been saying about inequality in the province."

Governments in recent years have set policies that favour pharmaceutical companies over patients, he said.

B.C. Health Minister Mike de Jong was not available for an interview.

"Through PharmaCare, British Columbians have access to one of the most comprehensive universal pharmaceutical programs in Canada," said Health Ministry spokesperson Ryan Jabs in an email.

"Deductible levels are set up to reflect patients' ability to pay," he said. "The lowest income earners pay no deductible or drug costs at all." That includes people on income assistance or living in residential care, he said.

About 10 per cent of the people registered with PharmaCare, or 274,000 patients, are eligible for 100 per cent coverage of drug costs. B.C. fully covers psychiatric medications and protects all residents from catastrophic drug costs, he said. The province has the best coverage in the country for cancer, renal, transplant and HIV/AIDS patients, he said.

Still, ministry officials will take time to review the UBC study, he said. "This study shows us that we may need to take a closer look at why some residents report having challenges accessing prescriptions."

PharmaCare deductibles a barrier

PharmaCare deductibles are based on a percentage of a person's income. Someone making under $15,000 a year pays two per cent of their income, or up to $300, before coverage kicks in to pay 70 per cent of the cost.

For a person making $30,000 a year or more, the deductible is four per cent of their income, or at least $1,200.

"That's coverage, but for a lot of people who are taking prescriptions every month, even that deductible can form a barrier," said Law. For people who may have several prescriptions to fill, the total adds up quickly, he said.

There may be good reasons for a person to stop taking the medicines that are prescribed to them, such as adverse reactions or a harmful interaction between two drugs, but cost is not one of them, said Law.

When people decide they can't afford the drugs they've been prescribed, they may end up sicker and costing the health care system more in the long run, said Law. There are also costs to individuals, employers and society as a whole, he said. "Keeping people healthy through the use of these drugs... is in everyone's best interest."

Governments have options to make drugs cheaper for patients, he said. They can lower the deductible, negotiate better prices or make more medicines free. They could also start a national plan and take advantage of bulk buying, he said.

"[The study] shows the need to take some steps to protect consumers, to address these questions of affordability," Dix said.

Over the past decade PharmaCare's share of the money spent on drugs in the province has shrunk from 50 per cent to 33 per cent, he said. The provincial government could reduce costs in several ways, including pushing to get the same deal on generic drugs that Ontario and Quebec have.

The government should also renew support for the Therapeutics Initiative, extend reference based pricing and refuse to accept parts of the trade agreement being negotiated with Europe that will add $250 million to drug costs in the province, he said.

Prescribed but unaffordable

The UBC study discussed in this story found that on average 9.6 per cent, or about one out of 10 people, said they hadn't filled or followed a prescription due to cost. The rate was lowest in Quebec at 7.2 per cent, and highest in B.C. at 17 per cent.

For people with insurance coverage for prescription drugs, the rate of non-adherence was a relatively low 6.8 per cent. For people who did not have coverage it was 26.5 per cent, or more than one out of four.

"Overall, the predicted probabilities of reporting cost-related nonadherence range from 3.6 [per cent]... among people with insurance and high household incomes to 35.6 [per cent] among people with low household incomes and no insurance."

By age, the highest rate of non-adherence was among 35 to 44 year olds, with people over 65 most likely to be able to afford their drugs. People who assessed their own health status as fair or poor and those who reported having two or more chronic conditions were also likely to have trouble affording prescriptions.

The high rate of non-adherence in B.C. was a surprise, but could be the result of PharmaCare's high deductible or the fact that personal debt levels are higher in B.C. than in other provinces, the report said.

"We're not exactly sure what's going on in British Columbia," said Law, though he noted that a TD Economics report found British Columbians had the highest level of financial vulnerability in the country.