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CMAJ Open. 2018 Feb 5;6(1):E63-E70. doi: 10.9778/cmajo.20180008.

The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey.

Author information

1
Affiliations: Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.

Abstract

BACKGROUND:

Many Canadians face substantial out-of-pocket charges for prescription drugs. Prior work suggests that this causes some patients to not take their medications as prescribed; however, we have little understanding of whether charges for prescription medicines lead patients to forego basic needs or to use more health care services. Our study aimed to quantify the consequences of patient charges for medicines in Canada.

METHODS:

As part of the 2016 Canadian Community Health Survey, we designed and fielded cross-sectional questions to 28 091 Canadians regarding prescription drug affordability, consequent use of health care services and trade-offs with other expenditures. We calculated weighted population estimates and proportions, and used logistic regression to determine which patient characteristics were associated with these behaviours.

RESULTS:

Overall, 5.5% (95% confidence interval 5.1%-6.0%) of Canadians reported being unable to afford 1 or more drugs in the prior year, representing 8.2% of those with at least 1 prescription. Drugs for mental health conditions were the most commonly reported drug class for cost-related nonadherence. About 303 000 Canadians had additional doctor visits, about 93 000 sought care in the emergency department, and about 26 000 were admitted to hospital at the population level. Many Canadians forewent basic needs such as food (about 730 000 people), heat (about 238 000) and other health care expenses (about 239 000) because of drug costs. These outcomes were more common among females, younger adults, Aboriginal peoples, those with poorer health status, those lacking drug insurance and those with lower income.

INTERPRETATION:

Out-of-pocket charges for medicines for Canadians are associated with foregoing prescription drugs and other necessities as well as use of additional health care services. Changes to protect vulnerable populations from drug costs might reduce these negative outcomes.

Conflict of interest statement

Competing interests: Michael Law has consulted for Health Canada and has acted as an expert witness for the Attorney General of Canada. No other competing interests were declared.

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