Up to a third of Canadians with disabilities may skip doses of medication or neglect to get their prescriptions filled because of the cost of prescription drugs. One of the aims of pharmacare is to remove financial barriers to prescription drugs, and overcome inequities among Canadians for this important aspect of health care.
While the federal government reiterated its commitment to implementing pharmacare in the speech from the throne in September, a key task for implementation will be to ascertain who needs it most, ensuring that tax dollars are spent where they can do the most good.
Myths about medication costs
Recent research from investigators at Queen’s University exposes two myths that could interfere with making sure the right people get the help they need from a pharmacare or public drug benefit program.
Myth No. 1: People with disabilities are either seniors or welfare recipients, and therefore already receive their drugs free of charge.
The Canadian Survey on Disability (2017) shows that 60 per cent of disabled adults are under the age of 65, and therefore are not eligible for seniors’ benefits. Furthermore, between 30 and 60 per cent of working-age disabled adults are employed (depending on the severity of their disability), and thus may be ineligible for government drug programs. In our research, 27 per cent of our sample received coverage for prescription drugs from government sources exclusively. Many were covered only by private health insurance (47 per cent) or by a mixture of private and public health insurance (17 per cent).
Myth No. 2: Drug insurance alleviates the financial burden of prescription medications.
The study also showed that although 92 per cent of our sample had some type of drug insurance, they still experienced extraordinary out-of-pocket costs for prescription medications — more than five times the national average.
Like many people with disabilities and chronic illnesses, members of our sample took a number of prescription medications. The average in our sample was five, which is significantly more than most Canadians take, particularly those under age 65. For each of these prescriptions, there may be co-payments, dispensing fees or other point-of-purchase costs. These costs added up to an average of $197 per month in our sample, with some people bearing costs near $3,000 per month for their medications.
There were also often deductibles and/or premiums that had to be paid on a monthly or annual basis to maintain coverage. Deductibles are typically calculated as a percentage of net income, and range from $100-$400 annually. Catastrophic coverage of high-risk patients is intended to prevent financial hardship for people with high drug costs. However, deductibles for these patients can be as high as 20 per cent of annual income plus a co-insurance of up to 35 per cent — a percentage of prescription costs that patients pay directly while making a purchase.
Prescription drug costs were often layered on top of other health-related costs, such as over-the-counter medications, expendable health supplies such as catheters, gloves and skincare supplies, dietary supplements and adaptive devices such as wheelchairs and special cushions. These additional costs added up on average to $600 per month in our sample.
The excess costs of prescription drugs for disabled people are particularly problematic when we take into account that disabled people are typically significantly less well off than non-disabled Canadians. National data show the average income for someone with a disability is $20,000 lower than for those without a disability ($19,000 versus $39,000 per year). Twenty-eight per cent of people with a severe disability live below the poverty line, compared to 10 per cent of the non-disabled. Even among those who are employed, many work part-time, work for small employers or are self-employed.
When we surveyed 160 people with disabilities for a study, we found that the high cost of medications led 37 per cent of individuals to ration their medications by taking a smaller dose, taking medications less often or simply not filling prescriptions. Many resorted to cutting back on essentials such as food, shelter or other disability-related expenses in order to be able to pay for their drugs. These measures caused their symptoms to get worse, which ultimately affected their quality of life and caused them to use more health-care services.
Given this rising burden of prescription drug costs on patients, a national pharmacare program for Canada needs to respond to the breadth (who is covered, or population-coverage), depth (what services are covered, or cost-coverage) and scope (how much of the cost is covered, or service-coverage) of drug insurance. In particular, the extraordinary needs of people with disabilities need to be taken into account.
Our study demonstrated that paying for medications is a significant issue for many Canadians, but especially for those who live on a precarious margin of health. If we are to find a workable solution for pharmacare for Canadians, it needs to prioritize the needs of people who need it most.
Shikha Gupta receives funding from Mark S Lodge Foundation.
Mary Ann McColl receives funding from Mark S Lodge Foundation; Social Sciences & Humanities Research Council
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