Julia, a patient in the emergency department, was having trouble breathing. The oxygen in her blood was low; her lungs weren’t moving air. A simple inhaler could have prevented this crisis, but she hadn’t filled her prescription: she didn’t have the money to cover her insurance deductible.
Because Julia couldn’t pay $102 at the pharmacy, she needed a hospital visit that cost the health-care system much more. To recover from this preventable crisis, Julia had to take time off work, making it even harder to pay for her next prescription.
Even though a limited national pharmacare plan passed into law recently, it offers no remedy for Julia and few solutions for the hundreds of thousands of people in Canada who cannot afford their medications. The plan is slated to cover only some diabetes and contraceptive drugs and devices. Yet, despite its modest scale, some critics claim pharmacare will be too expensive.
This view turns a blind eye to decades of scientific evidence and the daily personal experiences of people in Canada. To start, we can tally up how much private insurance premiums cost. A 2018 analysis in the Canadian Medical Association Journal totalled those premiums at more than $10 billion. It’s likely to be substantially higher now, but we don’t hear this figure often because it’s paid from the pockets of millions of people, such as Julia.
Beyond the costs of private insurance, what Julia experienced was the maze of deductibles, copayments, coinsurance, ceilings and caps that anyone covered by a private plan will recognize. These gaps in private coverage are paired with uncertainty about whether she can keep her insurance through major life events, such as changes in employment or relationships. Even though Julia had private insurance, it didn’t cover what she needed, when she needed it.
People who can’t afford their medications can’t take them.
Simply put, people who can’t afford their medications can’t take them. Like groceries and housing, prescription drug affordability is a major concern. From a 2016 national survey, an estimated 1.4 million people in Canada could not take medications properly due to out-of-pocket costs. For one third of them, the prescription they couldn’t afford was less than $50. The result? An estimated 303,341 extra doctor visits and 93,295 ED visits in a year. That’s a staggering burden when one in five people in Canada doesn’t have a regular primary care provider and emergency departments face overcrowding and unexpected closures.
All these avoidable health-care visits have a cost. For three groups of conditions alone – diabetes, cardiovascular and chronic lung disease – researchers estimate we could save $1.2 billion a year with a universal, first dollar pharmacare program. That’s because not being able to afford essential medications can lead to worse health, poor quality of life and premature death. Recent evidence suggests that the medication affordability problem has only gotten worse.
The new law offers hope, but so far it is only a small step toward universal, comprehensive, public pharmacare. In the meantime, we continue to endure unnecessary strain on hospitals and primary care clinics while folks like Julia face ongoing stress about how to pay for medications they need.
To get all the efficiency and equity benefits of a national pharmacare plan, governments will need to move fast and fix things:
- Make federal/provincial/territorial deals so that diabetes and contraceptives coverage starts quickly.
- Rapidly expand the list of covered drugs so that everyone in Canada can benefit.
- Guarantee that pharmacare is portable so that it moves with us regardless of job, relationship or location in Canada.
- Ensure that coverage is publicly funded, not-for-profit and starts at the first dollar so nobody is left out because of affordability.
