Canadians support pharmacare and it’s time to get on with making it a reality

By Steve Morgan, Dr. Nav Persaud, Marc-André Gagnon and Dr. Danielle MartinThu., Nov. 5, 2020

[Excerpts] National pharmacare is needed — and supported — now, more than ever. A new national survey by the Angus Reid Institute makes this clear.

The survey results indicate that more than half a million Canadian households (one in 20 households) have lost prescription drug coverage during the dual health and economic crises of COVID-19. In total, more than one in 10 Canadian households currently has no prescription drug coverage at all.

Millions of additional Canadian households (about one in seven) has inadequate coverage for prescription drugs because, although they are insured, their insurance plans involve deductibles and/or coinsurance terms that require them to pay for most of their prescription costs out-of-pocket.

As a result, one in five Canadian households paid more than $500 out-of-pocket for prescriptions over the past year. One in 10 households paid over $1,000 out-of-pocket.

This happens because Canada is the only high-income country with a universal health care system that does not include universal coverage of prescription drugs.

Provinces provide some drug coverage, primarily for vulnerable segments of the population such as social assistance recipients and the elderly. But, for most Canadians, access to prescription drug coverage is a “perk” associated with having a decent, full-time job in an organization large enough to offer extended health benefits to its employees.

The result is structural inequality in prescription drug coverage and access in Canada.

Households with incomes between $50,000 and $100,000 are twice as likely to be uninsured for prescription drugs as households with incomes over $100,000 are. Women and Canadians of colour are more likely to be uninsured than men and whites.

Studies have found this form of inequality before. Even after adjusting for age, income, and education, immigrants and people of colour are less likely to have prescription drug coverage than nonimmigrants and whites in Canada.

These inadequacies and inequities in prescription drug coverage have significant effects on health.

The Angus Reid Institute survey shows that Canadians in one in four households did not fill prescriptions or skipped doses of prescriptions because of out-of-pocket costs in the past year. Women, young people, people of colour, and middle- and low-income households are all more likely to experience these financial barriers to taking medicines as prescribed than others in Canada are.

Skipped prescriptions result in preventable deterioration in health and increased use of our health care system by hundreds of thousands of Canadians every year. The Advisory Council on the Implementation of National Pharmacare estimates that this is costing our hospital system more than $1 billion every year.

All of this is occurring at a time when Canadians are most vulnerable and when we most need to keep everyone healthy and out of hospitals that remain under intense pressure from COVID-19.

What is particularly stunning about the lack of government action to solve this problem is the fact that the solution — adding necessary medicines to Canadian Medicare — would not only improve care, reduce disparities, and save lives, it would also save money. A lot of money.

Every credible estimate of the cost of a national pharmacare program — including estimates by Canada’s Parliamentary Budget Officer and the Department of Finance — has found that such a system will save Canadians billions of dollars more than it will cost government to run.

So, when investing in Canada’s pandemic recovery, the choice isn’t pharmacare or another program. The choice is pharmacare and another program because pharmacare will literally save the money needed to do the other thing.

Canadians appear to understand this. They sure support it.

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