Why Do Canadians Need a Catastrophic Drug Plan?

Because too many Canadians can’t afford their prescriptions.

When out-of-pocket medication costs become too high to manage, some people cut corners in ways that can compromise their health. In the Commonwealth Fund 2007 survey, 8% of Canadian respondents said they had not filled a prescription or had skipped a dose in the past year because of the cost.⁽¹⁾

Other research confirms that patients who can’t afford medications often fail to get their prescriptions filled, cut back on the dosage without telling their doctor or pharmacist⁽²⁾, or share the medications of family or friends.⁽³⁾⁽⁴⁾ High prescription costs now pose a similar financial threat to some Canadians that hospital care and doctors’ fees once posed in the days before these services were funded by governments.

This isn’t acceptable to Canadians: In a 2006 public opinion survey, 83% of Canadians said that governments should ensure there is a limit to how much individuals should personally pay for the costs of their prescription medication. Even more respondents (90%) said that if a medication is covered by one province then the other provinces should automatically cover it.⁽⁵⁾

Why target the provincial governments and not the federal government?

In September 2008⁽⁶⁾ at their annual meeting, the provincial and territorial ministers of health issued a public statement about the National Pharmaceuticals Strategy, saying they held a “common view that Catastrophic Drug Coverage is as essential to Canadians as physician and hospital coverage” and that the “federal government has a funding responsibility to establish a minimum standard of drug coverage for all Canadians”. They indicated their intent to pursue this issue with the federal government.

As of January 2009, no further public statements had been made about catastrophic drug coverage. The renewal of the 2004 Health Accord – the funding agreement between federal and provincial governments – is starting now and this is the opportunity for action by provincial and federal governments.

Who is at risk?

The following profile⁽⁷⁾ of persons lacking prescription drug insurance coverage under a conventional plan includes people who are:

• more likely to reside in one of the Atlantic Provinces, Manitoba or Saskatchewan;
• prone to be young (less than age 25 or to a lesser extent age 25-34);
• more likely to have no post-secondary education;
• more likely to be self-employed;
• more likely to be working part year or part time;
• prone to be single persons living on their own;
• more likely living in a rural area; and
• more likely to belong to households with lower middle incomes ($10,000-$30,000).

With regard to pharmaceutical benefits for children⁽⁸⁾, provincial drug programs vary considerably in terms of whom they cover, what drugs are covered and how much subscribers must pay out of pocket. Unlike seniors and social assistance recipients, the provinces do not agree on the importance of providing comprehensive coverage for all children. For many Canadian children, significant financial barriers exist to medication access.

How many Canadians are affected?

The problem is large and growing. One in nine residents is not protected against high drug costs and this proportion increases each year (The Standing Senate Committee on Social Affairs, Science and Technology, 2002). Many new targeted therapies for severe illnesses are not automatically covered by the public health system because they are taken outside the hospital.

What provinces have a plan?

The eligibility criteria and cost-sharing details of the publicly funded prescription drug plans⁽⁹⁾ depends on where in Canada you live, as does the personal financial burden due to prescription drug costs. Seniors pay 35% or less of their prescription costs in 2 provinces, but elsewhere they may pay as much as 100%. With few exceptions, nonseniors pay more than 35% of their prescription costs in every province. Most social assistance recipients pay 35% or less of their prescription costs in 5 provinces and pay no costs in the other 5. In an example of a patient with congestive heart failure, his out-of-pocket costs for a prescription burden of $1283 varied between $74 and $1332 across the provinces.

References

1. The Commonwealth Fund. (2007). The Commonwealth Fund 2007 International Health Policy Survey in Seven Countries.
2. Piette JD, Heisler M, Horne R, et al. (2005). A conceptually based approach to understanding chronically ill patients’ responses to medication cost pressures. Social Science & Medicine; 62(4): 846-857.
3. Wallston KA. (2007). Patient health care behaviours related to medication use and adherence. Safe and Effective: The Eight Essential Elements of an Optimal Medication-Use System. MacKinnon NJ (editor). Ottawa: Canadian Pharmacists Association.
4. Goldsworthy RC, Schwartz NC, Mayhorn CB. (2008). Beyond abuse and exposure: Framing the impact of prescription-medication sharing. American Journal of Public Health; 98(6): 1115-1121.
5. Pollara Inc. (2006). Health Care in Canada Survey, 2006. Toronto: Pollara. www.pollara.ca.
6. Canadian Intergovernmental Conference Secretariat. (2008 September 4). Annual Conference of Provincial-Territorial Ministers of Health. National Pharmaceuticals Strategy decision points. [backgrounder]. www.scics.gc.ca.
7. Drug Coverage in Canada: who is at risk? Kapur, V; Health Policy. 2005 Feb;71(2):181-93.
8. Public Drug Plan Coverage for Children Across Canada: A Portrait of Too Many Colours Wendy J Ungar, MSC, PHD and Maciej Witkos, MSC Wendy J Ungar, Scientist, Population Health Sciences, The Hospital for Sick Children, Assistant Professor, Department of Health Policy, Management and Evaluation, University of Toronto, Adjunct Scientist, Institute for Clinical Evaluative Sciences Toronto, ON;
9. Comparison of provincial prescription drug plans and the impact on patients’ annual drug expenditures CMAJ • February 12, 2008; 178 (4). doi:10.1503/cmaj.070587. Correspondence to: Dr. Louise Pilote, Division of General Internal Medicine, McGill University Health Centre, 687 Pine Ave. W, Rm. A4.23, Montréal QC H3A 1A1; louise.pilote@mcgill.ca

Documents

	Spinning the Wheel – The High-stakes Game of Catastrophic Drug Coverage for Canadians Campaign to Control Cancer, September 2008 A national catastrophic drug plan is critically needed in Canada. Over three million Canadians are unprotected against high drug costs. A wave of new targeted therapies is entering the market, offering promise in once-untreatable diseases but at prices beyond the reach of individual Canadians. The time has come for action. Source
	Cancer Drug Access for Canadians Canadian Cancer Society, September 2009 Having access to cancer drugs means that all Canadians should be able to obtain the medications recommended by their oncologist, based on clinical evidence, in a timely manner and without financial hardship. The structures that make this possible include the cancer care system, publicly funded drug plans and private insurance. There are many gaps in the present system that need to be recognized and addressed. Because half of all newer cancer drugs are taken at home they are not covered by the public health system, patients require coverage either by public or private drug plans. Not all Canadians have insurance. Source
	Catastrophic Drug Coverage in Canada Karin Phillips, Social Affairs Division, September 01, 2009 Library of Parliament “Despite this progress, some Canadians still lack access to catastrophic drug coverage. This paper provides an overview of catastrophic drug coverage in Canada and current challenges facing the system, and it examines the potential for creating a national catastrophic drug coverage plan, as envisioned by the first ministers.” Source
	Standing Senate Committee on Social Affairs, Science and Technology Study on the State of the Health Care System in Canada (1999-2002) “Gaps in the Health Care Safety Net: As pointed out in the Committee’s fourth report, there are presently serious gaps in our health care safety net, particularly with respect to drugs and home care. For example, a number of Canadians are not protected against the consequences of having to pay catastrophic drug costs…. If Canada is to have national standards in health care, and not only in hospital and doctor care as we do now, more money will clearly be required in the form of additional government funding in order to expand public coverage and reduce or close gaps in the health care safety net.” Source
	Commission on the Future of Health Care in Canada: The Romanow Commission In April 2001, the Prime Minister established the Commission on the Future of Health Care in Canada. It’s mandate was to review medicare, engage Canadians in a national dialogue on its future, and make recommendations to enhance the system’s quality and sustainability. RECOMMENDATION 36: The proposed new Catastrophic Drug Transfer should be used to reduce disparities in coverage across the country by covering a portion of the rapidly growing costs of provincial and territorial drug plans. Source
	2003 First Ministers’ Accord on Health Care Renewal “First Ministers agree that no Canadian should suffer undue financial hardship for needed drug therapy. Accordingly, as an integral component of these reforms, First Ministers will take measures, by the end of 2005/06, to ensure that Canadians, wherever they live, have reasonable access to catastrophic drug coverage. As a priority, First Ministers agree to further collaborate to promote optimal drug use, best practices in drug prescription and better manage the costs of all drugs including generic drugs, to ensure that drugs are safe, effective and accessible in a timely and cost-effective fashion.” Source