Study reveals one in 20 people in Canada skip doses, don’t fill prescriptions because of cost

Affordability in Canada affects not just groceries but also medications, with one in 20 people unable to take their medications as prescribed because of cost, found research published in CMAJ (Canadian Medical Association Journal).

Prescription medications are not universally covered under Canada’s 13 provincial and territorial health insurance systems. In 2021, Canadian households paid more than $7.4 billion out of pocket for prescription medications.

The study, which included a nationally representative sample of more than 223 000 respondents over age 12, was conducted to better understand the burden of prescription costs in Canada.

One in 20 (5%) respondents reported cost-related nonadherence, meaning they skip or reduce dosages, delay refilling prescriptions, or do not fill prescriptions at all because of out-of-pocket costs. The authors found that females were 44% more likely to report cost-related problems than males, as were bisexual, pansexual, and questioning individuals (43%).

“Our findings show that intersections of personal, health, and health care system factors affect whether people in Canada skip or cut back on medications because of cost. We saw this pattern in the overall population and in both males and females when looking at them separately,” says Dr. Mary De Vera, a pharmacoepidemiologist and associate professor in medication adherence in the Faculty of Pharmaceutical Sciences at University of British Columbia and Arthritis Research Canada, Vancouver, BC.

Race and ethnicity were also associated with prescription affordability, with Indigenous, Latin American, West Asian, Arab, Black, and multiracial people having 20–67% higher odds of nonadherence. People aged 18–34 years were nine times more likely to report cost-related nonadherence than adults aged 75 years and older.

People living in Quebec were least affected by prescription costs, as each province has its own drug insurance program.

“The lack of national standards for these programs has led to interprovincial disparities in public drug coverage related to eligibility, premiums, and cost-sharing policies (e.g., deductibles, co-payments, out-of-pocket limits) and has created the need for financing of prescription drugs via private insurance and out-of-pocket costs incurred by patients,” says Nevena Rebić, a postdoctoral fellow at the University of Toronto who led the analysis.

Previous studies have been restricted to specific populations or a narrow time frame, whereas this study is more comprehensive and includes data from five iterations of the Canadian Community health Survey from 2015 to 2020.

The authors suggest that these findings can help inform public drug coverage plans, premium amounts, and other ways to reduce financial barriers to prescription medications in Canada.

In October 2024, Canada took concrete steps to ensure a national pharmacare program, as it became law under Bill C-64.

“As an initial step toward full national pharmacare, it is a laudable achievement,” writes Dr. Matthew Stanbrook, deputy editor, CMAJ, in a related editorial.

“Yet the legislation is low on substance, high on promises and aspirations, and vulnerable to political change. This leaves people living in Canada mired in uncertainty as to when or whether they will have the guaranteed access to medications and therapies, regardless of ability to pay, that citizens of almost all other countries with a public health care system receive.”

He urges the federal government and people of Canada to ensure that pharmacare is extended in the future.