Why millions of uninsured, eligible Canadians aren't using public drug plans

Pain, suffering, mobility issues and death are outcomes of disease that large bodies of medical and public health research have aimed to cure for centuries.

For every condition that can be treated without the use of drugs, there are others that respond best to medication.

Nonetheless, a recent Nanos survey found that close to 900,000 Canadians who are prescribed drugs for serious chronic conditions and those that impact their quality of life don’t take their medication as prescribed.

Meanwhile, provinces and territories work continuously to manage public drug programs that 4.1 million Canadians with no private insurance were eligible for but not enrolled in at the end of 2017.

And of the Canadians who said they don’t take medication as prescribed, 54 per cent were not aware and three per cent were unsure if there were any public programs in place to help pay for their prescription drugs.

These findings were published in a December 2017 report by the Conference Board of Canada. The study looked to profile the groups of Canadians uninsured for drug coverage, not enrolled in coverage programs, insured but paying out-of-pocket fees and the ones who don’t fill their prescriptions at all.

The aim was to better understand gaps in drug coverage across the country, and how to close them.

“The system we have does a good job of at least making Canadians eligible for coverage,” report co-author Greg Sutherland said, but he added part of the confusion seems to lie in whose job it is to ensure people know what they’re eligible for.

Canada’s universal healthcare system is the only universal healthcare system that does not include universal prescription drug coverage.

Instead, provinces use their own public drug plans in conjunction with the private plans available. Whereas virtually every Canadian in the country is entitled to free healthcare, many provincial drug plans are only available to people who meet certain age, health or socio-economic criteria.

Sutherland pointed out, however, that of the people surveyed, less than seven per cent who said they don’t take their medication as prescribed cited cost as the reason, and that with the launch of OHIP+ on Jan. 1, four million people under 25 in Ontario who previously had no drug coverage are now covered.

In fact, as of Jan. 1, about 98 per cent of Canadians are eligible for private or public drug coverage.

So why do so many not use it?

When it comes to each province’s advertising of existing plans to eligible people, there’s no universal strategy for that either.

“Each province from the public side is trying to make sure its most vulnerable citizens have access or are eligible for prescription drug coverage,” Sutherland said. “It’s just, every province has a different way of doing this and there are communication issues around whether the population even knows that these things even exist.”

The study’s findings point to a lack of communication between governments, healthcare practitioners and patients that has left patients in the dark.

“There probably needs to be a little more education about what is available,” Sutherland said, though careful to add there should still be an impetus on individuals to arm themselves with knowledge.

Although the study couldn’t establish a strong link between the cost of prescribed medications and whether people filled them, Sutherland said there’s no question being aware of and taking advantage of available drug plans leads to better health and financial outcomes.

“Knowing our coverage and having education about our coverage allows us to make better decisions in our daily lives, in our financial decisions, and you could come at it from a whole wellness perspective,” Sutherland said.

“It’s arming yourself with healthcare knowledge…And it’s a good financial knowledge because you hate to be throwing your money away.”

A possible symptom of healthcare “disorganization”

Public health specialist David Beking has conducted his own research on Canada’s drug coverage gap with his team at Edward Jenner Public Health Consultants, in Ottawa.

Beking — who specializes in program monitoring, policy analysis and health information technology — wasn’t surprised the report concluded that millions of Canadians don’t know they’re eligible for drug coverage.

“It kind of gets at the disorganization of our healthcare system and drug coverage,” he said, adding provincial drug programs are “kind of disjointed from the overall healthcare system, so there’s not a lot of education or pharmaceutical counselling that goes along with prescriptions.”

Programs like Ontario’s new OHIP+ are a step in the right direction when it comes to ensuring more Canadians are covered, he said, but he doesn’t think they’re exactly what public health in Canada needs right now.

Through their own secondary research, his team looked at a national drug formulary — a list of medications approved for universal coverage — as a potential remedy for Canada’s drug coverage gap. They paid close attention to a 2015 study on the potential efficacy of a national formulary in Canada.

“They found that a national drug formulary would save businesses and consumers as much as $5 billion annually,” he said, adding some research has found annual savings for consumers and businesses could be as high as $11 billion. “And it would only cost the federal government a billion dollars [annually].”

By comparison, OHIP+ is expected to cost Ontario’s government half a billion dollars annually.

“Most of the efficiencies that are the result of [a national formulary] are from the increased purchasing power that a national government has over provincial governments,” he said.

Beking admitted that to make an approved list of drugs covered for all Canadians wouldn’t close the general healthcare gaps for marginalized groups, like First Nations communities, elderly populations and homeless populations. Nor would it help people who use prescription drugs left out of the national formulary.

But streamlining the bulk of drug coverage across the country, he said, would free up resources that could be used to tackle those gaps.

“We’re using up a lot of resources on the great debate about universal coverage of drugs,” he said.

“That needs to become a national coverage and then we can start looking at programs of better counseling for pharmaceutical use, working with elderly populations on the medications that they’re taking, starting programs with marginalized populations.”

And when it comes to people not using programs they’re eligible for due to a lack of education or communication, he believes a national drug program could help with that, too.

For some people, paying for drugs out of pocket, or simply not filling prescriptions, is easier than trying to navigate through private or provincial drug coverage programs,

“It [would] give us something national and consistent that everyone knows they have access to, and then from there, we can expand more targeted programs.”