Jan. 16, 2012

By Patricia Nicholson

Results of a new study suggest that about 10 per cent of Canadians may not be taking their prescribed medication as directed because of the cost of treatment.

Although Canada has universal health coverage, many people are not covered by an insurance plan that includes prescription drugs. Someone who is unable to afford to take their medication as directed may be at risk for poor treatment outcomes and further health problems.

To investigate how common this situation is in Canada, and what factors might contribute to it, Canadian researchers led by Michael Law, PhD, at the University of British Columbia studied data from more than 5,700 Canadians. All of the study subjects provided information about the effect of drug costs on their treatment on the 2007 Canada Community Health Survey.

The results showed that in the past year, 9.6 per cent of Canadians – about one in 10 people – had been prescribed a medication that they had not taken as directed because of cost factors. People diverged from prescribed treatment for cost reasons in many ways: by not filling or renewing a prescription, by waiting longer to refill a prescription, or by trying to make a prescription last longer.

Drug insurance and household income appeared to be major factors in these findings. In high-income households with drug insurance, only 3.6 per cent of people who received a prescription did not take their medication because of financial considerations. That number was 10 times as high in low-income households with no drug insurance: 35.6 per cent of people in this group reported not taking medication as directed because of the expense.

Several single factors were also associated with non-adherence to drug treatment:

• Not surprisingly, people with lower incomes were twice as likely to report not taking their medication as directed because of the cost.
• The researchers also found that people in poor health were more than two and a half times as likely to not take medication as directed for cost-related reasons.
• People who did not have drug insurance had a 4.5-fold higher risk of not following their drug treatment.
• The researchers also found that people in British Columbia were more likely than people in other provinces to not take prescribed drugs because of out-of-pocket expenses. The reason for this is not clear, but may be related to a high-deductible provincial drug plan, or to high levels of personal debt in the province.

The study authors concluded that drug costs were a factor in about 10 per cent of Canadians not taking medication as prescribed. Addressing this situation would probably help improve Canadians’ health and also cut spending in areas such as hospital admissions because people would be less likely to need acute care if they took their medication. The researchers suggest that insurance coverage might be the factor that could best be addressed by government.

The study was published in the Canadian Medical Association Journal on Jan. 16.