Prescription preparations form an integral part of modern healthcare system. If appointed and applied properly and in accordance with good practices, a tiny pill can eliminate the disease or prevent it, as well as prolong and enhance the quality of life. The essential role of pharmaceuticals is recognized by the WHO, calling on the nations to provide and maintain accessibility to medications. The authoritative organization recommends to accomplish this task through drug policies embedded in more complex health protection mechanisms. Acknowledging the importance of drugs accessibility, each developed country is putting efforts into providing the coverage for the necessary drugs.
Despite a well-developed healthcare system and positive trends in its development, Canada is lacking a well-balanced, effective mechanism as for prescription medications. And frankly speaking, the coverage of prescription meds applied outside Canadian medical institutions can hardly be referred to as extensive or comprehensive.
In fact, an exact description of the local medications coverage would be a faulty and unregulated domain in both public and private sector. This domain deprives or leaves poor opportunities for those in need of treatment solutions.
This patchwork leaves many patients with little or no coverage at all and, since this fact adversely impacts the purchasing power, the increase impact on drug costs in the local market is an inevitable consequence. In 2016 Canadian residents are expected to fill 500+ ml. of prescriptions at retail drugstores and the total sales volume will certainly exceed $30bn. Despite the fact its going to be twice as less in comparison with all the hospital services provided in the country, the amount is still almost equal to the one covering the entire list of medicinal and diagnostic services provided by physicians. $30bn. amount looks even more imposing against the background of all the expenditures associated with dental care ($13bn). A vital fact: 30+ bn. today is a fourfold increase in comparison with 1996 - this is the most dynamically growing component of healthcare spendings in the country.
The reality of Canadian Medicare: is it that inaccessible?
Despite the fact that the drugs used in the hospitals are provided within a Medicare system, an overwhelming majority of common Canadians take advantage of assistance from private sector as for the the expenses associated with purchasing meds in retail drugstores. Public drug plans from province to province: in some cases age factor is decisive, in other cases the level of income matters, while at some areas you’ll get the desired help with the financial burden in case of a serious diagnosis (e.g. diabetes or cancer). All in all, only 42% of prescription drugs are covered within public drug plans, while private plans cover 36% of meds costs. Importantly, these plans are available on voluntary basis across the entire country with the exception of Quebec - in this province providing drug coverage is mandatory for the employer.
A better part of private insurance plans is acquired within health benefits provided for employers - as a rule, these benefits are a prerogative of skilled full-time personnel and those working for large organizations. The majority of Canadians do not hold any drug insurance plans, while those who do are obliged to make various payments on their own. These out-of-pocket payments accounts for $6bn annually in total, which is 22% of all the prescription meds costs.
But insufficiently thought-out drug coverage programs is not the only problem - poor coordination, another negative aspect, is reflected in inconsistency of such programs across Canada. Neither these plans are well integrated with healthcare services policies: as a result, the need in this or that medication is not the decisive and the most essential factor. The area of residence, age or a bunch of other factors can be ranked higher than a need in drug because of a certain condition. The policies are too cost-oriented, they have been created in the process of tough labour negotiations and in certain aspects are divorced from reality.
How it works and how it should work
Making sure each Canadian has access to the necessary drugs should be the paramount goal of any drug coverage plan, because, unfortunately, with a highly-developed public and private medical and hospital care, many people can’t afford the required medications.
According to the recent research (Prescription drug access and affordability an issue for nearly a quarter of all Canadian households), approximately 10% of adults don’t stick to the prescribed treatment regimen because of high medications costs (the state of affairs is actual for 1 of each 4 households). In many of these cases a person cannot purchase the necessary drug because of the absence of drug coverage. However, although the scope of the problem is narrower, even the holders of insurances tend to experience financial difficulties because of deductibles and co-payments.
The research has also revealed that even $2 charges (the cost of prescription) may have a crucial impact on patients with low-income (a patient may simply refuse from filling in the necessary prescriptions); the research even shows that minimum charges in a small number of cases influence the decision of average-income patients. Another important finding: an income-based drug plan (the one that covers the costs of drugs exceeding the income-based deductibles) is not an option when it comes to promotion of the required drugs. The authors assume that deductibles such plans imply are meant to be covered out of pocket in case of routine (but, probably, vital) treatment courses. So when a patient comes across a certain financial obstacle to the required prescription medication, it has to be dealt with on her own.
As soon as the scope of meds that Canadian citizens should have access to is defined in terms of cost-efficiency and public health priorities, the appropriate, effective mechanisms of payment are needed to be developed. The vital objective of providing access to drugs is ensuring that the charge for a drug is not going to be an obstacle for buying a particular medication.
Undergoing a treatment course with a prescription drug can be a tough financial burden. According to the study, an average Canadian household spends $500+ on prescription drugs in 25% of cases, while the spendings of $1,000+ account for 10% of cases. The absence of drug coverage in conjunction with high costs of medicines - the reasons remain obvious and are exactly the same as indicated above.
These expenses tend to significantly increase, even in case of relatively routine treatment courses, which is explained by the need in a medication on a daily basis. The fact makes the life of people with chronic diseases even more complicated, as they have no chance to consider predictable, fixed pricing models.