Access for all: Near universal support for a pharmacare plan covering Canadians’ prescription drug costs

Access for all: Near universal support for a pharmacare plan covering Canadians’ prescription drug costs

One-in-four Canadian households struggle to fill needed prescriptions


October 29, 2020 – The COVID-19 pandemic has put Canada’s health care system under a microscope – revealing millions of people in this country are struggling to access the prescription medicines they need.

A new study from the non-profit Angus Reid Institute finds the situation unimproved from 2015, when a landmark ARI study found one-quarter of Canadian households struggling to keep up with prescription drug costs.

The study was conducted in partnership with the University of British Columbia’s School of Population and Public Health; St. Michael’s Hospital and University of Toronto; the Carleton University Faculty of Public Affairs and School of Public Policy and Administration; and Women’s College Hospital, Toronto.

In 2020, during a pandemic that threatens their economic livelihood and health, the same is true. Over the past year, one-quarter (23%) have decided not to fill a prescription or not to renew one due to cost or taken measures to extend it because they could not afford to keep the recommended dosage schedule.

Against this backdrop, overwhelming support emerges for a national pharmacare program. Nearly nine-in-ten Canadians support the idea (86%), while more than seven-in-ten (77%) say increasing coverage for Canadians should be a high priority for government.

More Key Findings:

  • One-quarter (26%) of Canadians say they have had to pay for half or more of their prescription drug costs over the past year. This rises to 37 per cent for households that earn less than $50,000 per year.
  • Canadians are twice as likely to have lost prescription drug coverage (14%) as to have gained it (7%) over the past year.
  • More than two-in-five Canadians (44%) are concerned about their ability to afford prescription drugs in 10 years. Just one-quarter (24%) feel very confident that they will always be able to pay for their needs.

About ARI

The Angus Reid Institute (ARI) was founded in October 2014 by pollster and sociologist, Dr. Angus Reid. ARI is a national, not-for-profit, non-partisan public opinion research foundation established to advance education by commissioning, conducting and disseminating to the public accessible and impartial statistical data, research and policy analysis on economics, political science, philanthropy, public administration, domestic and international affairs and other socio-economic issues of importance to Canada and its world.

 

INDEX:

Part One: Prescription drug coverage and costs

  • Current situation in Canada
  • One-quarter face current challenges
  • More worry about the future

Part Two: Attitudes about pharmacare and access to prescriptions

  • “No one should go wanting”
  • Is employer and private coverage enough?
  • Three-quarters say improving access a priority

Part Three: Support for pharmacare

  • Vast majority support a federal program
  • Regional variation in enthusiasm for pharmacare

Part Four: How to get there and how to pay for it

  • How quickly to act and how much to cover?
  • Funding measures

 

Part One: Prescription drug coverage and costs

Current situation in Canada

In a year where a global pandemic has strained Canadians’ finances and put the health of many at risk, discussions of social safety net frameworks have dominated public discourse. Among them: prescription drug coverage. It is an issue that touches almost everyone. In the past year, nine-in-ten households (89%) have been prescribed medications by a doctor. One-in-three (32%) have filled a prescription six or more times over the past year. This represents a seven-point increase from the one-quarter that said this in 2015.

While the majority of Canadians (72%) have most or all of the cost of their prescriptions covered by insurance and government support, one-quarter (26%) must find money for at least half the cost – or more – on their own:

Regionally, the highest rates of self-payment for prescriptions are found in British Columbia, Saskatchewan, and Manitoba. In all three of these provinces, one-in-three households reported paying half of their prescription drug costs or more. By contrast, Ontario and Alberta report the highest rates of insurance and government coverage:

The same people who could most use help with paying for medicine are also the least likely to have the support of an insurance plan or government assistance. Lower income households are more than twice as likely as those with household incomes over $100,000 to have paid more than half of the cost for their prescription(s) out of their own pocket (37% to 15%).

It is worth noting that rates of prescription drug coverage also vary by gender and ethnicity, with women and Canadians who identify as a visible minority more likely to report having no insurance or only partial coverage (see detailed tables).

Many Canadian households are also bearing considerable out-of-pocket expenses for their prescriptions. Among those who received prescriptions, one-in-four (26%) Canadian households found themselves having to pay $500 or more for them in the last year:

Looking at annual prescription drug costs by region, Ontario residents again appear to be paying less out-of-pocket than the rest of the country. This may be in part related to the fact that, unlike the other provinces, Ontario offers a comprehensive, public drug coverage for seniors as well as children and youth under 25 years old. By contrast, the rates of those paying $500 or more are highest in British Columbia, Saskatchewan, and Quebec:

As with nearly every aspect of life, the COVID-19 pandemic appears to have had an impact on prescription drug coverage. During the outbreak, many businesses and workplaces have laid off employees or reduced their hours in response to lockdown measures. Since work-related extended health insurance is the most common way working-age Canadians obtain drug insurance, this has likely resulted in many Canadians temporarily or permanently losing drug coverage – a phenomenon also occurring in the United States.

Indeed, twice as many Canadians reported losing prescription drug coverage in the past year (14%) as have gained coverage that they did not have (7%). Looking at this by net effect (the difference between the rate of coverage gained minus lost), approximately one-in-20 households overall have lost their prescription drug coverage.

With the economic recovery progressing at different speeds across the country, it is perhaps unsurprising that the impact on coverage for drug costs is similarly uneven. Alberta, which currently has one of the highest unemployment rates in Canada, saw the highest proportion of its households lose prescription drug coverage this past year, with nearly one-in-five (18%) saying they lost some or all of it.

One-quarter face current challenges

The ramifications for those struggling with these costs can be significant, not just financially but medically. In the last year one-quarter (23%) of Canadians have made difficult decisions about paying for prescriptions, from trying to make a prescription last longer (for example by splitting doses), to not filling a prescription at all simply due to its cost.

Of course, such hardship varies depending on the income a household can draw on. More than two-in-five (44%) of those earning below $25,000 a year have dealt with at least one challenge related to prescription costs, nearly twice as many as the overall average. While this number is much lower for higher-income households, it is notable that even among those in the highest income group, one-in-ten (10%) say they have had one of these challenges in the past year.

The prevalence of such problems also varies with ethnicity. People who self-identify as visible minorities are more likely to struggle with paying for prescribed medicine. One-in-three minorities (36%) reported that members of their household skipped or stretched prescriptions because of out-of-pocket costs, compared to one-in-five (21%) Caucasian respondents:

There is some notable variation by region as well. Three-in-ten (29%) B.C. residents reported dealing with drug cost problems, while just 16 per cent of those in Manitoba and Quebec said the same.

More worry about the future

These new data also show that more Canadians are worried about drug costs in the future than are struggling with them today. More than two-in-five Canadians (44%) are at least somewhat concerned about their ability to afford prescription drugs in 10 years, and just one-quarter (24%) feel very confident that they will always be able to pay for them.

This anxiety is once again heightened among lower income households. One-quarter (24%) of those in the lowest income group say they are very worried about drug costs they will face a decade from now, more than three times the proportion in the highest income group (7%).

As with current challenges, visible minorities seem to be at more risk of prohibitive prescription costs in the future as well. Half within this group (50%) are at least somewhat worried about affording necessary medicines in 10 years, compared to 43 per cent of Canadians that do not identify as visible minority (see detailed tables).

Part Two: Attitudes about pharmacare and access to prescriptions

So how should the issue of drug affordability in Canada be addressed? Values associated with fairness and equality – and where medicines should fit in the larger framework of universal health care – underpin opinions on policy for the vast majority of Canadians.

“No one should go wanting”

Indeed, there seems to be a strong consensus that there is a moral imperative to fix the inequities in access to necessary medicine. About nine-in-ten Canadians agree with each of the following statements:

This is an issue for which there is strong cross-partisan support. While past Conservative Party voters are less likely to agree with each of these statements, they are nonetheless overwhelmingly in agreement:

Is employer and private coverage enough?

One possible argument against providing prescriptions free of charge appears to be unconvincing to respondents: the idea that most people already have drug coverage of some kind, making a new universal plan unnecessary. Roughly three-quarters (73%) of Canadians disagree with this.

While B.C. residents are least likely to agree that current coverage is adequate, Alberta, Saskatchewan, and Quebec have the highest proportions of those who believe that a new plan is not needed since enough people have existing coverage. Yet even in these provinces they are in the minority, with one-in-three agreeing.

Political differences are distinct on this statement. Conservative voters, less likely to favour government intervention in general, are almost evenly split (45% agree, 55% disagree), while just 12 per cent of NDP voters and 16 per cent of Liberal voters agree.

Three-quarters say improving access a priority

Even in a chaotic year with an ongoing pandemic, most Canadians (77%) consider improving prescription drug access and affordability a high priority issue for their government representatives to tackle. At least three-quarters in all age cohorts agree that this is either a high or very high priority:

Part Three: Support for pharmacare

The implementation of a national pharmacare program was promised by the federal Liberal Party during the last election and, more recently, in the latest Throne Speech, which stated that the federal government is “committed to a national, universal pharmacare program and will accelerate steps to achieve this system.” This appears to be a relatively uncontroversial idea.

Vast majority support a federal program

Nine-in-ten (86%) Canadians surveyed indicated overall support for “the concept of having “pharmacare” in Canada, providing universal access to prescription drugs”. Notably, more than half (57%) voiced strong support, compared to 29 per cent that expressed moderate support. These levels of support have stayed statistically consistent since the Angus Reid Institute last asked this question in 2015.

As highlighted earlier in this report, lower-income households are more likely to experience inadequate prescription drug coverage. It is therefore unsurprising that people in such households are most supportive of universal pharmacare. That said, even 83 per cent of those with the highest household incomes say this is a good idea:

Support for a national, universal pharmacare remains consistent across age groups. When it comes to political affiliation, however, significant differences emerge. Past Liberal, NDP, and Green voters voice near unanimous support for such a program. By contrast, opposition among those who voted for the Conservatives last October rises to 31 per cent, twice that of the national average (see detailed tables).

Regional variation in enthusiasm for pharmacare

Opponents of a national pharmacare program have pointed out that health care is under provincial jurisdiction, and argue that provinces can tailor prescription drug plans to suit the needs of their own populations, but will lose the ability to customize under a national plan. Others contend that provincial governments which oppose national pharmacare are standing in the way of progress.

Given this debate around a provincial vs. a national approach, it bears noting that support for a national pharmacare program, funded and administered by the federal government, varies across regions. Asked about their provincial government participating in such a program, one-in-three (37%) Alberta residents opposed the idea. That said, majorities in all regions support their provincial government’s involvement:

Part Four: How to get there and how to pay for it

How quickly to act and how much to cover?

On the issue of coverage and timing, for instance, survey respondents were asked about the Advisory Council on the Implementation of National Pharmacare’s recommendation that universal, public drug coverage begin immediately and cover 100 to 200 types of medication that Canadians most commonly need, then subsequently phase in other necessary medications over a few years. Three-in-five (60%) support proceeding with the Council’s recommendation, compared to 22 per cent that would prefer covering all necessary medications at once, even if it meant the program took longer to implement:

*See questionnaire for full question text

Funding measures

One of the most commonly cited criticisms of a national pharmacare program is its cost. The Advisory Council on pharmacare estimated that additional costs to the government would rise from $3.5 billion in 2022 to $15.3 billion by 2027 (as the list of covered medications expands). As a result, experts have warned that the implementation of such a program would require some form of tax increases.

It should be noted that the Advisory Council’s report also estimates that overall, including all sources of public and private spending on prescriptions, the country would be saving close to $5 billion per year in reduced costs for prescription drugs.

For the most part, Canadians remain supportive of a national pharmacare program even if it were to come with tax increases. For instance, a wealth tax on high income-earners (>$250K), such as that proposed by NDP Leader Jagmeet Singh during the 2019 federal election campaign, receives the support of four-in-five Canadians (82%). Support for increasing the corporate tax rates is similarly high, with three-quarters (76%) in favour of such a funding measure. One measure dividing Canadians, however, is the idea to increase the middle-class tax bracket by one percent:

Support for tax increases to fund a national pharmacare program is highest among those who would benefit most – Canadians from low income households. Among households where income exceeds $100 thousand annually, however, the proposals of a wealth tax and of an increase to the corporate tax rate still receive the support of at least 73 per cent:

For detailed results by age, gender, region, education, and other demographics, click here.

To read the full report, including detailed tables and methodologyclick here.

To read the questionnaire, click here.

MEDIA CONTACTS:

Shachi Kurl, President: 604.908.1693 shachi.kurl@angusreid.org @shachikurl

Steve Morgan, PhD, University of British Columbia, steve.morgan@ubc.ca;

Dr. Nav Persaud, MD, MSc, University of Toronto, nav.persaud@utoronto.ca;

Marc-André Gagnon, PhD, Carleton University, Ma.gagnon@carleton.ca;

Dr. Danielle Martin, MD, Women’s College Hospital, danielle.martin@wchospital.ca 


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