Skipping doses and delaying filling: For many, prescription medications come at a cost

For many Canadians, prescription medications are essential in the management of many health issues and chronic conditions.

In 2021, over two-thirds (67%) of Canadians reported taking or being prescribed medication in the last 12 months.

Medication use tended to vary in the same way as provincial patterns in prescription coverage. The three provinces with the highest percentages of residents without prescription insurance coverage—British Columbia, Prince Edward Island and Ontario—were also the provinces with the lowest percentages of medication use (63% to 67%, compared with the highest percentages of 75% for Newfoundland and 73% for New Brunswick).

Currently, each province and territory offers prescription insurance coverage to some Canadians through public drug plans that vary in terms of eligibility, affordability, and eligible drugs covered.

Alternatively, some Canadians obtain private prescription insurance through their employer or their spouse’s employer. Others obtain their own private insurance. Those with private or employment-based insurance often have higher paying, full-time jobs and work for larger, often public sector and unionized organizations.

In contrast, Canadians who are self-employed, unemployed or who work for smaller companies and earn lower wages are often left without private prescription insurance.

According to the 2021 Survey on Access to Health Care and Pharmaceuticals During the Pandemic, just over one in five (21%) Canadians reported not having insurance to cover any of the cost of prescription medication in the past 12 months. Unlike every other developed country with universal health care, Canada does not have universal coverage of prescription medication (i.e., universal pharmacare).

The proportion of the population without prescription insurance coverage was similar for men (21%) and women (20%) and across age groups up to the age of 64. For adults aged 65 years and over, a higher percentage (25%) reported not having prescription insurance compared to adults aged 25 to 64 years (18%).

Overall, the share of Canadians reporting no prescription coverage varied considerably across the provinces, ranging from a high of 26% in British Columbia to a low of 14% in Nova Scotia.

The situation for seniors was similar, as the highest percentages of reporting no prescription coverage were among seniors living in BC (33%) and Manitoba (33%) and lowest among seniors in Alberta (9%) and Nova Scotia (11%). 

Prescription insurance is one important route to accessing medication, because prescription medication can be expensive without it. People without prescription insurance spent more money out-of-pocket annually on prescription medications than people with coverage.

Additionally, among Canadians who took or were prescribed medication in the past 12 months, close to 1 in 10 (9%) reported not adhering to their prescription medication (e.g., delayed filling, skipped doses) because of costs.

Most often, Canadians who took or were prescribed medication were spending less than $250 out of pocket in the past year, with almost two-thirds (65%) either having no out-of-pocket expenses or paying up to $249 in the past year.

Still, close to one in five (18%) were spending $500 more out of pocket for their prescription medication over the past year, with no difference between men and women.

Not unexpectedly, the amount spent out of pocket differed between those with and without prescription insurance coverage. In particular, 27% without prescription insurance coverage spent $500 or more, compared with 16% with coverage.

By examining self-reported data from Canadians in 2020-2021 (during part of the COVID-19 pandemic), the Statistics Canada study “Pharmaceutical access and use during the pandemic” provides estimates on the proportion of Canadians who reported not having prescription insurance to cover their medication costs and who reported that their prescription insurance was affected by the pandemic. It also further reports on amount spent out of pocket and percentage who reported not adhering to medications because of cost.

Read the full study here.

For further reading, check out this article in Health Reports, which provides data and analysis on prescription medication use among children and youth in Canada.