Abstract

Background

Approximately one-third of Canadians’ prescription medication costs are paid directly out-of-pocket. This study attempts to determine if out-of-pocket spending greater than 5% of household income on drugs and pharmaceutical products is associated with cost-related prescription non-adherence among people with cardiovascular-related chronic conditions.

Methods

The data are from the survey on Barriers to Care for People with Chronic Health Conditions. Three categories of out-of-pocket spending on drugs and pharmaceutical products as a percentage of household income were identified: 0%, more than 0% to less than 5%, and 5% or more. Log-binomial regression was used to investigate associations between category of out-of-pocket spending and cost-related non-adherence.

Results

In 2012, about 80% of people aged 40 or older who lived in British Columbia, Alberta, Saskatchewan or Manitoba and had cardiovascular-related chronic conditions reported out-of-pocket spending on drugs and pharmaceutical products; 4.8% reported out-of-pocket spending of at least 5% of their household income. These individuals were significantly older, more often lived in households with incomes less than $30,000, and more often reported multiple morbidities than did people whose out-of-pocket spending on drugs and pharmaceutical products was less than 5% of household income. When the results were adjusted for age and sex, people whose spending amounted to 5% or more of household income were almost three times as likely (prevalence rate ratio = 2.6) to report cost-related prescription non-adherence than were those spending less than 5%.

Interpretation

Spending at least 5% of household income on drugs and pharmaceutical products was significantly associated with cost-related prescription non-adherence. Additional data are required to determine if even lower levels of spending put individuals at risk of cost related non-adherence.

Keywords

Chronic disease, cost-related non-adherence, health policy, out-of-pocket expenditures, prescription drugs

Findings

Prescription drugs are essential in the management of chronic diseases—an estimated 90% of individuals with major chronic conditions report taking one or more medications. Unlike hospital and physician care, prescription medications (other than those provided in hospital) are not covered by a universal insurance plan. Although all Canadian provinces provide some publicly funded drug insurance for certain segments of the population such as seniors and people receiving social assistance, provinces differ in their coverage of prescription medications for other groups and in the provision of catastrophic drug coverage. For many Canadians, prescription drugs are financed primarily through private insurance and out-of-pocket expenditures. According to the Canadian Institute for Health Information, out-of-pocket spending made up 34.3% of total expenditures on prescription medications in 2010. [Full Text]

Authors

Deirdre Hennessy (Deirdre.hennessy@canada.ca) and Claudia Sanmartin are with the Health Analysis Division at Statistics Canada. Paul Ronksley is with the Ottawa Hospital Research Institute. Rob Weaver, Dave Campbell, Braden Manns, Marcello Tonelli, and Brenda Hemmelgarn are with the Department of Community Health Sciences, University of Calgary.

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What is already known on this subject?

  • Approximately one-third of Canadians’ medication costs are paid directly out-of-pocket.
  • All Canadian provinces provide some publicly funded drug insurance for certain groups, but prescription medications are not covered by a universal insurance plan.
  • Inconsistent public insurance coverage for prescription drugs and high out-of-pocket spending have raised concern that some people may forego medications owing to cost.

What does this study add?

  • Based on results from the Barriers to Care for People with Chronic Health Conditions, an estimated 4.8% of western Canadians with cardiovascular-related conditions reported out-of-pocket spending on drugs and pharmaceutical products amounting to 5% or more of their household income.
  • These individuals were older, more likely to live in households receiving less than $30,000 annually, to have at least two chronic conditions, and to use more medications on average compared with those who spent less than 5% of their household income on drugs and pharmaceutical products.
  • Those spending at least 5% were significantly more likely to report cost-related prescription non-adherence than were those spending less than 5%.

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