Clinical Consequences of Delayed Medication Access

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Access to novel therapies like immunotherapies or tyrosine kinase inhibitors (TKIs) is often delayed due to formulary restrictions, provincial drug funding decisions (in Canada), or prolonged reimbursement approval processes, leading to inequitable access and potential survival disparities

Cost-RelatedMedicationNonadherence

Financial barriers remain a primary cause of delays in initiating or continuing treatment:

A study by Kennedy et al (2020) using NHANES data revealed that 1 in 5 adults aged 65+ in the US reported skipping or rationing medication due to cost, many of them managing chronic diseases suchashypertension,hyperlipidemia,andType2 diabetes In diabetes care, missed doses of antidiabetic medications can quickly destabilize glucose control, leading to complications like retinopathy, neuropathy, nephropathy, or hyperosmolar hyperglycemicstate(HHS).

A landmark observational study in Circulation (2006) demonstrated that nonadherence to prescribed statins or antihypertensives led to a 30%higherrisk of cardiovasculareventsover3years

Cost-related nonadherence (CRN) is a pervasive and welldocumented challenge in both high-income and low-income countries. Despite universal health coverage in many regions, including Canada, financial barriers to accessing prescribed medications continue to delay treatment initiation and compromise disease management. The downstream effects are not only felt at the individual level, through worsened health outcomes and loss of quality of life, but also ripple across the healthcare system via preventable hospitalizations and increased healthcare expenditures.

TheCanadianPerspective

Despite Canada’s publicly funded healthcare system, prescription medications are not universally covered, creating significant disparitiesinaccessacrossprovincesandpopulations.

Gaps in Canada's Drug Coverage

Approximately 1 in 5 Canadians (21.1%) report not taking their prescribed medication due to cost (Law, Cheng, & Dhalla, 2018).

Unlike physician and hospital services, outpatient prescription medications are not comprehensively insured under the Canada Health Act. Instead, coverage is provided through a patchwork of provincial drug plans, private insurance, and out-of-pocket payments.