Clinical Consequences of Delayed Medication Access

In 2021, 3.5 million Canadians reported they could not afford to fill one or more prescriptions(StatisticsCanada,2022).

Thisdisproportionately affects:

Seniors not covered by provincial pharmacare plans, especially in provinces with limited formularies or high deductibles (e.g., British Columbia’sFairPharmacare).

Younger Canadians are less likely to have employer-sponsoreddrug plans

Patients with rare diseases, whose medications may not be listed on public formularies due to high cost or lack of provincial negotiations.

Real-WorldConsequences

The consequences of cost-related nonadherence in Canada are tangible and measurable:

A study published in CMAJ (2012) found that introducing out-of-pocket charges for essential medications, even as low as $2, resulted in higher rates of emergency department visits and hospitalizations, particularly among those with diabetes and cardiovasculardisease.

In Ontario, a delay in accessing second-line antihypertensive medications due to limited public coverage contributed to higher rates of stroke and myocardial infarction, especially among low-income individuals (Gupta et al., 2017).

Additionally, patient organizations across Canada have reported that financial stress from affording medications often leads patients to make trade-offs prioritizing rent or food over their medications, which exacerbatessocial determinantsof health.

Case Example: Diabetes in Indigenous Communities

Indigenous Canadians experience disproportionately high rates of Type 2 diabetes, and many live in remote areas with limited access to pharmacies. While the NonInsured Health Benefits (NIHB) program covers prescription costs for eligible First Nations and Inuit peoples, logistical delays, medication shortages, and bureaucratic inefficiencies lead to substantial delays in receiving treatment, resulting in increased rates of diabetic complications and earlier mortality (Reading &Wien,2009).

Canada’sMovementTowardPharmacare

In response to the growing concern over costrelated nonadherence, momentum has been building toward implementing national pharmacare The 2019 Advisory Council on the Implementation of National Pharmacare recommended establishing a universal, singlepayerpublicpharmacaresystem.

Potentialbenefitsofsuchasysteminclude:

Reduced nonadherence through lower or eliminatedout-of-pocketcosts

Streamlined access across provinces, ensuring equity regardlessof geography orincome Cost savings through bulk purchasing of medicationsandadministrativeefficiencies.