Did you know that more than 60% of Canadians spend out-of-pocket on the purchase of prescription drugs? According to the Canadian Union of Public Employees, an average Canadian household spends about $450 per year out of pocket on prescription drugs.
Managing your mental and physical health should not come at the cost of other necessities of your life. Still, unfortunately, the high cost of prescription drugs can put a financial strain on many Canadian families. According to the latest estimates reported by the Canadian Institute for Health Information, the total spending on prescription drugs is expected to cross $34.3 billion in 2021 This cost will be collectively incurred by:
- Provincial government (public payers) who will be incurring 43.1% of the total cost (or $14.8 billion)
- Private insurance companies will be paying 36.9% of this cost (or about $12.7 billion)
- Canadian individuals will be incurring 19.9% of the total cost (or about $6.8 billion) as an out-of-pocket expenditure.
Cost of Prescription Drugs in Canada
According to data reported by Statistics Canada, 55% of Canadian adults (aged 18 to 79 years) have used at least one prescription drug in the past month, over 35% of Canadians used at least two or more prescription drugs, while 24% used three or more prescription drugs in the past month.
The most commonly reported prescription drugs in Canada include:
- Blood pressure medications prescribed to 16% of Canadian adults on prescription drugs
- Cholesterol-lowering medications prescribed to 12% of Canadian adults on prescription drugs
- Mental health drugs (medications to treat depression, mania, and bipolar disorders) are prescribed to 10% of Canadian adults on prescription drugs
The Canadian healthcare system is often held up as an example against other healthcare systems around the globe since it is designed to deliver the services of qualified doctors and hospital care on a per-need basis, regardless of the patient's ability to pay.
The prescription drugs that are administered in the hospitals are provided to the Canadian residents at no additional charge. The prescription drugs that are to be administered outside of the hospital settings are usually covered by territorial, provincial or federal drug programs that decide the coverage and eligibility of recipients. Most Canadians have access to prescription drugs through private or public insurance plans. The publicly funded drug programs are mainly designed to provide prescription drug coverage to those in need based on their medical condition, socioeconomic status and age. Some Canadians also get insurance through their employers, and about 700,000 Canadians have no prescription drug coverage and pay the entire cost of their prescription drugs as an out-of-pocket expense.
8 Ways Canadians can Save Money on Prescription Drugs
The cost of prescription drugs in Canada is one of the highest in the world. According to a study published in the Canadian Medical Association Journal, investigators reported that approximately 1 million Canadians cut back on necessities such as food and heat to afford their prescription medications. The study also reported that about 8.2% of the population on prescription drugs (corresponding to 1.6 million Canadian) skipped the medication or missed the refills to reduce the cost of prescription drugs.
If you are looking to save money on your refills, here are some tips:
1. Ask your doctor or pharmacist if you should (still) be on the medication:
Some prescription drugs are needed for only a designated period of time. For example, Clopidogrel is usually recommended for only one year after certain heart operations. Continuing to take the medication after 1 year may pose a risk, which is why it is highly recommended to ask your doctor or pharmacist how long you are going to stay on particular drug therapy. It is imperative to mention that you should never stop or change the dosage of a prescription drug without communicating with your healthcare provider, as it can lead to serious complications.
Deprescribing Network, Canadian Medical Association, Choosing Wisely Canada, and other related organizations aim at educating individuals about the impacts of overmedication or unnecessary medications, especially in seniors and individuals with serious healthcare issues. Overmedication or unnecessary medication is a leading cause of complications among the elderly and should be avoided. For example, drugs like sleeping pills that are often prescribed to help with insomnia (or sleeping difficulty) can increase the risk of falls in the elderly by 47 to 57%.
It is also vital to keep up with your regular check-ups and follow-up appointments. The key benefits to discussing your drug therapy with a doctor or pharmacist are:
- Knowing whether a particular medication is working or not.
- Periodic assessment of your health so you know whether your health issues are improving or getting worse.
- Staying on top of your health issues can also help in minimizing the risk of complications.
2. Choose generic instead of brand name drugs:
It is a good idea to opt for generic medications over brand-name drugs whenever possible, simply because generic medicines are much cheaper (up to 20-80 percent). It is noteworthy to mention that the active ingredients, efficacy (or effectiveness of the medication in treating the illness or managing symptoms), and side effects or risk profiles of both generic and brand name drugs are the same. If you would like to know how the generic version of your medication is different from the branded version, speak to your pharmacist or doctor to learn more.
Some prescription drugs are also available as over-the-counter or non-prescription formulations. For example, non-prescription Naproxen is available as Aleve – an over-the-counter painkiller that can be used as a replacement for prescription Naproxen – Naprosyn or Anaprox. Aleve is generally available in doses 220 mg or lower, as an over-the-counter formulation to manage headaches. Naprosyn, on the other hand, is generally prescribed in much higher doses (such as 500-750 mg) to treat conditions like gout, arthritis, or more severe muscle and joint pain etc. Make sure to check with your healthcare provider to see which option is appropriate for you.
In some cases, you may not find a generic drug, especially if the medication is relatively new. This is because most newly discovered drugs are protected by patents that are issued by government institutions to support and safeguard pharmaceutical companies. Pharmaceutical patents give the drug company sole rights to manufacture, market and sell their formula for a defined period of time to recover the costs associated with the research and development of new drugs.
In all such cases, you can ask your doctor or pharmacist for an alternative option if possible.
3. Get to know your prescription drug coverage:
While enrolling in a health coverage plan, it is of utmost importance to know what your program covers. Certain important items to look for in your health coverage plan are:
- Formulary: Formulary is a list of prescription drugs that lists all the drugs covered by your health insurance plan. Some health coverage plans may choose to not pay for certain medications. It is important to check with your insurance company about your formulary.
- Percentage of coverage: Make sure to look at the rate of the prescription drug coverage per person per year.
- Deductible: This is the amount you would pay out of pocket before your health coverage provider pays any expense. For example, some plans require patients to pay the first $100 of their drug expenses before the insurance plan will cover any costs. After the deductible is paid, there may continue to be other expenses such as copays. Try to choose a health coverage plan that has minimal to no deductibles, but keep in mind such plans may come with a higher monthly cost. It is a good idea to evaluate your current health issues and prescription drug needs before choosing a certain plan over the other.
- Co-pay: It is a flat amount that an insured person pays out-of-pocket for their covered healthcare services. It is usually a fixed dollar amount or percentage that is paid each time you go to see your doctor or to fill your prescription. Copays do not have a dollar value maximum, like deductibles do, and will be charged on all prescriptions that you fill.
- Prior authorization: It refers to approval needed from your insurance company to allow claims for certain medications to be covered. Prior authorizations may exist for certain procedures, medicine or medical devices.
- Tiering: Insurance companies list the drugs in different tiers according to the cost of drug, effectiveness of formulation, availability of drug, and how it compares against similar drugs for the management of the medical condition. A higher drug tier suggests a more expensive medication and a higher co-pay amount for the recipient. Tier 1 has mostly generic drugs and lowest co-pay among all the tiers. Likewise, tier 3 has the most expensive mostly brand name specialty medications.
4. Ask your doctor if they have access to free samples:
Most physicians and healthcare providers get free drug samples as an incentive from pharmaceutical representatives to promote a particular brand or class of drug. According to estimates, pharmaceutical representatives gave out over 10 million pills to Canadian doctors in 2016. While it is beneficial for pharmaceutical companies to create brand awareness for their drugs, it is equally helpful for the patients who can get free samples from the doctor to see how their body and symptoms respond to a new drug. Make sure to check with your healthcare provider if they have any available samples of your prescription drugs.
5. Shop around for less expensive dispensing fees & compare prescription drug prices at different pharmacies:
The dispensing fee may vary from pharmacy to pharmacy and should be considered while choosing your pharmacy, even if the difference is not huge as it adds up over time with each refill. The price of your prescription drug may also vary from pharmacy to pharmacy.
Be sure to check with your doctor if you'd be taking your prescription drugs for an extended period, as reducing the frequency of refills can also help you save on the dispensing fee. For example, getting up to 3 months of refill is cheaper than bi-weekly or monthly refills as you will be paying dispensing fee once in the former case vs. 3-6 times in the latter case. It is important to remember that filling your medications in shorter intervals may be helpful for patients in certain scenarios e.g. patients who are prone to losing their medications, filling medications in compliance packages etc.
When trying a new medication, do not buy in bulk unless you know how your body reacts and responds to the new medicine. If the drug doesn't help with your symptoms, ask your doctor for an alternative option to test out.
6. Follow the Medical Instructions:
Education and awareness are the keys to better health. Make sure to educate yourself about your health issues to learn about holistic and lifestyle interventions that can improve your overall health. Make sure to use your pharmacist as a resource to learn:
- What medications you are taking
- How do your medications help in improving the symptoms?
- How long are you going to need your medications?
- How long would it take to notice an improvement in symptoms?
- What are some side effects to watch out for?
- When can you evaluate whether medication is helping your health issues?
It is imperative to follow your doctor's advice to improve your health. Not following your doctor's advice or suggested drug regimen is referred to as non-adherence in medical terms and includes:
- Skipping your doses
- Taking a different dose than recommended dose
- Avoiding prescription refills to try to save money
According to a new report released by the World Health Organization, non-adherence to prescription medications costs $4 billion in healthcare costs in Canada, as 5% of all hospitalizations and 5% of emergency visits to physicians' offices are caused by non-adherence medical instructions.
7. Consider ordering prescription drugs from an online pharmacy:
Ordering prescription drugs from an online pharmacy has several advantages besides cost reduction. For example, it is convenient to order online and receive your prescription drugs in the mail without having to worry about making trips to your local pharmacy
It is generally safe and convenient to order from an online pharmacy, but ensure the online pharmacy is registered or affiliated with the Provincial College of Pharmacy. Always choose a pharmacy that requires a prescription to place the order and gives you access to a pharmacist who can answer your questions.
There are 2 ways of knowing whether your online pharmacy is legitimate or not:
- For pharmacies that have a physical location or street address, check to see if that pharmacy is licensed with the Pharmacy Regulatory Authority of that territory or province. Here is a link to access all the Canadian Pharmacy Regulatory Authorities.
- For all online pharmacies, check the credibility of the pharmacy at the Pharmacy Verified Websites Program - an American program that assesses the safety and legitimacy of online pharmacies in North America.
8. Check for subsidized programs:
The Canadian healthcare system has programs at provincial and federal levels to offer subsidized coverage of prescription medications to specific groups, such as elderly or retired individuals, people with disabilities, refugees, native populations, and people under a certain income level. Make sure to check with your healthcare provider to connect you with a government-subsidized program.
Some territorial or provincial programs that can offer a prescription drug plan for eligible groups are listed below:
- New Brunswick (Prescription Drug Program)
- Nova Scotia (Pharmacare)
- British Columbia (Pharmacare)
- Manitoba (Pharmacare Program)
- Newfoundland (Pharmaceutical Services)
- Ontario (Drug Benefit Program)
- Northwest Territories
- Alberta (Prescription Drug Programs)
Another valuable resource that can connect you to a government-subsidized program would be non-government organizations (or NGOs) that focus on seniors or serious health care issues.
Besides, some pharmaceutical companies also have patient assistance programs to help needy patients. You may need to get a referral from your healthcare provider to qualify for assistance.
If you don't have prescription drug coverage, it may seem tempting to skip medications to reduce the cost, but it may have harmful complications in the long term. Make sure to check out different options and seek help from your healthcare provider to see if you qualify for any patient assistance programs.
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This article offers general information only and is not intended as medical or other professional advice. A healthcare provider should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed, and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the authors as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products, or services is expressly given or implied by Mednow or its affiliates.Commencer