Ottawa, December 7, 2017—While the majority of Canadians have access to prescription drug coverage through private or public plans, many do not take advantage of that coverage. A new Conference Board of Canada report finds that over 4 million Canadians are not enrolled for either public or private coverage, despite being eligible.
“While prescription drug coverage across the country varies from one province to the next, most Canadians are eligible for either public or private coverage making the uninsured gap very small,” said Thy Dinh, Director of Health Economics and Policy, The Conference Board of Canada. “Where the gaps in prescription drug coverage may exist in Canada are among those who are not accessing insurance coverage programs when they need them and are eligible. The reasons might include a lack of awareness of their eligibility or out-of-pocket costs.”
- 95 per cent of Canadians are eligible for some form of prescription drug coverage (more than 34 million).
- An estimated 1.2 million Ontarians age 24 and younger without any coverage will be eligible for public coverage when the expanded Ontario Health Insurance Program comes into effect on January 1, 2018. This will lower the province’s uninsured population to 4 per cent and to 1.8 per cent across the country.
- Approximately 4.1 million Canadians are not enrolled for either public or private prescription drug insurance plan.
The report, Understanding the Gap: A Pan-Canadian Analysis of Prescription Drug Insurance Coverage, finds that 95 per cent of Canadians (more than 34 million) are eligible for some form of prescription drug coverage. Approximately 5 per cent of the total population (1.9 million) are not eligible for enrolment in either a public or private plan. Ontario residents represent a significant share of Canadians without insurance coverage, with just over 13 per cent of Ontario’s population considered uninsured. However, once the expanded Ontario Health Insurance Program comes into effect on January 2018, an estimated 1.2 million Ontarians under the age of 24 currently without any coverage will be eligible for public coverage. This will lower the province’s uninsured population to 4 per cent and to 1.8 per cent across the country.
The report estimates that there are 4.1 million Canadians across the country who are not enrolled in a program for which they are eligible. Reasons for not enrolling in a public program include lack of awareness of the existence of the program and whether they are eligible for the program. According to a recent survey conducted by Nanos Research for this report, of the 7 per cent of Canadians who did not take their medications as prescribed, roughly 60 per cent of them were either unaware or unsure that there might be a public program to help pay for prescription drugs. Another reason may be that the cost of enrolment outweighs the benefit of enrolling, although according to the Nanos survey, only 7 per cent of those who did not take their medications as prescribed cited cost as being the reason (represents less than 1 per cent of the Canadian population).
The report also takes a closer look at out-of-pocket spending on prescription drugs. Relying solely on public programs can pose a significant financial cost, especially for lower-income Canadians, as they require deductibles or premiums paid out-of-pocket before coverage kicks in. For example, the deductible can total up to $600 annually for an individual making $30,000 per year in British Columbia, while in Nova Scotia and Manitoba the deductibles are $900 and $1,410 per year, respectively. Some provinces impose premiums, such as Alberta, where residents under the age of 65 pay between $760 to $1,400 per year. Lower income Albertans are eligible to receive a subsidized rate that is 30 per cent of the full premium. Nearly two-thirds of Canadian households paid out-of-pocket on at least a portion of their prescription drug in 2015.
While most provinces try to limit the financial burden by using a sliding scale for deductibles based on household income, this can represent a disadvantage for lower income working Canadians. Those on income assistance programs normally have access to public coverage free of charge.
This research was funded by Innovative Medicines Canada and The Canadian Life and Health Insurance Association, with additional support from the Neighbourhood Pharmacy Association of Canada and The Canadian Alliance for Sustainable Health Care.