Cost-Related Medication Nonadherence in Canada: A Systematic Review of Prevalence, Predictors, and Clinical Impact

Holbrook, Anne; Wang, Mei; Lee, Munil; Chen, Zhiyuan; Garcia, Michael; Nguyen, Laura; Ford, Angela; Manji, Selina; Law, Michael R.

doi:10.21203/rs.3.rs-27665/v2

Cited by 5 publications

(9 citation statements)

References 31 publications

(50 reference statements)

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“…41 Other studies have suggested that higher financial coverage promotes higher use of and financial access to drugs among populations. 1,16,41 In contrast, a more restrictive model of universal drug coverage offers limited access and mixed drug expenditure based on the payer. 1,4,6,16 From a societal perspective (i.e., total use and costs from both private and public plan coverage), the total cost of medications would change if the total use per person changed after OHIP+ coverage or the total costs per medication changed.…”

Section: Discussionmentioning

confidence: 99%

“…Our study aligns with others that have found that public prescription drug plans that provide noncatastrophic, firstdollar coverage increase use of public coverage for medications. [5][6][7][34][35][36][37][38][39][40][41][42][43] Expanded coverage, on the other hand, may not improve clinical outcomes because access or adherence is not sufficiently improved, or because the benefit of essential medicines is outweighed by the lack of benefit from nonessential or harmful medicines, which would likely reduce cost burdens for many people but would increase costs for governments. 41 Other studies have suggested that higher financial coverage promotes higher use of and financial access to drugs among populations.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][34][35][36][37][38][39][40][41][42][43] Expanded coverage, on the other hand, may not improve clinical outcomes because access or adherence is not sufficiently improved, or because the benefit of essential medicines is outweighed by the lack of benefit from nonessential or harmful medicines, which would likely reduce cost burdens for many people but would increase costs for governments. 41 Other studies have suggested that higher financial coverage promotes higher use of and financial access to drugs among populations. 1,16,41 In contrast, a more restrictive model of universal drug coverage offers limited access and mixed drug expenditure based on the payer.…”

Section: Discussionmentioning

confidence: 99%

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The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis

Miregwa

Holbrook

Law

et al. 2022

cmajo

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Universal health coverage promotes access to necessary care and protects patients from health-related financial hardship that may affect health outcomes. The World Health Organization declared that governments are obligated to promote universal coverage of essential health care services, including prescription drugs. [1][2][3][4] Given the importance of reducing out-of-pocket spending for prescription drugs, universal access to affordable, safe and appropriately prescribed treatments is an important goal for health systems in all countries. 2-5 However, approaches to universal health coverage for prescription medications or universal pharmacare varies according to the population covered (who), health products and technologies (what) and the extent of coverage (proportion of direct costs covered). The amount spent on prescription drugs, including per capita spending, has significantly increased over time. [4][5][6][7] Health system expenditure on prescription drugs has also increased in many countries, often growing faster than other health system costs. [5][6][7][8][9][10][11][12][13][14] Therefore, implementing universal pharmacare can enhance equitable access to needed care and medicines, which is central to the ongoing debate about the need for a national pharmacare program in Canada. 11 Although Canada's provincial and territorial health systems provide a single-payer system with coverage for medically necessary hospital and physician-based care, this universality does not extend to outpatient prescription medications. [2][3][4][5] Instead, prescription drugs are funded by a fragmented patchwork of public and private drug plans that varies by province and leaves many Canadians with little or no drug coverage. [4][5][6] Children and youth are a vulnerable population, and studies that have investigated coverage variation have shown that younger adults are the most disadvantaged in coverage. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis

Miregwa

Holbrook

Law

et al. 2022

cmajo

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“…Cost is known to be a barrier to accessing medications in Canada. 32 In addition, user fees, copayments or limits on the quantity of subsidized prescriptions create barriers to essential medications and are associated with worse health outcomes in people whose medication use is most likely to be affected by these cost-sharing measures. 33 Beginning Apr.…”

Section: Temporal Trends In Hba 1cmentioning

confidence: 99%

Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis

Giruparajah

Everett

Shah

et al. 2022

cmajo

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T ype 1 diabetes is a common chronic disease of childhood with substantial morbidity and mortality. 1 Optimizing glycemic management is key to preventing complications. 2,3 There are known socioeconomic status (SES) disparities in diabetes management and outcomes. 4,5 For Canadians, financial barriers to medications continue to be an important adverse social determinant of health. 6 This is important because insulin is life sustaining for people with type 1 diabetes.Ontario residents (population 14.5 million) have publicly funded coverage for medically necessary services but not for prescription medications. On Jan. 1, 2018, the Ontario government introduced publicly funded pharmacare (Ontario Health Insurance Plan [OHIP]+), the first payer for drugs for Ontarians younger than 25 years.Before the introduction of OHIP+, only people older than 64 years and those eligible for social assistance had access to publicly funded medications; all others paid out of pocket, through private insurance or were supported, in part, by the Trillium Drug Program (a government program that provides drug coverage for out-of-pocket expenses that are more than 4% of household income). The OHIP+ program covered the cost of medications on the provincial formulary, with no deductible or copayment. Fifteen months after its introduction, the Ontario government changed OHIP+ to exclude those patients with private drug coverage. 7 Thus, Ontario provides a unique "natural experiment" to assess the impact of 15 months of publicly funded pharmacare.Competing interests: Rayzel Shulman has received speaker fees from Dexcom. No other competing interests were declared. This article has been peer reviewed.

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“…3 Numerous research studies conducted on CRNA have reported that economic factors such as high out-of-pocket medication costs, low income, and absence of medication insurance increase the risk of self-reported CRNA. 6,7 At the same time, CRNA has also been associated with several factors that have no links with financial hardship (e.g., physician communication, medication beliefs). 4 A conceptual framework distinct from general medication nonadherence has been proposed specifically for CRNA.…”

mentioning

confidence: 99%

Cost-related nonadherence can be explained by a general nonadherence framework

Alefan¹,

Cheekireddy²,

Blackburn³

2022

Journal of the American Pharmacists Association

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Cost-Related Medication Nonadherence in Canada: A Systematic Review of Prevalence, Predictors, and Clinical Impact

Cited by 5 publications

References 31 publications

The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis

The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis

Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis

Cost-related nonadherence can be explained by a general nonadherence framework

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