Impact of a household-level deductible on prescription drug use among lower-income adults: a quasi-experimental study

Abstract

D rug coverage in Canada varies widely despite universal coverage for physician and hospital services. 1 Some provinces, including British Columbia, Saskatchewan, Manitoba, and Newfoundland and Labrador, provide coverage through so-called income-based coverage programs. These programs require households to spend a fixed proportion of their household income on prescription drugs before public coverage takes effect. Other provinces have coverage programs that include deductibles for particular segments of the population, such as Ontario's Trillium Program for residents aged 25-64 years. We know from prior surveys that cost-related nonadherence remains an issue for many Canadians. 2 Furthermore, the use of deductibles is potentially problematic, as there is extensive evidence, from both Canada and other countries, that out-of-pocket copayments reduce the use of essential drugs. 3-5 However, the specific impact of income-based deductibles remains less clear. For example, an analysis done shortly after BC's income-based plan Fair PharmaCare was implemented, in 2003, suggested the plan did not alter population-level prescription drug use, 6 whereas, evidence from Manitoba suggested that income-based deductibles decreased the use of inhaled corticosteroids by children with asthma. 7 Yet as with the BC study, the prior coverage regimen in Manitoba included a deductible per family. 7 Our recent study using a

Long-acting injectable antipsychotic (LAI) prescribing trends during COVID-19 restrictions in Canada: a retrospective observational study

“…In Canada, prescription payer type can be seen as a surrogate for SES. Canada has near universal healthcare coverage for services, but prescription drug coverage by public money varies by province with most provinces keying coverage to household income level [ 23 , 24 ]. As a result, most individuals who qualify for pharmacare coverage in Canada are economically disadvantaged.…”

Exploring Privatization in Canadian Primary Care: An Environmental Scan of Primary Care Clinics Accepting Private Payment

“…This raises concerns about equity in access to care, which is achieved when access is based on need and not one's ability to pay ( Whitehead 1991 ). Parallel private systems can threaten equitable access to healthcare services ( Dahlgren 2014 ; Leatherman and Sutherland 2008 ; Tuohy et al 2004 ), and evidence suggests that even modest user fees or co-payments can have a detrimental effect on access, particularly for lower-income households ( Kesselheim et al 2015 ; Law et al 2019 ; Schoen et al 2010 ).…”

The best defence is a good offence: Ensuring equitable access to primary care in Canada

“…filling prescriptions). [49][50][51][52][53][54][55] These implications have also been documented in a small but important way through reviews of crowd-funding campaigns in Canada. Research shows that funds are being raised for medical equipment, medicalrelated travel costs, and to help pay for medications, to give just three examples.…”