photos: For many low-income seniors in B.C., prescription drugs are prohibitively expensive. Photo: Chris Zielecki / flickr

B.C.’s income- based drug plan less efficient, equitable than other age-based plans

A recent study find that seven per cent of B.C. seniors don't fill their prescriptions because they cost too much. In Ontario, on the other hand, there's universal coverage for medically necessary drugs to anyone 65 and older.


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Mary Hall takes a lot of prescription medications. The 74 year-old Esquimalt resident is on two types of insulin and oral medications to manage her diabetes. She also takes antibiotics several times a year for the numerous kidney and bladder infections she gets annually.

Hall has PharmaCare and Pacific Blue Cross coverage. But because she’s on a fixed income, she sometimes can’t afford the $350 deductible encompassing her medication for the first three to four months of the
year. So she cuts back on her insulin.

“Sometimes I can afford it and sometimes I can’t. So I just neglect it, which is not good,” says Hall, who’s on a fixed income of less than $12,000 a year. “If you can’t afford insulin, you can’t afford insulin. That’s all there is to it.”

She’s not alone. Seven per cent of B.C. seniors don’t fill their prescriptions because of the cost. This finding and others are in a recent report comparing B.C.’s income-based drug coverage to Ontario’s age-based coverage. A critical difference: Ontario gives universal coverage for medically necessary drugs to anyone 65 or older.

The report, titled “Are Income-Based Public Drug Benefit Programs Fit for an Aging Population?” is co-written and researched by Steve Morgan, director of the University of British Columbia’s Centre for Heath Services and Policy Research, concludes that Ontario’s program is more efficient, accessible, and equitable than B.C.’s.

The reason, Morgan told Megaphone, is because the Ontario government has enough purchasing power to negotiate a better price for drugs from pharmaceutical companies. Here in B.C., private insurance and government buy drugs separately. That means administrative costs are higher and our purchasing power is divided.

Canada is one of the few countries with a single-payer healthcare system that doesn’t cover prescription medicine. If universal drug coverage, not just for seniors like Hall but all Canadians, were to become reality, we could save as much as $11 billion each year, Morgan says.

He compares our current system of drug coverage to shopping for a new car: “Nobody pays sticker price: you’d be an absolute fool to walk into a dealership and take the first price that they told you. But in Canada our prescription drug market is as though everyone paid retail price and the insurance companies and government just reimburse [people] for the cost of that. No one’s negotiating.”

In a well-run system, Morgan says, governments purchase the drugs and negotiate pricing with drug manufacturers on behalf of patients.

“Good published evidence, even from our government’s own regulatory bodies, show that Canadians pay far more than any other country that we would normally compare ourselves to,” he says. “We’re talking differences of 20 to 50 per cent in terms of how much more we pay for medicine because we have this crazy system.”

Morgan is in favour of universal drug coverage for medically necessary drugs for all Canadians, not just seniors. He suggests that B.C. start the transition by removing the deductible for preventative or disorder managing drugs, like the insulin Hall takes, funded by the savings achieved by negotiating lower drug prices.

The plan would benefit more than just low-income seniors like Hall. Morgan says the average senior citizen in B.C. pays about $1,250 a year for drugs, whereas Ontario seniors pay $200 a year despite taking more prescription drugs than their B.C. counterparts.

But for Hall, universal coverage wouldn’t just allow her to keep her insulin consistent year-round. It would also help her manage her disease in other ways.

“Everybody says [to me] ‘You do not need to be a diabetic, if you go on proper food,’” she says. “Ha ha ha. I can’t afford proper food!”

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