High drug costs lead many people to split pills, miss doses or halt prescriptions.GETTY IMAGES
Heather Evans, 60, used to eat boxed macaroni and cheese three times a week, but not because she loved it. She had to scrimp on her food budget to afford the thousands of dollars a month for the medication keeping her alive.
Ms. Evans was diagnosed with a chronic heart condition in her 30s. “I had my first two heart attacks when I was 39. I didn’t sleep for almost 10 months because I was afraid I wouldn’t wake up, and I didn’t want my five-year-old son to find me gone.”
At the time, Ms. Evans was an unemployed single mom in Calgary with no health insurance benefits. Most prescription medications aren’t covered under Canada’s universal health care plan, meaning patients without extended benefits have to foot the bill. Canada is the only country with universal health care that does not have universal coverage for prescription drugs (outside hospitals).
The cost of survival nearly broke Ms. Evans. “You go to sleep with tears in your eyes, worried about the next day. If it wasn’t for my doctor giving me samples for so many years, I don’t know that I’d be here today.”
As millions of Canadians struggle to cope with the cost of their medications, many have taken drastic steps to alleviate the pressure, often leading to a worsening of their symptoms over time.
A 2024 survey by Leger found that nearly one in four Canadians (22 per cent) say they’ve split pills, skipped doses, or chosen not to fill or renew a prescription because of the cost. The survey also revealed that 1 in 10 Canadians living with chronic conditions have landed in emergency after their health worsened because they couldn’t afford the medications they needed.
“There are real downstream impacts. If you can’t access drugs for prevention purposes you end up burdening the health care system, and that’s much more expensive,” says Manuel Arango, director of Health Policy and Advocacy for the Heart and Stroke Foundation. “It’s way more cost effective to provide these drugs and tear down affordability barriers, so that people can be healthy, manage their conditions and stay out of the emergency rooms.”
Canada has a patchwork of public drug benefit programs (with varying eligibilities), along with many private insurance plans. But insurance coverage, while helpful, isn’t a guarantee of affordability. The 2019 Hoskins report about pharmacare implementation found that about 7.5 million Canadians still face high out-of-pocket costs.
Gaps in coverage are made worse by shifting work patterns and employer plans that offload costs onto workers, putting part-time, contract, and low-income workers most at risk.
Canada’s proposed national pharmacare plan aims to provide coverage for essential prescription medications. The federal government says the program will roll out in phases, and has already started with coverage for contraceptives and diabetes drugs in British Columbia, Prince Edward Island, Manitoba and Yukon.
The plan’s advisory panel recommended covering medications for cardiac conditions, but they remain uncovered.
“We appreciate these initial steps the government has taken, but we need to move more quickly,” says Mr. Arango. “We need to get on the same playing field as all other countries that have universal health care systems and institute universal drug coverage.”
A recent study from Arthritis Research Canada (ARC) showed that for nearly 1 in 20 people aged 12 or older, cost is a major barrier to taking their medications as prescribed. Some groups face higher risks for non-adherence with prescriptions, including women, members of racialized communities and people with diverse sexual orientations. Each skipped dose has ramifications for patients, says Dr. Mary De Vera, an ARC senior scientist.
“Drugs are health care. So why is it so disjointed?” she says. “The ideal situation is that we have a system that mirrors our medical system.”
Ms. Evans is now the general manager of a GoodLife gym in Calgary, and has health insurance that covers her medication. Others are not as fortunate. She says she wishes decision-makers would put themselves in the shoes of families forced to choose between paying for food or their prescriptions.
“I want them to think about their own loved ones being in the same situation and tell me they wouldn’t move a mountain to make sure they’d be okay. People are dying because they can’t afford life-saving medications,” Mr. Evans says. “It’s so unjust and we need to do better.”
