National pharmacare program would save lives

I was recently discharged from the hospital after a heart attack. I needed the blood thinner ticagrelor, in addition to several other essential medications. The first bill at my pharmacy was more than $300.

I earn a good income as an assistant professor at the University of Waterloo but I would have found the cost significant if my employer’s insurance hadn’t covered 80 per cent of the bill. What about my fellow citizens that do not have prescription medication coverage?

Almost one million Canadians cut their household spending on food and heat to pay for medication in 2016, according to research presented in the recent final report of the Advisory Council on the Implementation of National Pharmacare: A Prescription for Canada: Achieving Pharmacare for All. And one in five households reported a family member who was prevented from taking a prescribed medicine due to its cost.

This is why we need a national Pharmacare plan.

The research evidence clearly shows that prescription medication coverage is necessary for people to be able to take their prescribed medications. Providing coverage for essential and effective medications would be the "ounce of prevention" that is worth a pound of cure in our cash-strapped Canadian health-care system.

Patients failing to take medications

I conduct research using population-based databases to examine the effects of health policy on clinical outcomes such as hypertension and statin medication adherence.

We know that evidence-based medications — such as cholesterol medications (like statins) and blood thinners — help patients by preventing clinical events and save the health-care system money at the same time.

Nonetheless, many studies have found that a significant proportion of patients still do not take their medications. For example, one study shows that one out of five patients quit taking their statin a year after their heart attack. Low adherence rates have also been reported for other cardiovascular medications including blood thinners such as ticagrelor and clopidogrel.

While it is difficult to point at a single factor as the main cause of non-adherence, several health care system-related factors, including prescription medication coverage are among the most important factors.

A graduate student in our research group estimated in her master’s thesis that almost one quarter of non-adherence to medication for hypertension and diabetes — common and devastating clinical conditions in Canada — is associated with lack of prescription medication coverage.

She estimated that providing universal pharmacare to 13 patients would help one Canadian to adhere to hypertension and diabetes medication.

Generalising these findings to all chronic medications, pharmacare is expected to improve Canadians’ health outcomes and create significant savings for the health-care system.

Cheaper than a heart attack

The blood thinner clopidogrel can reduce future clinical events — including death from cardiovascular causes, heart attacks or stroke — by 20 per cent, if patients are treated after a heart attack. Newer medications — such as ticagrelor, the one that I needed — are expected to have even more profound effects.

On the other hand, stopping the blood thinner prematurely was found to be associated with a five- to seven-fold increase in the risk of future events.

The estimated direct cost of a heart attack in Canada is about $15,000, and this is only 60 per cent of the total cost. Most patients who survive a heart attack need to be on aspirin for life and need a second blood thinner for a year or longer.

Accordingly, it would be a reasonable cost-saving approach to cover blood thinners — along with all other essential medications — on a national pharmacare plan.

Wasem Alsabbagh is an assistant professor of pharmacy at the University of Waterloo.

This article was first published at The Conversation Canada: theconversation.com/ca.