The recession has not slowed Canadians' consumption of prescription drugs: They are popping pills at a rate of almost $60-million a day, newly released figures show.
Prescription drug sales reached $21.4-billion in 2008, up $1.2-billion from the previous year, according to data published by IMS Health, a private company that tracks prescription drug sales
While the number of prescriptions dispensed is rising steadily - to an average of 14 a person - spending patterns are changing, with consumers increasingly turning away from expensive brand-name drugs to cheaper generics.
"Whenever you substitute a generic for a brand, you're looking at significant savings," Jim Keon, president of the Canadian Generic Pharmaceutical Association, said in an interview.
The average price of a prescription for a brand-name drug is $64.19, while the average price for a generic is $26.07.
While Canadians are increasingly turning to cheaper drugs, the overall cost of prescriptions is rising because the sheer number of prescriptions continues to increase - to a total of 453 million in 2008.
Mr. Keon said the use of generic prescription drugs saved the Canadian health system about $3-billion last year, but if practitioners and drug plans were more aggressive in their use of generics, they could save close to $1-billion more.
"With governments running deficits, it makes sense to maximize use of generics."
Russell Williams, president of Rx & D, the group representing brand-name drug manufacturers, said that while there is a place for generics, governments and their drug plans should be opting for the most effective and cost-efficient treatments, not merely those that are cheapest.
"All health care decisions should be made on health outcomes, not on cost containment," he said.
Mr. Williams also noted that generics - copycat drugs that can be sold only after patents expire on brand-name products - would not exist without the research and innovation of brand-name pharmaceutical companies, so it is unfair to make direct cost comparisons.
"Our companies discover new medicines and vaccines that save lives. It's costly, it's time consuming, there are a lot of regulatory hurdles and there is a great deal of risk involved," he said.
The data from IMS Health reveal that, for the first time, the majority of drugs dispensed in Canada - 51.6 per cent - were generics.
Steve Morgan, associate director of the Centre for Health Services and Policy Research at the University of British Columbia, said that number will rise significantly in coming years, in large part because a number of blockbuster drugs are coming off patent.
Most notably, Lipitor, a cholesterol-lowering drug (and the bestselling drug in Canada last year with 14.8 million prescriptions), will come off patent in 2010, as will the high blood pressure medication Norvasc (7.6 million prescriptions).
"The pharmaceutical industry is undergoing a profound shift with the blockbuster drugs falling off patent," Dr. Morgan said.
He noted that while "generic drugs are cheaper than brand names, they're not as cheap as they should be." A Competition Bureau report cited a lack of competition among generic drug firms and an absence of price controls on generic drugs (brand-name drug prices are strictly regulated).
The bestselling drugs in Canada, according to IMS, are cardiovascular medications such as Norvasc, with sales of almost $3.2-billion last year; followed by cholesterol-lowering drugs such as Lipitor at $2.4-billion; psychotherapeutics at $2.2-billion; and gastrointestinal drugs at $1.8-billion. Despite the controversy surrounding the use of hormone replacement therapy to treat the symptoms of menopause, HRT sales still were close to $1-billion in 2008.
The IMS data also show that Canadians spend $643 per capita on prescription drug purchases in pharmacies but there significant regional variations.
Quebeckers, for example, spend an average of $775 a year and fill an average 23 prescriptions annually. Neighbouring New Brunswick is next with $732 per capita and 12 prescriptions on average.
At the other end of the scale is British Columbia, where retail spending is $489 per capita for an average of 10 prescriptions, while in Albertans spend $548 a year for an average nine prescriptions.
While the population is older in Quebec and New Brunswick compared with British Columbia and Alberta, Dr. Morgan said there are also important "cultural differences" that result in difference prescribing practices and patient expectations in Western Canada compared to Eastern Canada.
André Picard