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One in 12 older Canadians are forced to do without taking prescribed medication because they can't afford them, according to a new analysis that highlights gaps created by the lack of universal drug coverage. The trend is most pronounced in Canadians between 55 and 64 – one in eight can't afford medication costs – who are not old enough to qualify for public drug benefit plans aimed at seniors.

Canada had the second highest rates of cost-related prescription drug non-adherence of all 11 countries included in the analysis. The U.S. had the highest rates.

The findings, published this week in two separate studies in the journals CMAJ Open and BMJ Open, were based on data from the 2014 international health policy survey conducted by the Commonwealth Fund, a private foundation based in the U.S. that promotes health-care system improvements.

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The survey found that older Canadians unable to afford drug costs tended to have fair or poor health and not have health insurance. It's a serious issue because skipping medication is likely to lead to more serious health problems down the road for the individual, and to higher health costs to the system.

"The very real issue here is patient health and well-being," said Steve Morgan, senior study author and health policy professor at the University of British Columbia's School of Population and Public Health. "When you face a barrier to filling prescriptions that help maintain good health, you end up with worse health status and you end up in hospital and it makes us all pay in the long run."

Dr. Morgan notes the trend is not new. A similar Commonwealth Fund survey conducted in 2007 found similar rates of cost barriers keeping Canadians from getting the prescription drugs they need. Canada is one of the few countries with a universal health-care system that doesn't have a public drug-coverage plan and the survey results show it's having a real impact on the health of many across the country, he said.

Drug coverage is a patchwork across the country, with provinces offering some coverage for low-income people, those with disabilities or seniors, while others have access to private insurance, such as through an employer. While public plans can help some low-income Canadians, Dr. Morgan noted that some only cover very expensive drugs, meaning patients are left to pay lower costs out-of-pocket, which is impossible for some.

In 2012, Toronto researchers conducted a study that found low-income people with diabetes under age 65 are more likely to die than older, higher-income people with the disease. The study found that drug costs were one of the issues behind the disparity.

There have been growing calls for a national pharmacare in Canada, but it's far from becoming a reality. Dr. Morgan said much of the discussion has focused lately on bringing down the costs of drugs over all, but that this won't help those Canadians who can't afford to pay even small out-of-pocket medication expenses.

"Just getting the cost of drugs down alone will not help with the access problem," he said. "For some patients, it's a matter of life and death."

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