Access to arthritis meds falls prey to postal code lottery

Report shows access to arthritis medications depends on where you live and how much you can afford.

Jordan Heuvelmans 3 minute read February 22, 2020

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While there may be no cure for arthritis, medications can make a crucial difference in the quality of life of those living with it. So why is it so difficult for some patients to get these important drugs?

In a recent report released by the Conference Board of Canada called, Accessing Arthritis Medications — A Pan Canada Analysis shows patient access to arthritis medications depends on where they live and what they can afford.

Arthritis includes more than 100 forms of degenerative and autoimmune inflammatory conditions. Approximately six million Canadians (one in five) live with arthritis, needing treatment to help manage their condition and pain. While common in older adults, over half of Canadians affected with arthritis are under 65. It tends to be more common in women than in men.

Despite its prevalence, arthritis is still not well understood and it affects everyone differently. While there are treatments available, most people rely on medical drugs to help treat their symptoms. Treatment is ideally tailored to the patient’s needs and condition by healthcare professionals, but the actual ability to access necessary medications were the cause for the report.

“Our analyses show that for Canadians living with arthritis, the treatment experience, in terms of access to medications, varies from province to province and by drug insurance plan,” said Dr. Monika Slovinec D’Angelo, Director, Health at The Conference Board of Canada in a press release on the organization’s website.

“We see variations in public, as well as private, coverage of arthritis medications across the country, with private plan claimants generally having access to a wider range of drugs compared to those who have only public coverage,” she said.

Those living with arthritis who have private health plans tend to have access to a wider range of drugs. Private plans cover all 79 of the arthritis drugs currently prescribed in Canada, while about 10 per cent are not accessible through public plans. Still, public plans represent a much larger share of arthritis claims — about 41.5 per cent compared to the 36.5 per cent that are private.

However, the cost for reimbursement is lower, at about 40.4 per cent for public plans versus 46.7 per cent for private. The report points out that public programs negotiate cheaper drug prices, yet private programs offer more coverage on a larger variety of drugs.

It’s not just drug costs that vary. Depending on the province, the number of drugs available to people on public plans also differs. Each province has its own public plan that gives patients access to arthritis medication, however some drugs require people to pay out of pocket. For example, the costs of two drugs prescribed for rheumatoid arthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) varies depending on the province. In Ontario and Newfoundland, accessing these drugs without private coverage means the cost would be absorbed by the government. In other provinces like Nova Scotia, Quebec and Manitoba, how much a drug costs depends on the annual deductible of the public plan (which is based on income).

The report calls for the equality in drug access across provinces. Particularly in provinces without a pharmacare program (such as Ontario and Saskatchewan), public coverage is usually only accessible for more financially vulnerable or dependent groups (i.e. those living in long-term care homes). In these provinces, the only option for employed patients without access to a private plan or unemployed individuals is to pay for it themselves.

The report advocates for healthcare system reform to help improve the affordability of drugs, and increased accessibility and consistency across the country. To create equitable access to medications, the Conference Board of Canada has already looked at different pharmacare options that could expand the role of the federal and provincial governments, such as a common form of reimbursement for drugs in order to streamline the process for patients.