Leadership on prescription drugs needed

The article by Michael Law and coauthors raises issues germane to both clinical practice and public policy.¹ After hospitals, drugs comprise Canada’s second greatest national health expenditure.² That low-income and chronically ill Canadians struggle to maintain medication adherence is surprising.

The high cost of medications for people with chronic disease may also have effects beyond nonadherence. Patients have told me about sacrifices they have made, such as limiting dental care, child care or even food to afford their prescriptions. The relative benefits of each prescription should be weighed against these possible repercussions. Perhaps patients should be screened for cost-related nonadherence at the time of prescription.

Encouragingly, awareness about the cost of drugs is increasing among clinicians. Some hospitals I have worked at cite antibiotic costs on microbiology reports. Printed resources such as RxFiles³ and the Medication Use Management Services⁴ books are available for office practice. Additionally, drug price guides can be added to electronic medical record systems.

As the authors allude to, public policy is of critical importance and can and should have a role in reigning in nonadherence and expenditure on prescription drugs. A vast gap exists in the Canada Health Act that leaves drug coverage fragmented among the provinces and territories.⁵ Unifying this “patchwork” could be a cheaper and healthier option. It is time for Canada to follow the example of many other developed nations⁶ and seriously explore a national prescription drug strategy.