I happened to get a prescription refilled yesterday which got me thinking about this discussion, and I am getting seriously pissed off at some of the misleading implications being made here about prescription drug non-coverage – a classic case of selective facts with important information omitted. I suspect that many folks don’t appreciate how little this matters to most Canadians, in part because of the ubiquitousness of cheap supplemental insurance and specific public programs that provide outpatient drug coverage, and in part because of the impact of drug price controls here. So let me say a few more words on this bit of digression about outpatient prescription drug coverage.
Let’s work through a specific illustrative example. The most expensive drug by far that I still regularly take is Brilinta, an anti-platelet medication that has no generic equivalent. Here is the US pricing. For 60 tablets of Brilinta 90 mg, retail prices are listed from a low of $418 to a high of $494, with discounted prices coming in at an average of around $400 provided you have a “free coupon” to qualify. They are taken twice a day and I get them dispensed in quantities of 180 for a three-month supply, so that would cost considerably over $1,200 in the US. In Canadian dollars at the current exchange rate, that’s over $1,597!
Now that’s serious money for most of us, and non-coverage begins to sound like an issue, but let’s look at what I actually pay.
First, drug prices are regulated in Canada through the Patent Medicine Prices Review Board, which requires justification of the prices charged for all patented (non-generic) drugs. The cost of 60 Brilinta 90 mg is just over $100 Canadian (approximately $75.06 USD), presumably the highest price point that AstraZeneca was able to justify. For a quantity of 180 my pharmacy currently charges $300.74 (instead of at least $1,597! :eek:), plus a standard dispensing fee of $8.83, so a total of CAD $309.57. Still a fair chunk of cash, but I was shocked at the price differential, even though it’s common knowledge that prescription drugs are generally much cheaper in Canada. (If you want something meaningful to argue about, US residents may well ask why they have to pay more than five times or even six times as much as the manufacturer is actually able to justify, which does in fact make prescription drug costs and coverage something of an issue in US health care.)
I’m retired, so I don’t have supplemental insurance. But for the same reason, I’m covered by the Ontario Drug Benefit. My total out of pocket cost? $4.11. Which is some weirdly calculated maximum dispensing fee. The amount is such a pittance that some pharmacies don’t even bother collecting it. Mine is not so generous, so every three months it costs me four bucks. Either way, the medication is essentially free.
What about younger people who don’t qualify for the Ontario Drug Benefit but who are unemployed or otherwise lack supplemental insurance and would find even the regulated cost hard to afford? In Ontario, they would likely qualify for the Trillium Drug Program for low income earners, so they wouldn’t be paying for expensive prescription drugs either. And the unemployed in the US? Let’s not even go there.
And let’s not forget that my example here centers on the most expensive drug I’ve ever had to take. Most others that I’ve been prescribed have generic versions and cost a pittance, even if it wasn’t covered by the ODB. It’s just never been a big deal, whether I was covered or not.
Meanwhile, as discussed many, many times on this board, on the big items like actual health care procedures, any health care I need, no matter how expensive, is guaranteed to be covered with no out-of-pocket costs at all, and no possibility of denial.
So, survinga, or anyone else, please tell me why I should prefer to be getting my health care in the mercenary clusterfuck of the US health care system.
Full disclosure: Because prescription drug coverage is an extra benefit not governed by the terms of the Canada Health Act, it’s an unusual case where an annual deductible applies. In Ontario the annual deductible is $100, but even that is waived for anyone whose income is below some threshold. I believe the $4 dispensing fee would be waived as well.