How Do Sicker Canadians With Chronic Disease Rate The Health Care System?

RA Guy Community News 2 Comments

Lene Andersen from The Seated View is in this video!

Toronto, ON (December 12, 2011) – Today, the Health Council of Canada released results from the 2011 Commonwealth Fund International Health Policy Survey. The bulletin How Do Sicker Canadians with Chronic Disease Rate the Health Care System? compares experiences of sicker Canadians with chronic conditions to those of the general public.

Sicker Canadians report using more health care services than the general population. They are more likely to be hospitalized, have surgery, use emergency departments and take prescription medication compared to the general public. Most of this group is 50 years of age or older, but 34% are adults under the age of 50.

Along with being more frequent users of the health care system, sicker Canadians report experiencing considerable barriers to accessing the health care they need. Cost being one of the major barriers. Almost a quarter (23%), said they skipped a dose of medication or did not fill a prescription due to cost, compared to just 10% of the general population. This is a significant number since 90% of sicker Canadians take at least one prescription drug, and 54% take four or more. In addition, one in eight (12%) respondents have skipped a recommended test of follow up treatment due to cost concerns, compared to just 5% of the general population.

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  1. Joie

    Affording prescription drugs is also a problem for many in the United States. From a Kaiser Family Foundation report:

    “An April 2009 survey found that uninsured nonelderly (ages 18-64) are more than twice as likely as insured nonelderly adults to say that they or a family member did not fill a prescription (45% vs. 22%) or cut pills or skipped doses of medicine (38% vs 18%) in the past year because of the cost.(25)

    Among nonelderly adults in 2008, 27% of the uninsured could not afford a prescription drug in the past 12 months, compared to 13% of those with Medicaid or other public coverage, and 5% of those with employer or other private coverage.(26)

    A September 2009 survey found that during the past 12 months, 26% of American adults did not fill a prescription, and 21% cut pills in half or skipped doses of medicine, because of cost.(27)”

    Even the insured have difficulty in affording biologics to treat RA. If their drug benefit classifies the biologic as a Tier IV drug, then the co-insurance, cost to patient, can be several hundred dollars a month. And, some insurance plans do not cover expensive biologics at all. There are however patient assistance drug programs to help some of these people.

    Those on Medicare may also have difficulty affording injectible biologics since they are covered under Medicare Part D. In Part D’s gap in coverage (the donut hole), the patient has to pay 50% of the full cost of the brand biologic (prior to the Affordable Care Act, patients had to pay 100% of the cost of a brand biologic while in the donut hole.) Enbrel costs about $1,500 a month, so a Medicare patient’s out-of-pocket cost could be $750 a month until they climbed out of the donut hole.

    Biologics to treat RA are expensive drugs – but there was some hope in that some of them would be going off patent in the next few years. Enbrel’s patent was to expire in 2012, but there’s been an extension of its patent that could extend its price protection for another 17 years.

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