PHARMACARE: Cost-related nonadherence to medications and pharmacare

Joëlle Doucet


Canada is the only developed country with a universal healthcare system that does not cover prescription medication outside the hospital setting (Morgan, Martin, Gagnon, Mintzes, Daw & Lexchin, 2015). Canadians pay for their prescription medications either through private insurance programs or out of pocket (O’Grady, n.d.; Statistics Canada, 2016). As well, many private insurance programs pay a fixed price or percentage, which may still leave people with high out-of-pocket costs (Luiza et al., 2015); especially those needing cancer symptom management medications. Some people, including patients with cancer, report not filling prescription medications, not renewing medications or skipping doses to make the prescription last longer due to financial barriers (Angus Reid Institute, 2015; Briesacher, Gurwitz, & Soumerai, 2007). This can be defined as cost-related nonadherence, a common issue in Canada. In fact, one in 10 Canadians experience cost-related nonadherence (Morgan et al., 2015). Nonadherence to prescription medications is related to poorer health outcomes and an increased use of the healthcare system (Morgan & Lee, 2017). This paper will discuss the current policies and programs for pharmacare in Ontario, and propose solutions that oncology nurses can use to address cost-related nonadherence.

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Angus Reid Institute. (2015). Prescription drug access and affordability an issue for nearly a quarter of all Canadian households. Retrieved from

Briesacher, B.A., Gurwitz, J.H., & Soumerai, S.B. (2007). Patients at-risk for cost-related medication nonadherence: A review of the literature. Journal of General Internal Medicine, 22(6), 864–871. doi:10.1007/s11606-007-0180-x

Government of Canada. (2017). Health Care Act. Retrieved at

Luiza, V., Chaves, L.A., Silva, R.M., Emmerick, I.M., Chaves, G.C., Fonseca de Araújo, S., Moraes, E.L., & Oxman, A.D. (2015). Pharmaceutical policies: effects of cap and co-payment on rational use of medicines. Cochrane Database of Systematic Reviews, 5, 1–150. Art. No.: CD007017. doi:10.1002/14651858.CD007017.pub2

Morgan, S.G., & Boothe, K. (2016). Universal prescription drug coverage in Canada: Long-promised yet undelivered. Healthcare Management Forum, 29(6), 247–254. doi:10.1177/0840470416658907

Morgan, S.G., Martin, D., Gagnon, M.A., Mintzes, B., Daw, J.R., & Lexchin, J. (2015). Pharmacare 2020: The future of drug coverage in Canada. Vancouver, Pharmaceutical Policy Research Collaboration, University of British Columbia. Retrieved from

Morgan, S.G., & Lee, A. (2017). Cost-related non-adherence to prescribed medicines among older adults: A cross-sectional analysis of a survey in 11 developed countries. BMJ, 7(1), 1–7. doi:10.1136/bmjopen-2016-014287. Retrieved from

Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., Agoritsas, T., … Haynes, R. (2014). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, Issue 11, 1–730. Art. No.: CD000011. doi:10.1002/14651858.CD000011.pub4

O’Grady, K. (n.d.). Four ways you could save money on your prescription medications. Retrieved from

Ontario. (2017). Get coverage for prescription drugs. Retrieved from

Ontario. (2016). Get help with high prescription drug costs. Retrieved from

Ontario. (n.d.). Publicly Funded Drug Programs. Retrieved from

Registered Nurses’ Association of Ontario. (2015). Taking action: A toolkit for being politically involved. Retrieved from

Statistics Canada. (2016). Health Reports: Out-of-pocket spending on drugs and pharmaceutical products and cost-related prescription non-adherence among Canadians with chronic disease. Retrieved from


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