Making meds stick: why we skip our pills and how it costs our health system

Personal · Oct 5, 2022

Modern medications have transformed how health professionals care for people with chronic conditions. Pharmaceutical breakthroughs allow us to have longer and happier lives.

Yet, around half of patients with chronic conditions do not take their medications as prescribed.

As a family doctor, I see the many complicated barriers people face to taking a prescription. Sometimes, we do not hit the mark in effectively sharing the benefits of treatment. Other times, the regimens might be complex, or people may not trust that the pill will make a difference. Most tragically, one in four Canadian households struggle to pay for prescriptions, even skipping doses, splitting pills, or cutting spending on necessities like food or heat.

Barriers to taking prescriptions are costly to people and society.

A person might leave a doctor’s visit with medication to prevent a stroke—a pill they dutifully add to their already costly and growing medication list. Day-to-day, they do not notice a difference from the medication, and have already cut back on groceries to cover the bill. Given their financial circumstances, they decide to pause the pill—at least until they can afford it. Weeks turn to months, and suddenly they are in the emergency room with a life-changing crisis that the medication was intended to prevent.

Big-picture, not taking medications as prescribed has an enormous impact on your health and the health of our system. Preventable underuse of medications accounts for around seven percent of hospitalizations. Higher-quality prescribing might prevent as many as one in six hospitalizations. In a highly strained health system, these are visits that add further pressure to doctors and nurses working in clinics, emergency rooms, and hospitals.

All in all, hundreds of Canadians die prematurely every year as they cannot pay for their costly medications.

It is time to commit to removing the barriers people face in taking prescriptions.

This commitment will involve the following steps from our leaders and decision-makers:

  1. Removing cost as a barrier to life-saving medications. Canada is the only country with a universal health system that does not have pharmacare. In 2019, the Advisory Council on the Implementation of National Pharmacare recommended that Canada implements a “universal, single-payer, public pharmacare.” Pharmacare is not just the right thing to do for Canadians and our health system, it is also the cost-effective choice for a health system. Several studies support billions of dollars in savings for government and for Canadians, including lowering drug prices and preventing healthcare costs.

  2. Building on existing facilitators to taking prescriptions, including consistent links to the health system. For instance, people with a family doctor report greater trust in their care and adherence to their treatment. Every Canadian deserves a family doctor or primary care professional, who can be their trusted main entry point into healthcare, including as a guide in their medications.

  3. Transforming the technology that supports high-quality prescribing. In Canada, most prescriptions still go through fax. The courier pigeon of healthcare, fax has a failure rate of up to 20 per cent, unacceptable for life-saving communications. In primary care offices, managing faxes can take up to half of all administrative time, leading to time taken away from seeing patients. Our vision must be for health professionals, patients, families and caregivers to have shared digital access to a full timeline of their medications.

Canadians can visit a hospital or doctor’s office without receiving a hefty medical bill. However, actually following through with treatment is much more complex—it will depend on their ability to pay, their connection to the health system, and a patchwork approach to technology in healthcare, among other barriers.

In a health system as strained as Canada’s, now is the time for our leaders to commit to sustainable change. Anything less will continue to cost us deeply.

Dr. Dominik Nowak is a family doctor and health leader. As Chief Medical Advisor at TELUS, Dr. Nowak bridges disciplines with health, community and business leaders toward a health system that is more kind, caring and careful. He is also a faculty member in the Dalla Lana School of Public Health and the Department of Family and Community Medicine at the University of Toronto.

This article was re-posted with the permission of Postmedia Network. It was originally published on on September 16th, 2022.

Any of the stories shared in this column are rooted in clinical practice but fictitious composites, meant to illustrate themes in modern healthcare.

Authored by:
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Dr. Dominik Nowak
Chief Medical Officer at TELUS Health; Chief Medical Advisor at TELUS

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