No Little Plans Season Two

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In recent years—and especially during the Covid pandemic—lots of people have touted the benefits of Canada’s universal health care system. But how universal is it?

In Canada, the umbrella of universal health care excludes many services that are essential to Canadians. This includes dentistry, the bulk of mental health services and, most crucially, pharmaceuticals. Even before the pandemic hit in March 2020, Canadians were having trouble paying for their prescription drugs. According to a report from the Canadian Nurses’ Union, one in 10 Canadians don’t take their medications regularly because they can’t afford the out-of-pocket costs. 

Most health care workers have been aware of our system’s shortcomings for some time. In this episode of No Little Plans, host Vicky Mochama speaks with Danyaal Raza, a primary care physician at the Department of Family & Community Medicine at St. Michael’s Hospital in Toronto. He’s also the Board Chair of Canadian Doctors for Medicare, an organization of physicians who’ve banded together to close the gaps in the publicly funded system. 

In Ontario, where Dr. Raza works, there is a publicly funded pharmacare system, but people only qualify for it if they’re young enough, old enough or poor enough. Others get coverage from their jobs, if they’re lucky to have a job with benefits. 

According to Dr. Raza:

“There’s this huge gap right in the middle. People who are working part-time, precarious work, freelancers, people who are in the working poor, who are having to make some very significant decisions about what to pay for.” 

As of 2018, 2.1 million Canadians were working contract—and therefore non-benefit—jobs, and Dr. Raza cites a study from the Canadian Medical Association Journal reporting that many Canadians are cutting down on utilities and groceries in order to afford their prescriptions. 

When patients can’t pay for their medications, Dr. Raza says, doctors often dip into their own supplies to help them get the drugs they need. At his own clinic at St. Michael’s Hospital, they have what they call a “comfort fund” to help needy patients, and they regularly fundraise to help fill that gap. And the problem is only getting worse in the Covid era, as thousands of Canadians are losing their jobs and drug plans.

“The beautiful thing about hospital and physician care is that you just need your health card, and you get the care that you need. That’s what we need for prescription drugs, particularly in times where we’re facing such a high degree of economic uncertainty and of uncertainty with respect to our health”

When a patient is dealing with chronic health problems, the inability to afford their prescriptions adds a significant mental burden on top of their existing illness. In this episode, Mochama spoke to Rowan Burdge, a patient advocate who lives with Type 1 diabetes on the west coast and requires multiple daily injections of insulin. The Nurses’ Union estimates that “57 per cent of Canadians with diabetes reported failing to adhere to their prescribed therapies due to affordability issues related to medications, devices and supplies.” Burdge says that in her own experience, access and costs of medication vary wildly depending on where you live—when she moved to Saskatchewan for a year and a half, the same medications that cost her $300 in B.C. suddenly cost her $700. She is currently covered by a provincial drug plan, her work benefits and private insurance, and she still often has to pay out of pocket to cover her insulin. Her private insurance, for example, has a cap of $5,000 per year. Last year, she went so far as to crowdfund coverage on GoFundMe.

“I’ve spent upwards of $100,000 of my personal money on medication—on fair pharmacare copays, on prescription co-pays, on deductibles and limits and things like that. It’s been a very expensive ride”

Toward the end of the episode, Mochama spoke to Dr. Jacalyn Duffin, a medical historian and retired hematologist at Queen’s University in Kingston, Ontario. She also runs a website devoted to the issue of drug shortages in Canada. She first became interested in the subject about a decade ago, when a patient with metastatic breast cancer could not obtain a drug to control the nausea caused by her chemotherapy. On any given day, there are more than 1,500 drugs in short supply in Canada, she says—often, these shortages are due to problems with pricing, sourcing and manufacturing. Dr. Duffin wants Canada to create an “essential medicines” list, which would require the government to ensure the availability of certain drugs. 

Dr. Nav Persaud, who works in the Department of Family and Community Medicine at St. Michael’s Hospital, has created a prototype of this list. In a study, he found that distributing these essential medicines for free leads to a 44-per-cent increase in adherence, as well as improved health outcomes.

Says Dr. Duffin:

“A lot of Canadians don’t know that there is a drug shortage until they’re affected by it. We need to maintain a concerted effort to get to the bottom of the drug shortages and find out the cause.”


CREDITS: No Little Plans is hosted by Vicky Mochama. This episode was produced by Ellen Payne Smith  with executive production by Katie Jensen. This podcast was created by Strategic Content Labs by Vocal Fry Studios for Community Foundations of Canada. Subscribe or listen to us via the outlets above, and follow us at @nolittlepodcast on Facebook, Twitter, and Instagram. Meanwhile, like Daniel Burnham said: “Make big plans; aim high in hope and work.”