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Abstract

Background: Prescription medicines are an important component of outpatient healthcare in Canada and account for 13.6% of total health expenditures. However, access to medicines is unequal. Despite current gaps in coverage, there is of lack information on which groups cannot afford prescription medicines and the potential impacts of expanding drug coverage on medicine access. This thesis provides novel empiric contributions to both of these knowledge areas. Methods: This thesis includes two studies of medicine access in Canada. The first used Latent Class Analysis (LCA) to identify subgroups in the population of Canadians that experienced cost-related nonadherence (CRNA) to prescription medicines. With data from the Canadian Community Health Survey, LCA was used to characterize and identify predictors of membership in different subgroups. The second study used a controlled interrupted time-series study design to examine the impact of a 2019 policy that eliminated all copayment requirements for the lowest income patients in the British Columbia (BC) Fair PharmaCare program. Using population-level administrative data, I studied the impact of the change on prescription drug use and expenditures. Additionally, I conducted a pre-post analysis to examine if the impacts of this policy were broad-based or concentrated amongst specific drug classes. Results: We identified four subgroups in the population of Canadians that experienced CRNA. There are significant differences in the profiles of patients across latent classes, and 73% of patient who report CRNA belong to subgroups characterized by higher incomes and prevalent insurance coverage. The copayment elimination policy in BC led to a 16% rise in monthly prescription drug expenditures and a 13% increase in the mean number of prescriptions dispensed for the target population, after accounting for changes in the control group. We observed increases in expenditures and dispensing across most therapeutic classes with the elimination of copayments. Conclusion: While financial constraints and insurance coverage are important determinants of CRNA, this phenomenon is not confined solely to low-income and uninsured patients. Nonetheless, the elimination of copayments for low-income households in BC led to improvements in prescription drug access and may represent a model policy for advancing access to medicines for low-income Canadians.