About This Document
In Canada, annual prescription medication costs over $33 billion and are only second to overall hospital expenditures in health care spending.1 These costs largely reflect the treatment of chronic medical conditions predominantly cared for by family physicians,2 including heart disease and lipid management, hypertension, diabetes and depression.3
Among OECD nations, Canada has the third highest drug spending per capita (behind only Switzerland and the United States).4 In Canada, one in 12 do not fill a prescription or skip doses due to medication costs.5 In Alberta, trade name medications account for 33% of prescriptions but around 80% of prescription drug costs.6 On a national level, the 100 most expensive prescription drugs (of ~3000 available products),7 account for almost half of total prescription drug spending.8 Antivirals for treatment of hepatitis C and anti-neovascularization agents for treatment of macular degeneration contributed the most to growth in medication spending, while statins and proton pump inhibitors had significant declines in spending.1 Canada is currently the only country with a universal health insurance system without a national pharmacare program.9
Adopting a national pharmacare program would save approximately $4 billion annually in prescription drug costs.9 Many medications within a drug class are therapeutically interchangeable with similar anticipated clinical outcomes. Newer medications within a class are often derivatives of older products, frequently at a substantially higher cost, and often not covered under provincial drug plans. In 2015, pharmaceutical companies spent over $500 million on journal advertisements and sales representative visits in Canada,10 with over 90% of marketing aimed at medications with little or no therapeutic gain over existing products.11
Most provincial governments are implementing cost control measures for prescription medications. Alberta implemented a maximum allowable cost pricing for proton pump inhibitors, where patients are encouraged to use a covered lower cost alternative medication or personally pay the cost difference between their higher and lower cost alternative.12 Using lower cost PPIs could save over $200 million annually in Canada without an appreciable change in most patients’ clinical outcomes.
The pan-Canadian Pharmaceutical Alliance has negotiated substantial price reductions for 70 of the most commonly prescribed generic medications.13,14 Despite this, Canadians still pay significantly more for their generic medications than other countries like New Zealand.14 Educating about medication costs may influence prescribers to choose lower cost alternative medications.15 With this in mind, we are pleased to publish our 2019 Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta. We encourage prescribers to consider costs (and medication coverage) when treating chronic medical conditions and especially when choosing between therapeutically similar medications. In addition to considering least cost alternatives, other ways of decreasing medication costs include:
- Using combination products
- Extending long term prescriptions to at least 90 days
- Splitting medications
In this document, costs listed are primarily for the generic product (with generic name bolded) as provincial drug plans will generally only pay for the lowest cost formulation. Brand name prices (with brand name bolded) are for products still under patent protection. We also provide information on coverage by Alberta Blue Cross (BC) and Indian Affairs (IA) formularies and which products require Special Authorization (SA). Medications that are not covered (NC) are paid for entirely by your patients. The prices, rounded to the nearest $5, represent the entire retail cost of the prescription filled at a community pharmacy in Alberta, including markups and dispensing fee. This does not reflect what a patient would pay if covered under a drug plan, but rather the cost to an individual without coverage, or to the health system. The reported price reflects the maximum allowable dispensing fee charged under provincial regulations. Some pharmacies may charge less than that, but this tool allows for relative cost comparisons between medications in the same class or for treating the same condition. This list is up to date as of January 25, 2019.
We encourage you to contact your local pharmacist for information on medications not included that you routinely use in your practice. Please forward any feedback, including cases where knowledge of medication cost or coverage made a difference to your patients or practice to: firstname.lastname@example.org or email@example.com.
What’s New in the Document in 2019?
- Simplified antibiotic and iron categories
- Opioid Addiction Treatment section added
What’s New with Medication Cost and Coverage in 2019?
- Perindopril and Varenicline are now generic
Top 10 Prescriptions by class: By number of active beneficiaries
Top 5 Medication Classes by Drug Spending Dollars
1. CIHIs Prescribed Drug Spending in Canada, 2018. Available at https://www.cihi.ca/en/health-spending/2018/prescribed-drug-spending-in-canada Accessed January 21, 2019.
2. Stewart M, Ryan B. Ecology of health care in Canada. Can Fam Physician 2015; 61:449-53.
3. Prescription medication use by Canadians aged 6 to 79. Statistics Canada. 2014. Available at: http://www.statcan.gc.ca/pub/82-003-x/2014006/article/14032-eng.htm. Accessed November 23, 2015.
4. OECD Data: Per capita Pharmaceutical Spending. Available at: https://data.oecd.org/healthres/pharmaceutical-spending.htm#indicator-chart. Accessed February 14, 2018.
5. Morgan SG, Lee A. Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries. BMJ Open 2017; 7:e014287. doi:10.1136/bmjopen-2016- 014287
6. Alberta prescription drug market. 2016. Available at: http://canadiangenerics.ca/get-the-facts/canadian-market-facts/#info. Accessed February 5, 2018.
7. Author calculation based on: Alberta Drug Benefit List, Alberta Human Services and the Palliative Coverage Drug Benefit Supplements Price File January 1, 2016. Available at: https://www.ab.bluecross.ca/dbl/pdfs/ADBL_HSDBS_PCDBS_APHAP_2019_01_25.xlsx. Accessed February 5, 2019
8. Paquette A. Top drugs of 2013. 2014 Feb 18. Pharmacy Practice Plus. Available at: http://www.canadianhealthcarenetwork.ca/pharmacists/news/drug-news/top-drugs-of-2013-24773 Accessed December 3, 2015.
9. Wolfson MC, Morgan SG. How to pay for national pharmacare. CMAJ 2018; 190: E1384-8. doi: 10.1503/cmaj.180897
10. Lexchin J. Drug prices: How do we get to a better place? CMAJ 2017; 189:E792-3
11. Lexchin J. The relation between promotional spending on drugs and their therapeutic gain: a cohort analysis. CMAJ Open 2017. DOI:10.9778/cmajo.20170089
12. Alberta Health Pharmacy Benefact Number 639. September 2016. Available at: https://www.ab.bluecross.ca/pdfs/pharmacy-benefacts/pharmacy-benefact-639.pd
13. Zafar A. CBC News January 29, 2017. Generic drug industry agrees to cut prices up to 40% in 5-year deal with provinces Available at: http://www.cbc.ca/news/health/generic-drug-prices-1.4509073. Accessed Feb 1, 2017.
14. Adhopia V. Big Pharma Blinked. But Why? Available at: http://www.cbc.ca/news/health/second-opinion-february-3-2018-1.4517468. Accessed February 3, 2018.
15. Gorfinkel I, Lexchin J. We need to mandate drug cost transparency on electronic medical records. CMAJ 2017;189:E1541-2.