Financial and regulatory obstacles stand between many of Ontario’s mental health patients and the drugs they need
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Theresa Schrader struggles with anxiety, type II bipolar disorder and post-traumatic stress disorder. She’s also grappling with addiction and taking drugs for diabetes and blood pressure. But as soon as she was unable to afford her medications, she had to give them up, according to the Toronto Star.
She originally could charge medical expenses - $200 just for the psychiatric drugs - against an employee plan, but following a relapse and a mental breakdown, she lost her job. Without coverage, she had only enough money to either pay for medication or pay rent for herself and her son. She chose the latter, but her psychiatrist later insisted that she get back on them.
OHIP generally takes care of drug costs for people confined in hospitals, but not outpatients, who either pay out-of-pocket or use their employer-provided insurance. Unfortunately, more and more workers are entering the workforce without being given any health benefits.
Thus, most outpatients struggling with mental health have to pay for their prescriptions. They usually have to stay on medication for years, according to Dr. Kwame McKenzie, CEO of the Wellesley Institute.
“Often people with mental-health problems are on one or two or three medications for their mental-health problem and then other medication because they’re more likely to have physical problems,” McKenzie said, adding that finding the perfect blend usually takes months of experimentation. “Changing the brain’s behaviour, the chemistry in the brain, takes some time and it takes finding the right chemical formula.”
Many workers who cannot comfortably afford their medications are stuck in limbo: they don’t have employer-provided health coverage – as was the case for 37% of working Ontarians in 2015, according to the Wellesley Institute – but they also fall outside the provincial government’s safety-net drug programs because they earn too much.
Some patients may not even know that they are qualified to receive government-provided coverage. “The problem is that we’re (dealing with) people that are really ill and vulnerable and rather than making it a really easy process, some people find it quite difficult,” McKenzie said.
Those who manage to get themselves covered under a program may encounter another layer of red tape. “When drug plans are assessing whether they’re going to cover (specific) drugs, they tend to look at whether the drug works or not rather than the side effects,” McKenzie explained. “And so what you sometimes find is you get a new drug that’s much more expensive than the old drug . . . The side-effect profile is so much better, but it’s not going to get covered.”
Provincial, territorial, and federal governments have formed the Pan-Canadian Pharmaceutical Alliance to get better drug prices under public drug plans, but care providers generally see national drug plan is the way to go.
“We need a national pharmacare plan right now to help Canadians access needed prescriptions, not just for mental health,” said Centre for Addiction and Mental Health Physician-in-Chief Dr. Vicky Stergiopoulos. “A national pharmacare plan should also provide guidance about which medications are effective at the lowest possible cost.”
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She originally could charge medical expenses - $200 just for the psychiatric drugs - against an employee plan, but following a relapse and a mental breakdown, she lost her job. Without coverage, she had only enough money to either pay for medication or pay rent for herself and her son. She chose the latter, but her psychiatrist later insisted that she get back on them.
OHIP generally takes care of drug costs for people confined in hospitals, but not outpatients, who either pay out-of-pocket or use their employer-provided insurance. Unfortunately, more and more workers are entering the workforce without being given any health benefits.
Thus, most outpatients struggling with mental health have to pay for their prescriptions. They usually have to stay on medication for years, according to Dr. Kwame McKenzie, CEO of the Wellesley Institute.
“Often people with mental-health problems are on one or two or three medications for their mental-health problem and then other medication because they’re more likely to have physical problems,” McKenzie said, adding that finding the perfect blend usually takes months of experimentation. “Changing the brain’s behaviour, the chemistry in the brain, takes some time and it takes finding the right chemical formula.”
Many workers who cannot comfortably afford their medications are stuck in limbo: they don’t have employer-provided health coverage – as was the case for 37% of working Ontarians in 2015, according to the Wellesley Institute – but they also fall outside the provincial government’s safety-net drug programs because they earn too much.
Some patients may not even know that they are qualified to receive government-provided coverage. “The problem is that we’re (dealing with) people that are really ill and vulnerable and rather than making it a really easy process, some people find it quite difficult,” McKenzie said.
Those who manage to get themselves covered under a program may encounter another layer of red tape. “When drug plans are assessing whether they’re going to cover (specific) drugs, they tend to look at whether the drug works or not rather than the side effects,” McKenzie explained. “And so what you sometimes find is you get a new drug that’s much more expensive than the old drug . . . The side-effect profile is so much better, but it’s not going to get covered.”
Provincial, territorial, and federal governments have formed the Pan-Canadian Pharmaceutical Alliance to get better drug prices under public drug plans, but care providers generally see national drug plan is the way to go.
“We need a national pharmacare plan right now to help Canadians access needed prescriptions, not just for mental health,” said Centre for Addiction and Mental Health Physician-in-Chief Dr. Vicky Stergiopoulos. “A national pharmacare plan should also provide guidance about which medications are effective at the lowest possible cost.”
Related stories:
Are healthcare meeting participants taking their eyes off the prize?
Universal pharmacare is the cure for high Canadian drug costs, says expert
