Study examines cost of HIV medication across Canada

By Ana Gajic

Picture two men, living nearly identical lives.

They are both 30 years old, single, with no dependents and a net annual income of $39,000. Both have been diagnosed with HIV, and both are taking the most commonly prescribed medication to suppress HIV infection. This prolongs their life, reduces their risk of infections, and prevents the transmission of the virus to others.

One man lives in Nova Scotia, while the other lives in Ontario. Apart from their home province, what else is different about them?

According to a team of researchers at St. Michael’s Hospital, it’s the amount they’ll pay for their HIV medications, known as antiretroviral drugs.

Recently published in CMAJ Open, a St. Michael’s study suggests that depending on where a patient with HIV lives, the cost for medications can vary greatly. Also, in some provinces, income matters. For example, while the man living in Nova Scotia is eligible for four co-payments of $11.25 for each 90-day prescription equaling a cost of $45 annually, the man in Ontario would be required to pay an annual deductible of 3.4 per cent of his net household income and four co-payments of $2.00 – totaling $1,352 for the year. Someone in a different income bracket in Ontario would pay more or have no out of pocket payments.

“We found that because each jurisdiction, province or territory makes their own decisions about how drugs are covered, patients face different realities across the country,” said Dr. Deborah Yoong, a pharmacist at St. Michael’s who led this research. Her team gathered data from government websites and had a pharmacist in each jurisdiction validate the information they found.

In the wake of the 30th annual World AIDS Day earlier this month, Dr. Yoong said there have been great strides made in maintaining health and a high quality of life for patients with HIV — but gaps remain.

“HIV is a long-term disease that can be controlled with adherence to medication and engagement in care,” she said. “But we won’t be able to achieve all that the drugs are able to provide, such as decreased morbidity, mortality and transmission, if people aren’t able to afford their medication.”

Dr. Yoong noted that while it’s positive that antiretroviral reimbursement programs exist to support patients paying for treatment in different ways across jurisdictions, there is still considerable variability amongst them. An individual could incur hundreds or thousands of dollars of additional costs depending on where they live. Interestingly, Dr. Yoong found, the discrepancy was highest for high-income earners who didn’t have private drug insurance.

In addition to there being differences in government subsidies, the research team also uncovered a range of program eligibility, administration structures and restrictions in programs across the country.

“There are people in our clinic, in every clinic, who are stressed because they can’t afford treatment,” Dr. Yoong said. “Sometimes, people stop medications or alter their prescription by splitting their tablets or skipping doses to make them last longer. At that point, their private stress becomes a public health issue as well — uncontrolled HIV means the virus can be transmitted to others.”

The research team’s goal is that their work contributes to evidence that will one day inspire change.

“Our hope is to see cost equality in accessing essential medications for all, and especially for diseases that affect individuals and the public,” she said.

These papers are an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

St. Michael’s Hospital with Providence Healthcare and St. Joseph’s Health Centre now operate under one corporate entity as of August 1, 2017. United, the three organizations serve patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.