For Canadian health policy experts, the problem of drug shortages is certainly not new; neither are calls for an investigation into its causes. But as Canadian patients make plans to visit warmer climes this autumn, the need to resolve the issue may be more urgent than ever.
In a recent commentary, Dr. Charles Shaver, a former chair of the section on general internal medicine of the Ontario Medical Association, explained how a shortage of common medications could affect Canadian snowbirds who rely on travel insurance.
“Even a change in dose of medications within three months of travelling could invalidate private travel insurance, and certainly a change to a ‘close-cousin’ in the same family would do so,” Shaver wrote in the piece published by The Chronicle Herald. “Now a larger group of persons – those who have been stable for years on various medications – face possible loss of insurability.”
He explained that well-established drugs — including ones used in cancer therapy as well as treatments for hypertension, heart failure, diabetes mellitus, heartburn, and seizures — have been on “backorder” status for many months. Health Canada, he added, reports a total of 1,848 drug shortages in the country at present; around the world, over 100 countries are affected by such shortfalls.
Based on the work of Dr. Jacalyn Duffin from Queen’s University in Ontario, he said there are 16 possible causes, including “increased global demand, a lack of active ingredients, contamination issues, vague manufacturing problems or simply a decision to stop making an unprofitable drug.” Duffin has called for Canada to take the lead in investigating the reasons behind the problem.
Faced with the absence of their required medications, Canadian patients may be forced to change treatments; if it happens within three months of a trip abroad, Shaver said could make patients “unstable” in the eyes of companies that offer travel insurance.
“Unfortunately, few Canadians can instead rely on coverage by their provincial governments, even though it is required by federal law,” he said.
The Canada Health Act Annual Report 2017-18 notes that insured persons that are temporarily out of the country should be able to get insured services paid at their home province’s rate. But elsewhere in the report, Shaver said, it says that all jurisdictions except Prince Edward Island and the three territories appear to have lower per-diem rates for out-of-country services when compared to the home province or territory rate.
“Sadly, whereas financial penalties for violations of extra-billing and user fees are ‘mandatory,’ those for other violations such as portability are only ‘discretionary,’” Shaver said; he added that the CHA’s discretionary penalty provisions have not been applied, according to the report.
“Nova Scotia and most provinces have adopted the attitude that people should simply purchase private travel insurance,” he said. “But this will become increasingly difficult for many.”