Researchers looked at the volume and daily cost of primary care prescriptions in 10 high-income countries with universal health care. Everyone expected to see some pretty wild variation but not quite like this. For drugs in the six largest categories of primary care, pricing varied by more than 600%, and that’s not including the famous highly priced American pharmaceuticals. The United States was not included in the study because it does not offer universal health care.

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The countries analyzed by the researchers include Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. The focus was on pharmaceuticals from 6 widely used categories purchased at retail pharmacies rather than in a hospital setting like:

• hypertension treatments;
• pain medications (nonsteroidal anti-inflammatory drugs as well as opioids);
• cholesterol-lowering drugs;
• noninsulin diabetes treatments;
• gastrointestinal medications and
• antidepressants.

The Canadian researchers measured the frequency of use and calculated how much the therapy costs in each country.

Across countries, the average annual per capita expenditure on the primary care medicines studied varied by more than 600%: from $23 in New Zealand to $171 in Switzerland.

In the 5 countries with universal, single-payer coverage of prescription medications, the average per-person cost was $77. Average costs were $99 in the 4 countries with universal social insurance for prescription drugs. In Canada, whose system is a mix of private and public financing, the annual cost was $158.

“The volume of therapy purchased in Canada was about the same as that in the comparator countries; however, Canadians spent an estimated $2.3 billion more than they would have in 2015 if these primary care treatments had had the same average cost per day in Canada as in the 9 comparator countries combined,” writes Dr. Steven Morgan, School of Population and Public Health, University of British Columbia, with coauthors.

The findings suggest that citizens living in countries with single-payer financial systems get the best deals as the system seems to promote lower prices. Universal pharmacare could thus help reduce prices for consumers in both Canada and the United States.

“Average expenditures are lower among single-payer financing systems, which appear to promote lower prices and selection of lower-cost treatment options within therapeutic categories,” the study authors conclude in the journal CMAJ.