Canadian snowbirds might have new travel concerns. With changes in medication availability, prescriptions needed before travel might go unfilled. Some of the more well-known medications may be on back-order for unspecified time frames. This leaves Canadians with the option of requesting a change to a generic medication if available. Substitutions are often made to generic brands if a primary medication isn't available. While it's assumed that the generic version will have the same efficacy, that's not always the case.
The Concern with Drug Shortages and Substitutions
Back in March, there was a shortage of Bacillus Calmette-Guerin which is used to treat bladder cancer, the fifth most common type of cancer in Canada. Bladder Cancer Canada's (BCC) advisory board said that drug provider Merck Canada stated there was a shortage. BCC released a statement that they were working to correct the shortage as Merck Canada is the only supplier of the drug in Canada. BCC also requested that doctors closely monitor how much of the drug they carry while exploring other treatment options. Health Canada is working to find a solution like a substitute supplier and they anticipate the shortage will likely end in December.
When a medication is substituted, it might have different side effects or interactions on the person taking it. Medications can help a person maintain their livelihood and well-being. In some cases, medications are required to help a person continue their daily living activities. And, for older Canadians, certain medications can keep them out of the hospital. Some side effects can worsen a pre-existing condition.
Potential Side Effects
In some cases, the generic substitute version of a medication might not have the same effects or potency. Anticholinergic drugs can treat nerve pain, depression, vertigo and overactive bladders. But, a substitute drug might affect a person's sense of balance and thinking. If their balance is affected, it can lead to falls that might require hospitalization to recover from. For older Canadians, a fall that leads to a hip fracture is a major set-back. They sometimes can't fully recover from it or it might take longer than normal.
And, there are other risks associated with drugs that might have potential side effects:
- Tranquilizers and sedatives are another concern. Drugs like lorazepam and zolpidem are used to help with anxiety-related disorders and sleep apnea.
- Medications used for maintaining blood pressure also have potential side effects. These can include falls and lightheadedness.
- Diabetes drug side effects can include falls from low blood sugar or an increase in cognitive decline. Epilepsy drugs help to prevent seizures which are a neurological disorder. When drugs like these are substituted, the person might become more prone to fall risks or confusion.
- Medications that treat depression, pain, incontinence and depression might have side effects. These can occur if substitutes are made. For example, a person might start on a starter dose which is prescribed by their doctor. This is to give the person a chance to test the medication's effects. If it's too strong, the doctor might lower the dosage or switch to a different brand. When a substitute or generic version is used, the person might not realize that its effects are different. This can cause them to become more of a risk for travel insurance providers.
Drugs in short supply are used for a host of illnesses and medical diagnoses. These might include cancer therapy and drugs that treat diabetes, heartburn and high blood pressure. Also on the list are drugs that treat seizures and tuberculosis. But, why is there a shortage?
Why the Decline in Available Prescription Medications?
There are a few reasons why a common medication might not be available.
- There may be a production problem that limits how much of the drug is made.
- The area where the drug is produced might be affected by a natural disaster or another type of emergency.
- A drug manufacturer might not have all the ingredients available to make the drug.
- The company may have decided to reduce or stop making a drug.
- Two drug manufacturers might merge and agree to lessen or cease production of the drug.
Stable Versus Unstable Pre-Existing Conditions
When patients are forced to take a generic brand and if it's within three months before their trip, the medical situation might be deemed "unstable" by their insurance companies. That's because under many policies, starting a new medication is a trigger for insurance companies to deem a policyholder's condition "unstable". The difference between a generic and brand name drug might be enough to be considered a "new" medication. A stable condition usually signifies that a person has had no changes in their medications meaning there was no increase or decrease in dosage. And, it also means they didn't start or stop the drug recently. The insurer can then assume that no new treatments, tests, diagnoses or hospitalizations will be required while the person is away. However, a stability period can vary. It can range from 60 days up to 365 days depending on the person's age and the insurance plan.
Health Canada's Assistance
Legislation was passed in March of 2017 stating that drug companies must report any outages six months in advance or within five days if they hear about a shortage. And, Health Canada must be alerted. The website, Drug Shortages Canada lists about 7,545 different drug shortage reports. Fortunately, only about one percent (57 reports) are anticipated or upcoming medication shortages. The rest have been resolved or the drug shortage has been avoided in some way.
While Drug Shortages Canada is a knowledgeable, third-party database Canadians can reference, no one wants to skip their travel plans due to inadequate healthcare coverage while vacationing outside of Canada's borders and there's a lot snowbird travellers can do prior to their trip.
Preparing for Upcoming Travel
About one out of four Canadians were affected by a drug shortage since 2016 according to a Pharmacists.ca survey. While Canadians are inconvenienced when a medication they need is in short supply, there are a few things they can do.
These might include:
- Confirming in advance with their pharmacy that their medication is available and/or the time frame for when the necessary medication will be in stock
- Asking the pharmacist about fractional dosages as a workaround but this might require the person to have to go back to their doctor for another consultation and lab work
- Checking with Health Canada for updates and checking sites like DrugShortagesCanada.ca for the status of drugs affected by a shortage
- Reaching out to interest groups and organizations for specific assistance, i.e., epileptics can call 866-EPILEPSY
- Researching online which nearby pharmacies might offer the medication or if other websites like Amazon have it available as they are now letting people fill their prescriptions online
- Researching if a substitute or generic brand has any lessening effects
- Getting a note from their physician that states a substitute medication is equally as effective
- Shopping around for snowbird travel insurance providers if they are denied coverage or deemed unstable
Safeguard Your Travel Plans
Ultimately, no one wants to have their travel plans interrupted especially over a medication concern. So it's important for Canadian snowbirds to research in advance if their prescription isn't available and what substitutions can be made. That way they can do all the shopping and travel they want - without concerns about travel insurance coverage and medication shortages.