Thus the Canadian system penalizes patients who have difficulty with a more popular medicine but would thrive on the second, third or fourth medicine that is similar but not exactly the same. Canada also keeps down the price of some prescription drugs by depending on other developed countries to bear a larger share of the research and development costs required to bring drugs into production. However, the cost of actually manufacturing most drugs is small, so manufacturers have discretion in pricing, which is why Canada can force them to set drug prices lower. While keeping some prescription drug prices down through price controls, Canada has been unable to control overall drug costs. A study of international drug price comparisons by Prof. Patricia Danzon of the Wharton School of the University of Pennsylvania concluded that, on the average, drug prices in Canada were higher than those in the United States.
Some individual drugs cost far more in Canada.
For example, the anti-hypertensive drug atenolol is four times more expensive in Canada than in the United States. And a University of Toronto study found that the main effect of price controls on prescription drugs was to limit patients' choices so that they had to rely more on hospitals and surgery. All provinces require that chemically identical and cheaper generic drugs be substituted for more expensive brand-name drugs when they are available. Patients are often forced to switch medicines, sometimes in mid-treatment, when the reference price system mandates a change. Sixty-eight percent report confusion or uncertainty by cardiovascular or hypertension patients, and 60 percent have seen patients' conditions worsen or their symptoms accelerate due to mandated switching.