One in ten Canadians says they cannot afford to adhere to their prescription medication, according to a report from researchers at University of British Columbia and the University of Toronto.

A review of data from more than 5,700 people who answered Statistics Canada’s Canadian Community Health Survey, found 9.6 percent of Canadians who received a prescription said they didn’t fill the prescription, failed to refill or did not take the recommended dosage because of cost.

Though Canada has a nationalized health care system, prescription drugs fall outside of the Canada Health Act leaving two-thirds of Canadian households paying for prescription drugs out of pocket.

The Canadian Institute for Health Information estimated these out-of-pocket payments totaled $4.6 billion in 2010.

The UBC study shows that individuals without drug insurance are 4.5 times more likely to avoid taking prescribed medications because of cost. Similarly, Canadians with low incomes are 3.3 times more likely to not use prescription drugs because they cannot afford them.

Study findings were published in the Canadian Medical Association Journal.

Canadians aren’t the only ones struggling to fill prescriptions. A Consumer Reports study released in September found 48 percent of people surveyed reported skimping on prescription medication due cost.