Reimbursement costs for drugs to treat diabetes are rising by an average of 13 per cent per year since 2010, according to a new report released today by the Conference Board of Canada and supported by Diabetes Canada.
The report, Accessing Diabetes Medications - A Pan-Canadian Analysis of Patient Experiences, also shows that health insurance inequities persist between privately insured and publicly insured persons with diabetes.
From 2010 to 2017, the number of Canadians living with diabetes increased by 28.7 per cent. This is significantly higher than Canada’s population growth over the same period. There are currently more than 3 million Canadians diagnosed with diabetes. According to Diabetes Canada’s estimates, about 2 million live with diabetes and do not know it, and more than 6 million more are living with prediabetes, placing them at high risk for developing type 2 diabetes. Diabetes and prediabetes rates are expected to jump to more than 13 million by 2029.
Glucose lowering medications represent the second largest drug spending category in Canada. Canadians living with diabetes spend $1.8 billion on them every year – a figure expected to continue to grow.
“Our research shows that reimbursement costs for glucose-lowering medications, whether through public or private insurance or out-of-pocket payments, are growing more quickly than the number of Canadians living with diabetes,” says Cameron MacLaine, Research Associate, Health with Conference Board of Canada.
Managing these costs is a key challenge for patients and for public and private payers. Diabetes Canada hopes that the increase in reimbursement costs is translating into more people being treated appropriately than in the past but warns that some people still cannot access the medications they need.
The new report is part of a broader research agenda exploring options for universal pharmacare in Canada. The Conference Board of Canada completed research on how people living with diabetes access necessary medications. Results of quantitative analysis, validated by interviews with patients and physicians, showed that:
- Reimbursement costs are lower for public plans than for private plans; however, private plans cover more active ingredients and more expensive drugs than public plans.
- Patients with private insurance coverage generally have more extensive coverage, and have access to more medications, than patients with public coverage.
- Private plans provide access to a wider variety of medicines than public plans, including to new and innovative medicines that may better meet patients’ individual needs.
- Expenditures for glucose-lowering medications have grown steadily over the past eight years. The scale of these increases varies across provinces, coverage types, and drug types. Some of these increases result from the development of new medicines—reimbursement costs for SGLT2 inhibitors, for example, increased an average of 370 per cent every year between 2014 and 2017. Managing these costs is a key challenge for patients and for public and private payers.
- The high cost of private plans means that they are generally accessible only to high-income earners or to patients with employer-sponsored plans.
- There is a major shift toward private coverage for glucose-lowering drugs for every province in Canada except Ontario.
- Canadians living with diabetes who have no medical insurance continue to face distinct and unnecessary difficulties. For example, the high cost of some medications means that some uninsured patients cannot afford medically necessary medications like insulin, which can, in turn, severely impact their health outcomes.
The report notes a major difference in the accessibility in medications offered through public and private plans. This results in real inequities amongst Canadians and is an issue that needs to be addressed. “As is the case for many health conditions, there is no one-size-fits-all approach to treating diabetes,” says Seema Nagpal, vice-president of Science & Policy with Diabetes Canada. “As noted in Diabetes Canada’s Clinical Practice Guidelines, treatment regimens should be tailored to individual needs and based on clinical evidence. Insurance plans need to offer some flexibility for patients to receive the best treatment for them. A patients’ ability to manage their disease depends heavily on their insurance coverage.”
Diabetes Canada does not endorse a particular pharmacare delivery mechanism or model. Rather, it advocates for the fulfillment of the following principles:
- equity – every Canadian should have equitable and consistent access to necessary prescription medications to meet their treatment needs
- timeliness of access – Canadians should be able to access the medications they need in a timely manner
- appropriateness of therapy – all Canadians should have access to high quality medications that are appropriate to their individual needs
- affordability – all Canadians should be able to afford their medications at the point of care sustainability – all Canadians should benefit from a pharmacare system that ensures ongoing health system sustainability
To make any notable progress in tackling the diabetes epidemic, Diabetes Canada recommends a nation-wide approach, Diabetes 3600, to help all Canadians know their risk of diabetes, reduce individual risk factors for both diabetes and its complications, promote healthier environments and create measurable, attainable health outcomes.