May 27, 2019 Important information for British Columbians living with diabetes

Today, British Columbia’s Minister of Health, Adrian Dix, announced important new changes to the province's PharmaCare program.

In Canada, close to 11 million people live with diabetes or prediabetes. Diabetes prevalence continues to rise across the country year over year at a significant cost to health-care systems and human lives. In British Columbia alone, four more people are diagnosed with this progressive, chronic disease every hour. At this rate, a staggering 13 per cent of the province’s population is expected to be living with diabetes by 2029.

People with diabetes, their families and health-care providers welcomed the news that B.C. will now be joining the rest of Canada by adding a medication from the SGLT2 inhibitor class to its public formulary. Empagliflozin (brand name Jardiance) has been proven to help reduce blood glucose and significantly decrease the risk of major cardiovascular events in people with type 2 diabetes and clinical cardiovascular disease. Unfortunately, the criteria for access put in place by B.C.’s Ministry of Health are not consistent with evidence-based national recommendations for empagliflozin from the Canadian Agency for Drugs and Technologies in Health or Diabetes Canada's Clinical Practice Guidelines, and are more restrictive than in many of the other provinces that reimburse the drug.

“This is a step in the right direction, however the current access policy falls short of offering some people with diabetes a proven treatment to optimize their health,” says Dr. Seema Nagpal, Vice President of Science & Policy at Diabetes Canada. “Unfortunately, government funding in B.C. has not kept pace with the high need for services, devices and medications due to the proliferation of diabetes. While diabetes rates have increased, public drug expenditure has decreased in the province and is lower than the Canadian average.”

The government also unveiled its new Biosimilars Initiative today which will introduce changes to those whose diabetes therapies include insulin glargine. The Biosimilars Initiative will transition British Columbians currently on Lantus to Basaglar, an insulin glargine biosimilar medication. Lantus will no longer be reimbursed by B.C. PharmaCare for individuals currently being managed with insulin glargine or for those starting insulin glargine therapy, except under exceptional, government-approved circumstances.

Diabetes Canada strongly believes and recommends that therapeutic decisions be jointly made by patients and their diabetes care team based on best evidence and clinical context. Health-care providers should be able to individualize treatment plans without administrative barriers that restrict access to necessary therapies. People living with diabetes are encouraged to work with their physicians to request an exception to the Lantus-Basaglar policy when there are valid reasons to do so. For the vast majority of patients who will be required to switch, Diabetes Canada recommends consulting with the prescribing physician to thoroughly address any implications to the overall treatment plan, including possible changes to blood glucose monitoring, laboratory testing and frequency of visits with the diabetes care team during the transition period between medications.

“As is the case with any new health policy, Diabetes Canada firmly believes that patient consent, education and safety must feature prominently” says Dr. Nagpal.  “Under this new initiative, patients will have six months to complete the switch. They will be encouraged to seek counseling from their physicians and pharmacists during this time, and these health professionals will be supported to provide information about the medication change to their patients to maximize understanding and adherence. An evaluation will also be undertaken to detect any unintended consequences of the policy. These are some positive features of the Biosimilars Initiative.”  

Diabetes Canada recognizes that the diabetes epidemic in B.C. has considerably strained the province’s health-care budget and that B.C. PharmaCare has had to develop policies with the most efficient use of public funds as its top priority. However, cost considerations must not trump evidence-based clinical guidelines. Even in times of austerity, policies should be patient-centred with a view to improving health outcomes. “One-off changes in policies will neither achieve the best patient outcomes nor make the best use of public funds. To date, restricting and de-listing medications has not effectively managed the diabetes epidemic in terms of reducing the patient burden or overall financial costs,” says Dr. Nagpal. “British Columbians deserve a forward-thinking, comprehensive assessment of all the factors that influence the development and management of diabetes and policies that enable optimal care.”

Previous actions like the creation of the province’s Poverty Reduction Strategy and reduction of B.C.’s Fair PharmaCare deductibles for families with a household income of $45,000 or less signal the government’s willingness to remove barriers to healthy living. But greater support must be provided to the over half a million British Columbians who are living with diabetes in 2019. “We also need to ensure that the government works closely with stakeholders to address diabetes in a holistic manner, with better health and quality of life for those with the disease as the goal,” says Dr. Nagpal. “A nation-wide Diabetes 360⁰ strategy is an integrated approach that should be considered by the government of British Columbia to reduce the human burden of this rapidly escalating disease and the unsustainable pressure it is placing on the health-care system.”