Today, the Honourable Mark Holland, Minister of Health, announced the Government of Canada's next step toward the first phase of national universal pharmacare with the introduction of Bill C-X, An Act respecting pharmacare, into Parliament, and the intention to provide universal, single-payer coverage for a range of diabetes medications in collaboration with willing provinces and territories (PTs).
In addition, the federal government is announcing its intention to establish a fund to enable work with PT partners to support Canadians' access to supplies that diabetics require to manage and monitor their condition and administer their medication, such as syringes and glucose test strips.
Diabetes medications
Diabetes is one of the most common chronic diseases affecting people living in Canada. Around 3.7 million people in Canada, or 9.4% of the population, live with diagnosed diabetes. The number of people living with diabetes has doubled over the last decade and is expected to continue to increase as Canada's population ages and grows.
In 2015, 25% of Canadians with diabetes indicated following their treatments were affected by cost, in some cases rationing medications to save money. Uncontrolled diabetes can have very serious short and long-term health impacts and represents a burden to individuals, families, and Canadian society. High and unnecessary costs are incurred from lost productivity and elevated health-care system use due to diabetes and its complications, including heart attack, stroke, kidney failure, blindness and amputation. The full cost of diabetes to the healthcare system in 2018 is estimated to be around $27 billion and could exceed $39 billion by 2028.
Diabetes is a chronic condition that develops when the body either does not produce or effectively use insulin, which it needs to turn sugar into energy. Diabetes can lead to serious health complications if not properly managed.
Diabetes disproportionately affects certain populations within Canada. Evidence shows that First Nations and Métis people, and people of African, East Asian and South Asian ethnic backgrounds have higher rates of Type 2 diabetes compared to the general population.
There are three major types of diabetes, each with different causes and sometimes different treatments:
- Type 1 diabetes happens when the body stops producing insulin. Type 1 diabetes usually develops in childhood or early adulthood. About 5 to 10% of people living with diabetes have type 1.
- Type 2 diabetes happens when the body does not make enough insulin or does not respond well to the insulin it makes. People usually receive a diagnosis for Type 2 diabetes after the age of 40, but it is becoming more common in younger people. About 90% to 95% of people living with diabetes have type 2.
- Gestational diabetes is a form of diabetes that develops during pregnancy and disappears after delivery. Gestational diabetes develops in about 10% of pregnancies.
There is currently no cure for diabetes, but some treatments may help to manage it and improve quality of life.
Types of Diabetes Medications Being Covered
Today's announcement would ensure that, following agreement with PTs, diabetics in Canada will have access to first-line treatments for diabetes that lower blood glucose levels, including:
- Insulin, which is used by patients with type 1 and type 2 diabetes. Insulin can cost in the range of $900-$1,700 per year, depending on the type and dosage required.
- Metformin, which is used by patients with type 2 diabetes. Metformin can cost about $100 per year.
- Medications often used in combination with insulin and metformin by patients with type 2 diabetes, including Sulfonylureas, and SGLT-2 inhibitors. The cost of these medications can range from approximately $100 to over $1,000 per year.
Existing drug insurance coverage for diabetes medications and supplies varies widely across Canada. All PTs include many of the commonly-prescribed drugs to treat diabetes on their formularies although the cost to the patient can vary greatly.
Improving the affordability of these medications will improve the health of Canadians living with diabetes and reduce the risk of serious life-changing health complications such as blindness or amputations.
The Government of Canada will be launching discussions with PTs on providing universal, single-payer coverage based on the list of diabetes drugs attached to this backgrounder.
| Drug Class | Brand Names | Generic Names |
|---|---|---|
| Combination Formulations | Synjardy | Empagliflozin & metformin |
| Jentadueto | Linagliptin & metformin | |
| Komboglyze | Saxagliptin & metformin | |
| Insulins | Trurapi, Kirsty | Aspart biosimilar |
| Apidra | Glulisine | |
| Admelog | Lispro biosimilar | |
| Humulin R, Novolin ge Toronto | Regular, Human | |
| Entuzity | Concentrated Regular, Human | |
| Hypurin Regular Insulin Pure | Pork regular insulin | |
| Hypurin Nph Insulin Isophane Pork | Insulin Isophane, Pork Pure | |
| Humulin-N, Novolin GE NPH | Isophane Human, NPH | |
| Levemir | Detemir | |
| Basaglar | Glargine biosimilar | |
| Semglee | Glargine biosimilar | |
| Humulin 30/70, Novolin 30/70 | Reg-Isophane, NPH Human | |
| Insulin Secretagogues | Diamicron MR | Gliclazide |
| Glyburide | ||
| Biguanides | Glucophage | Metformin |
| SGLT2 Inhibitors | Forxiga | Dapagliflozin |
Diabetes devices and supplies
Canadians using insulin require the necessary equipment to administer their medication. This can include syringes, insulin pens and pen tips, or insulin pumps and supplies such as insertion sets and insulin cartridges.
People living with diabetes must also closely monitor their blood sugar levels to ensure their sugar levels are in a safe range, and to adjust their medication as needed. Equipment to monitor sugar levels can include glucometers, test strips and lancets, as well as flash and continuous glucose monitoring devices (CGM). Use of CGM or Flash GM devices leads to fewer complications and reduces long-term costs associated with hospitalization.
These devices and supplies can cost thousands of dollars per year. All PTs offer some form of coverage or financial assistance for diabetes-related medical devices and supplies but the programs vary in terms of the support provided and eligibility.
