By Nigel Rawson and John Adams

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Opinion: Ottawa’s pharmacare plan looks grim for diabetics Back to video

Opinion polls regularly show that most Canadians support the idea of national pharmacare. But they’re likely envisioning a comprehensive system covering a broad range of innovative medicines — not unlike what many of them have in their private plans. That does not describe the first stage of Ottawa’s national pharmacare plan, which covers only contraceptives and diabetes drugs. It’s far from the imagined ideal and could well harm many Canadians. Restricting coverage to older medications, as the plan seems intended to do, may save money, but at what cost to the health of Canadians?

Bill C-64 passed third and final reading in the Senate on Oct. 10 and received royal assent the same day. Following his testimony at a Senate committee last month, federal Health Minister Mark Holland wrote to its chair to confirm that diabetes medications and contraceptives included in the initial phase of the government’s “vision of a national universal pharmacare program” will be paid for and administered through a public plan — not a mix of public and private payers — and that coverage will be single-payer and first-dollar.

Holland twice mentioned that a “range” of medications will be covered. What does that mean for patients and their doctors? The only insight we have into which diabetes medications may be covered is a list “to be discussed with provinces and territories.” This list is remarkably short. Let’s compare what’s on it with the diabetes drugs currently covered by government drug plans across the country or by the large private insurer, Manulife. If you exclude medications not covered by any public plan or Manulife — either old drugs no longer used or newer medicines with no price agreement yet with government drug plans — you’re left with 52 diabetes medications that have been approved by Health Canada and are insured by at least one major plan, whether government or Manulife.

How many of the 52 do different plans cover? That depends on the current “postal code lottery”: what’s covered depends where you live. Coverage of the 52 medications ranges from 48.1 per cent in British Columbia to 84.6 per cent in Quebec. Manulife does even better, covering 96.2 per cent of them — all but two. And the federal government’s list for national pharmacare? It includes only 34.6 per cent of the 52 drugs — just 18 of them.

So short a list runs the serious risk of creating a new and worse postal code lottery in Canada.

It’s not just the shortness of the list that’s a problem, it’s also what’s on it. For instance, the past two decades have seen important developments in the treatment of type 2 diabetes with the introduction of three novel classes of medications. Ozempic and Rybelsus, used by about a million Canadians, are two of these drugs. Two of the new classes reduce the risk of heart attacks, strokes and end-stage kidney disease, which are common complications of diabetes and can be fatal. All government drug plans cover Ozempic and almost all list another 12 of the new medications. But Ottawa’s list includes just four of these drugs and excludes Ozempic and Rybelsus.

The list also includes a pork insulin, which isn’t in Diabetes Canada’s Clinical Practice Guidelines because it causes allergic reactions in many patients. Such insulins are not covered by the Manulife plan. Which raises the questions: Who drew up the list and what are their qualifications? It appears to have been prepared by government officials without advice from diabetes specialists but with a focus on less expensive, older drugs.

Another question: If a province signs a bilateral agreement with Ottawa to provide diabetes medications under pharmacare, will the provincial drug plan continue to cover other diabetes drugs on its own benefit list? If so, this will create further inequities beyond those already existing. But if not, all diabetes patients in the province will have poorer access to medicines they need.

National pharmacare with such a restricted list of diabetes medications is likely to result in increased hospitalizations, specialist interventions, disease complications and premature deaths. Our health-care system is already stretched to the breaking point. Limiting access to diabetes medications will save money only if you focus exclusively on the drug budget. When you consider all impacts on patient well-being and productivity it’s likely to cost more in the long run.

Canada’s governments should focus on providing Canadians with innovative medicines that can decrease the need for other services, reduce complications and extend lives — not on rationing medicines or even outright denying them to Canadians.

Nigel Rawson is a senior fellow with the Macdonald-Laurier Institute, as is John Adams, who is also co-founder and CEO of Canadian PKU and Allied Disorders Inc.

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