Easing the Burden of Access and Cost
People living with diabetes experience significant medical and financial burdens. To ease these burdens, ensure an optimal quality of life and possibly prevent or delay costly and devastating complications, people with diabetes deserve equal and affordable access to the right medication, devices and supplies, regardless of where they live in Canada.
People with diabetes should have timely access to medication, supplies and medical devices that can improve their immediate quality of life and that may decrease the likelihood of future complications.
Federal, provincial and territorial governments should commit to the development of an effective formulary system (or systems), which is (are) consistent with Diabetes Canada’s Clinical Practice Guidelines and which do not create additional barriers to access.
Therapies consistent with Diabetes Canada’s Guidelines should be listed in a timely fashion.
A formulary is a list of drug benefits available under government drug insurance plans, specifying who is covered (i.e. seniors, people receiving social assistance), which drugs, supplies and medical devices (such as syringes, lancets, blood glucose test strips or insulin pumps) are paid for and at what percentage of the cost.
Each provincial and territorial government has its own formulary. The federal government also maintains formularies that apply to some Indigenous people, veterans, the Royal Canadian Mounted Police and others.
Once a new drug is approved by Health Canada, the drug manufacturer makes a submission to health officials in each jurisdiction for the drug to be listed on each of the respective formularies. An expert advisory committee reviews the therapeutic benefits and/or economic impact of the drug on the province/territory and makes a recommendation to the relevant Ministry of Health. Treasury Board approval may be required. Listing a drug on the formulary determines its accessibility through the public drug insurance plan. Private sector drug plans may develop their own drug benefit policies, however, some follow provincial formularies and pricing policies.
Medication, supplies and medical devices are broadly defined to include all currently-accepted therapies, as well as newer technologies such as insulin pumps. Herbal remedies and alternative therapies that are not included on drug plans are not included.
Background and rationale
There is great variation as to the medication, supplies and medical devices listed on federal, provincial and territorial formularies. Access to these items depends as much on where someone lives in Canada as it does on a person's income or health status.
Often, new drug treatments are not listed on provincial or territorial drug formularies in a timely manner, or they are listed with limited or restricted access. This makes them, for all intents and purposes, unavailable to the majority of people who might benefit from them. To prescribe a 'limited' or 'restricted use' drug, a physician (often a specialist) usually must undertake a detailed and time-consuming application process. These variations in how formulary drugs are listed and prescribed have a profound effect on consumer access and ultimately, consumer health.
People with diabetes need timely access to medication, supplies and devices that can improve their quality of life and potentially reduce or delay the onset of serious complications. This has the potential to save the health-care systems millions of dollars by way of fewer doctor visits, medical interventions and hospital stays.
One proposal for addressing this vital aspect of diabetes care and treatment is the development of a single, national drug formulary and a common review process for new drugs. Proponents of such a system outline the following potential benefits:
- elimination of the pressuring of one province to add a new drug to its formulary simply because a neighbouring province has done so;
- enhanced ability to research the benefits of a new drug by conducting the research at a national level; and
- lower drug purchase prices for public plans
Some of the concerns expressed about a common review and formulary system are:
- the system as a whole may fall to the lowest common denominator, with only the least expensive therapeutics being listed;
- additional barriers to timely access may be created by adding a new layer of co-ordinating bureaucracy to the review;
- regional disparities may not be addressed if every region still maintains its own autonomy; and
- a national formulary may further hinder the ability for provinces and territories to consider drug therapy expenditure within the larger context of health spending as a whole.
Ultimately, the success of any changes to current formulary systems will depend on the extent to which the changes ensure that the needs of people with chronic health problems are the primary focus.
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