Diabetes: Access to Medications, Devices

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DiabetesAccess to Medications, Devices
Supplies

• 7th Annual Market Access Summit
• 4 December 2008, Toronto
• Karen Philp, Vice President
• Public Policy Government Relations
• Canadian Diabetes Association

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The Challenge of Diabetes

• 2.4 million Canadians living with diabetes.
• 74 report at least one diabetes complication.
• Est. 17.4 billion impact on Canadian economy.
• 5.6 billion in 2005 to treat diabetes in acute
  healthcare system.
• 1 in 10 admissions to acute care hospitals in
  2005 was for diabetes or a diabetes related
  complication.

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The evidence is clear in 2008

• Effective diabetes care supported by
  evidence-based clinical practice guidelines
  within an interdisciplinary healthcare team
  setting optimizes health outcomes for people
  living with this chronic disease.

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2008 CPGs T1DM

• Basal-prandial insulin regimens (e.g. multiple
  daily injections or continuous subcutaneous
  insulin infusion) are the insulin regimens of
  choice for all adults with type 1 diabetes.
• Insulin regimens should be tailored to the
  individuals treatment goals, lifestyle, diet,
  age, general health, motivation, hypoglycemia
  awareness status ability for self-management.
• All individuals with type 1 diabetes should be
  counselled about the risk, prevention treatment
  of insulin-induced hypoglycemia

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2008 CPGs T2DM

• If glycemic targets are not achieved within 2 to
  3 months of lifestyle management,
  anti-hyperglycemic pharmacotherapy should be
  initiated.
• Timely adjustments to and/or additions of
  anti-hyperglycemic agents should be made to
  attain target A1C within 6 to 12 months.
• In patients with marked hyperglycemia (A1C
  9.0), anti-hyperglycemic agents should be
  initiated concomitantly with lifestyle
  management, and consideration should be given to
  either initiating combination therapy with 2
  agents or initiating insulin.

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The reality today

• It still matters where you live, if you have
  diabetes.
• Greatest personal challenge remains affordability
  access to diabetes medications, devices
  supplies to manage the disease reduce the risk
  of costly health complications.

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Disparities in 2008 drug listings
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Trends in drug listings
Drugs available in 2001 Actos, Avandia,
Chlorpropamide, Glyburide, Diamicron, GlucoNorm,
Metformin, Tolbutamide, Prandase. In 2008
Actos, Amaryl, Avandamet, Avandia, Diamicron MR,
R Glucagon, GlucoNorm, Glyburide, Humalog,
Insulin regular, Metformin HCL, Novo Rapid,
Prandase, Starlix, Tolbutamide, Lantus, Levemir,
Januvia
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Insulin pumps supplies 2008
Government commitment to cover cost made public.
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Opportunities challenging diabetes

• Pharmaceutical policy in Canada
• Common Drug Review
• COMPUS
• Insulin analogues
• Provincial/Territorial public drug plans
• BC, Alberta Ontario
• Federal political situation
• Minority government/coalition

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Advocacy in the short-term

• Training our diabetes advocates
• Young Adults with Diabetes Advocacy Program
• National Advocacy Leadership Forum 2009
• Diabetes Day on the Hill
• BC Diabetes Day Reception
• Providing advocacy tools
• Advocacy OnLine campaigns
• Diabetes Advocate newsletter
• Leaflets Reports

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Public policy in the short-term

• Provincial / Territorial
• Ontarios 741 million Diabetes Strategy
• Patient focus groups
• BC Pharmaceutical Task Force recommendations
• May 2009 provincial election
• Alberta pharmaceutical policy proposals
• Federal
• Common Drug Review
• Think tank on alternatives
• A national plan that ensures Canadians pay less
  than 3 of their annual adjusted family income on
  medications, devices supplies.
• Economic burden of diabetes report

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Why are we advocating?

• Canadians living with diabetes deserve better
  access.
• Fewer than 50 are at recommended A1c targets.
• Nearly 75 have complications resulting from
  their diabetes.
• 27 report having 2 or more complications.
• Of those reporting diabetes-related
  complications
• 60 have high blood pressure.
• 48 have high cholesterol.
• 36 suffer nerve damage.
• 22 suffer depression.

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Why are we advocating?

• Canadians living with diabetes cannot afford
  their medications, devices supplies.
• Research shows people with diabetes feel the cost
  is so high that government must provide
  medications, devices supplies.
• Canadians with diabetes still pay out-of-pocket
  for diabetes medications supplies.
• 46 of CDA members spend 50 to 200 per month on
  medications supplies.
• 28 spend more that 200 per month out-of-pocket.
• 1 in 4 report they cannot afford physician
  recommended medications nor access them through a
  public or private insurance plan.

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What can you do?

• Develop partnerships with organizations like the
  Canadian Diabetes Association.
• Support efforts to organize, train support
  advocates.
• Raise awareness with everyone about the impact of
  limited access on individuals but also all
  Canadians who pay the economic price of
  uncontrolled diabetes.
• 1 invested upfront 4 in savings across the
  system.
• Help us find the alternative process that ensures
  greater transparency, accountability improves
  access.
• Expertise experience.

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Thank you!

• For more information, please contact
• Karen Philp, Vice President
• Public Policy Government Relations
• Canadian Diabetes Association
• Phone [phone]
• Email Karen.Philp_at_diabetes.ca