Canada Launches Pharmacare Bill, Aims to Improve Diabetes Care

On February 29, 2024, the federal government of Canada introduced Bill C-64, establishing the National Pharmacare Program. This significant legislation promises to enhance access to diabetes medications and a device fund, marking a potential breakthrough for the over four million Canadians living with diabetes.

While this development raises hopes for improved treatment access, concerns about the program’s execution cast a shadow over its potential benefits. Glenn Thibeault, Executive Director of Government Affairs, Advocacy and Policy for Diabetes Canada, emphasizes the urgency of ensuring that the pharmacare initiative effectively addresses the needs of those impacted by diabetes.

The introduction of this bill is a recognition of the pressing requirement for better access to medications and devices for individuals with diabetes. For many, the affordability of treatment can mean the difference between maintaining good health or facing severe complications. Yet, Thibeault warns that the current proposal may not align with modern clinical practice guidelines, which could leave many patients behind.

Critical Gaps in Coverage

The proposed list of covered medications under the National Pharmacare Program has raised concerns among advocates. Many of the most commonly prescribed and clinically recommended diabetes medications are absent from this list. Instead, older, less effective treatments are included, indicating a focus on cost rather than quality of care. Thibeault describes this as a “lowest-cost” approach rather than a “best-care” strategy.

If the agreements between the federal government and provincial authorities proceed without amendments, uninsured and underinsured Canadians will continue to face significant coverage gaps. Patients may find themselves caught between their healthcare provider’s recommendations and the limitations of the public plan. This scenario risks creating a two-tier system where those who can afford necessary medications are prioritized, while others are left with inadequate options.

Furthermore, individuals who currently have private insurance or employee benefits may find their medication coverage diminished as insurers assume that pharmacare will fill those gaps. This shift could exacerbate the situation, leaving many without the medications their doctors prescribe.

Opportunities for Improvement

There remains an opportunity for the Canadian government to refine the pharmacare model. By moving away from a rigid single-payer system to a multi-payer approach, the government could complement existing public and private coverage. This shift would preserve patient choice while expanding access to necessary medications.

To enhance the effectiveness of the program, Thibeault outlines several recommendations for improvement:

1. **Close the gaps** — Ensure that all medications recommended by Diabetes Canada’s clinical practice guidelines are included. These guidelines are developed through thorough evaluation of thousands of studies, ensuring relevance and quality.

2. **Do no harm** — Protect current patients by guaranteeing continued access to their existing medication coverage.

3. **Focus on equity** — Prioritize the needs of uninsured and underinsured Canadians so that no one is left behind in accessing essential treatments.

4. **Build in continuous improvement** — Mandate regular updates to the medication formulary, allowing for the inclusion of newer, more effective treatments as they become available.

5. **Listen to lived experience** — Involve patients, clinicians, and advocates in the development and finalization of bilateral agreements.

Canada now stands at a pivotal moment. The National Pharmacare Program has the potential to be a robust, modern initiative that ensures equitable access to medications for all Canadians, regardless of their financial situation. Conversely, it risks becoming an outdated system that provides inadequate support for those who need it most.

As the government moves forward with this legislation, it is crucial to seize this opportunity to create an effective pharmacare program. Done correctly, it could significantly improve the lives of those living with diabetes across Canada.