Diabetes: Access to Medications, Devices & Supplies

1. Diabetes:Access to Medications, Devices & Supplies 7th Annual Market Access Summit 4 December 2008, Toronto Karen Philp, Vice President Public Policy & Government Relations Canadian Diabetes Association

2. 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.

3. 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.

5. 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 individual’s 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

6. 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.

7. The reality today • It still matters where you live, if you have diabetes. • Greatest personal challenge remainsaffordability & access to diabetes medications, devices & supplies to manage the disease & reduce the risk of costly health complications.

8. Disparities in 2008 drug listings

9. 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

10. Insulin pumps & supplies 2008 * Government commitment to cover cost made public.

11. 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

12. 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

13. Public policy in the short-term • Provincial / Territorial: • Ontario’s $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

14. 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.

15. 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.

16. 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.

17. Thank you! For more information, please contact: Karen Philp, Vice President Public Policy & Government Relations Canadian Diabetes Association Phone: 416-408-7041 Email: Karen.Philp@diabetes.ca