PETITION: Remove the Pharmacare Deductible for Diabetes Drugs & Devices

Announcements, Living With Diabetes, News & Media

Author: Tristan Elliott

Petition calling on the BC Ministry of Health, Division of Pharmacare to:
Remove the Pharmacare Deductible for Diabetes Drugs & Devices

CLICK HERE TO SIGN THE PETITION AT CHANGE.ORG

To: BC Ministry of Health, Division of Pharmacare

Re: drugs & devices subject to Pharmacare deductible

The undersigned request that the following life-sustaining drugs & devices for the treatment of diabetes no longer be subject to the Pharmacare deductible:
insulin, continuous glucose monitors (CGM), and insulin pumps.

Diabetes affects 9.3% of the population: that’s around 450,000 people in British Columbia.  It is caused by a lack of insulin in the body.  During the initial stages of treatment, lifestyle modification alone, and then the use of oral medication, is usually sufficient.  Ultimately insulin therapy is required in the majority of cases.  In many individuals living with Type 2 diabetes (and all living with Type 1 diabetes) insulin needs to be injected multiple times a day (or given via insulin pump) – those on multiple daily injections or pumps also need to prick their finger to get a sugar value a minimum of 10 times per day (or use a CGM).  Doing all of this diligently is exhausting taking an average 14 hours per week.  And it is expensive – read on.

Insulin, CGM and insulin pumps as life-saving therapies
Without daily insulin injections individuals with severe insulin dependent diabetes can die within 48 hours.  Insulin is therefore a life-sustaining drug.

Glucose (sugar) levels will rise above a healthy level when insufficient doses of insulin are given.  Years of high sugar levels irreversibly damage the body organs leading to blindness, kidney failure, nerve damage, amputations, heart attack and stroke.  When too much insulin is given sugar levels go low (hypoglycemia) – this is dangerous because sugar is the fuel of the brain.  As sugar levels drop below normal a predictable series of events follow: impaired judgment and altered behavior, reduced level of consciousness, seizures, coma, and death.  Continuous glucose monitors are the only devices able to measure sugar frequently enough to allow for optimal control of high sugar, and to prevent low sugar.  CGM is therefore a life-sustaining device.

Automated insulin delivery (AID = “closed loop” & “artificial pancreas”) can be achieved with the integration of an insulin pump, a CGM, and a smartphone app to allow insulin doses to be adjusted precisely & safely minute to minute.  AID provides better sugar control than what is achievable with conventional insulin administration using insulin shots or an insulin pump not connected to a CGM.  AID reduces low sugar, improves quality of life, and in 2022 is the standard of care in insulin dependent diabetes.  Insulin pumps, a component of AID, are therefore a life-sustaining therapy.

The cost of insulin, CGM and insulin pumps
Insulin costs around $0.05 per unit: with an average requirement of 100 units of insulin per day, the average person living with insulin dependent diabetes must spend $5.00 per day on insulin alone.  CGM costs around $10.00 per day.  Insulin pumps and their accessories cost around $10.00 per day.  The combined average cost for insulin, CGM and insulin pump & accessories is therefore $25.00 per day, $761 per month and $9131 per year.

Aren’t diabetes life-sustaining therapies already covered by BC Pharmacare?
Yes, however this coverage is subject to a deductible or threshold that resets every year on January 1.  This deductible/threshold is based on net family income taken from line 23600 of tax returns from two years prior.  Pharmacare uses two terms: the “Family Deductible” & the “Family Maximum” to determine coverage. When Pharmacare eligible expenses reach the Family Deductible, Pharmacare provides a 70% subsidy & when Pharmacare eligible expenses reach the Family Maximum, Pharmacare provides a 100% subsidy.  This table outlines Family Deductibles and Family Maximums for British Columbians in detail.  Families with assessed income < $13,750 receive all BC Pharmacare endorsed medication and devices at no charge – they automatically qualify for a 100% Pharmacare subsidy.  Families with income in the $13,750-30,000 range immediately qualify for a 70% Pharmacare subsidy (Family Deductible) but they need to spend 5% of the difference between their income and $30,000 to qualify for a 100% subsidy (the Family Maximum).  So a family earning $20,000 per year will have to pay 5% of $10,000 = $500 before they hit their Family Maximum to receive BC Pharmacare approved drugs and devices at no cost.  Families with income >$30,000 have to spend 2.5-3.0% of the difference between their income and $30,000 to get the 70% subsidy (Family deductible) and 3.5-4.0% of the difference between their income and 30,000 to get to 100% subsidy.

The deductible and diabetes?
The average Family Deductible for British Columbians is $2500 per year.  For a person living with diabetes using insulin, CGM and an insulin pump spending $25 per day, it will take 100 days, or more than 3 months, before they hit the Family Deductible – at that point they receive a 70% subsidy on insulin, CGM and insulin pump – they pay only 30% of the price.  At $25 per day 30% of the price is $7.50.  They have to spend $7.50 per day for another 113 days before they reach their Family Maximum of $3350 to receive insulin, CGM and insulin pump at no cost.  So the number of days to get to 100% Pharmacare coverage is 100 + 113 = 213 days.  Since the Pharmacare deductible resets every January 1, it is not until August 2 every year that someone living with insulin dependent diabetes gets their life-sustaining therapy at no cost.  

How much does BC spend on life sustaining therapy for other conditions?
The BC Ministry of Health covers 100% of life sustaining costs for the following treatments and chronic conditions: 

• $277 Million per year on transplants and life sustaining immunosuppressive medications for 4825 transplant patients, or $57,367 per patient per year.
• $158 Million per year on hemodialysis for 2635 patients, or $60,000 per patient per year.
• $452 Million per year on 50,000 cancer patients, or $9040 per patient per year.
• $3 Million per year on cystic fibrosis and the necessary digestive enzymes for 385 patients in BC, or $7792 per patient per year.
• $54 Million per year on psychiatric conditions and its medications for 50,000 people living with mental illness, or $1080 per person per year. 
• $15 Million per year on HIV treatment for 5,000 British Columbians living with HIV, or $3000 per patient per year.

All together, $959 million is spent per year on people who are covered by Pharmacare plans outside of Fair Pharmacare.  Adding insulin dependent diabetes to the list of covered conditions would be a marginal increase in cost, and this would be expected to be recouped in reduced healthcare costs within 5 years.  Insulin dependent diabetes is life threatening, time consuming, and currently all too expensive to manage. Help us achieve our goal of extending Pharmacare coverage for people suffering from insulin dependent Diabetes such that the medications and devices they require do not come at the cost of sacrificing financial freedom.

The ask
This petitioner asks that insulin, CGM and insulin pumps be no longer subject to the BC Pharmacare deductible.  The British Columbians living with insulin dependent diabetes deserve to be treated the same way that other British Columbians with life-sustaining therapy are treated – by providing these therapies at no cost. 

BC Diabetes, the biggest diabetes clinic in British Columbia, runs on a case management model and is free for anyone covered by the Medical Services Plan. We offer all of our services both in-person and virtually and are accepting new patients. If you want to find out how to join, contact us by email at:  questions@bcdiabetes.ca