Insulin pump program changes need a rethink
Cost-cutting will have major impacts on health, well-being
About 40,000 Albertans live with Type 1 diabetes, a condition where the pancreas fails to produce enough insulin. The cause of Type 1 diabetes remains unknown, and we do not know how to prevent it.
The good news is that we now have two technologies that help reduce the burden. The first is the insulin pump, which allows people to finely tune delivery of insulin doses, avoiding the need for multiple daily injections. The second is the continuous glucose monitor (CGM), which lets people know blood sugar levels in real time instead of relying on painful and inconvenient daily finger pokes. Excitingly, there are even artificial pancreas systems where pumps talk to continuous glucose monitors to adjust insulin doses automatically, significantly improving blood sugar control and quality of life. Access to these technologies can provide people with a sense of normalcy in their day-to-day lives.
The bad news is that managing Type 1 diabetes is extremely expensive, even with private insurance. Without access to medication and supplies, people living with diabetes are forced to “drive blind,” dosing insulin without knowing their blood sugar levels. In financial distress, they may sometimes unsafely reuse supplies or ration insulin. Inaccurate insulin dosing can lead to complications such as seizures, coma, stroke, kidney failure, blindness, and amputation.
These complications increase physical costs to individuals, and financial costs to the taxpayer.
The Alberta Insulin Pump Therapy Program (AIPTP) provides access to insulin pumps and supplies, eliminating a large financial barrier to therapy. In August 2021, the Alberta government announced a flawed three-phased approach for access to diabetes technologies.
The first phase involved coverage for CGM for children under 18 years old. The challenge is that children with Type 1 diabetes grow into adults with Type 1 diabetes who are left with a yearly $3,600 bill if they want to continue using these life-changing devices into adulthood.
CGM technology is now the gold standard of care according to Diabetes Canada and is covered by government health plans in other provinces like Ontario and Prince Edward Island.
The Alberta government wants people in the AIPTP to pay for additional private insurance which does not adequately cover the costs associated with pumps. Their proposed changes mean additional costs to manage an already burdensome and expensive lifelong condition.
It is important for Albertans to understand that for people with diabetes to live some semblance of a normal life with Type 1 diabetes, the AIPTP program is a necessity, not a luxury.
The government's proposed changes suggest that there has been no meaningful consultation with people living with Type 1 diabetes. After public uproar over the proposed changes, the government hosted a town hall. At the town hall, callers raised concerns about a lack of consultation, oddly structured single-versus-family co-pay models, the government's hardline focus on immediate cost savings and the government's ignoring of evidence showing pumps and CGMS help people live more fulfilling lives while reducing costly health complications.
The government's plan has also ignored evidence showing that models of co-pay reduce quality, access and equity of care — and do not reduce overall health-care spending.
It also appears that recommendations to AIPTP published in 2021 in the Canadian Journal of Diabetes were not considered.
Further decisions on changes to this program must meaningfully engage the Type 1 diabetes community and be evidence-informed.
The Canada Health Act states that “continued access to quality health care without financial or other barriers will be critical to maintaining and improving the health and well-being of Canadians.” All Albertans should be concerned that a new precedent is being set for those with life-threatening chronic conditions.
Alberta is a worldwide leader in diabetes health care and research, yet the UCP health policies remain substandard for people living with Type 1 diabetes.
When changes to health policy do not include consultation from those affected, are we doing more harm than good?