Drug plans cuts create long-term pain
The provincial government plans to save $5.5 million a year by making cuts to the Newfoundland and Labrador Prescription Drug Program (NLPDP).
The NLPDP is publicly funded and used by the province’s poorest. Roughly $12 million will be removed from the program this year through cancelled coverage for most over-the-counter medications written with a doctor’s prescription, and limitations on test strips used by diabetics to monitor bloodsugar levels.
Health and Community Services Minister John Haggie, under whose jurisdiction the NLPDP falls, said most of the $12 million will come from the reduction in test strips.
“The reduction in the estimates line for the NLPDP of $12 million is made up of several components,” he said. “You mentioned in some detail the over-the-counter medications. The actual fact, the bigger portion of that will come from reduction in the number of diabetic test strips applied and in addition to that, that will take up most of that difference.”
The provincial estimates show that $137,185,200 will be spent on drug subsidization in 2016-17 as compared to $149,322,400 in 2015-16. Most over-the-counter medications were no longer covered as of May 1. Test strips to indigent diabetics will be limited as of July 1.
This latter measure is not sitting well with Jake Reid, the Director of Government Relations and Advocacy for Atlantic Canada at the Canadian Diabetes Association (CDA). He describes Newfoundland and Labrador as having “more people with diabetes than anywhere in Canada” and foresees difficulties should the government proceed with their limits.
At present, all NLPDP-funded diabetics receive 2,500 test strips a year. The limitations would see those on short-acting insulin still receive the 2,500, those on long-acting insulin would be reduced to 700, those not insulin dependent 100, and those who manage their condition solely through diet would receive 50. These are yearly figures.
Finance Minister Cathy Bennett says the limiting of the test strips is “consistent with national guidelines” or according to Reid, those of the Canadian Agency For Drugs And Technologies In Health (CADTH).
Haggie, a medical doctor, says the limitations are consistent “with other jurisdictions” and have the endorsement of the CDA. These comments have brought a rebuke from Reid, who describes CADTH as mainly concerned with the economics of health care. He also accused the province of falling behind CADTH limits where some insulin-dependent diabetics are concerned.
As an example, he cites the provision that will limit mainly Type 2 diabetics using long-acting insulin to 700 strips. “The CADTH breakdown doesn’t say anything about type of insulin,” he says. “CADTH says if you’re using insulin you should have access to more frequent testing. So they don’t break it down that way. But for some reason Newfoundland and Labrador (does). In that particular case, they’re not even following CADTH guidelines.”
Reid acknowledged the province could make exceptions to that directive. He supports maintaining the 2,500 test strips presently given each year to all insulin-dependent diabetics.
Some of the new limitations, he said, do not conform to CDA minimum guidelines and Haggie is wrong when he says the policy to be implemented this summer is “in line with other jurisdictions.” These jurisdictions, he explained, “have higher quantity limits.” And although he was referring primarily to Ontario, British Columbia, and Saskatchewan, he said all provinces, except New Brunswick and Prince Edward Island “are meeting or exceeding our minimum access guidelines and we believe that should be the standard for diabetes care. No province that has decided to institute limits has gone totally with the CADTH recommendation. They’ve gone, at least, with ours or better.”
Reid was also critical that diabetics not using medication will be limited to 50 strips a year, not the 180 recommended by the CDA, and fears the underprivileged will suffer.
“You can’t manage what you don’t measure,” he said, and described the Ball government’s decision as “short-term savings for long-term loss.”
If a diabetic can’t afford to manage his or her condition, we could, Reid said, see a rise in diabetes-related complications such as amputations, stroke, kidney dialysis and eye disease.
“There’s a reason why we’re seeing growth in a lot of these issues in Newfoundland and Labrador, why are more people passing away from heart-related events, why are there more people requiring kidney dialysis. These things are driven by numbers of people with diabetes.”
And they are problems that will cost the government much more in the long run.
While Reid again acknowledged the “exception policy,” he said it would enable this group to receive a total of 100 strips yearly, as far as he knew. This is still 80 short of he recommendations of his association and would also require “a bit of a process” which he described as “an added barrier for people.”
For the diabetic who may be short-changed by government and is forced to pay outof-pocket, test strips are not cheap. A check with a couple of pharmacies in the area revealed that a pack of the sort covered by the NLPDP costs from $50 to $93, approximately.
NDP Health and Community Services Critic Lorraine Michael expressed concern over a provision in a CADTH report that said Type 2 adult diabetics controlling through diet alone need not routinely self-monitor but rather have any monitoring done by their doctor through blood tests. This in a province where Michael said many don’t have “easy access to a doctor” and where many also can’t afford to eat healthy as part of their diabetes-management program.
She said if the measures are implemented, government should evaluate their impact after a year and so far they have not said they will. She is also worried that the de-listing of most over-the-counter medications to the majority of NLPDP users will increase poor health and emergency-room visits because necessary supplements and vitamins are no longer available to them.
A statement from Haggie’s department said roughly 15,800 people received governmentfunded test strips in 2015-16 so far. The highest per cent was old-age pensioners receiving the Guaranteed Income Supplement.
The leader of the PC Opposition and Health Critic Paul Davis did not return phone calls.