Drug plans cuts cre­ate long-term pain

The Compass - - EDITORIAL - Pat Cullen Pat Cullen is a jour­nal­ist and com­mu­nity vol­un­teer who lives in Car­bon­ear. She can be reached at 596-1505 or cullen.pat1@gmail.com.

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.

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