Jan Hux 

The recent attention given to health care affordability south of our border has received international interest, thanks in part to the troubling stories of U.S. citizens with Type 1 diabetes coming to Canada to purchase more affordable insulin, a therapy needed to live. It’s hard to imagine residing in a country where a person already dealing with the difficult task of managing a chronic disease like diabetes are also unable to afford their prescribed medication. 

Or is it?

Despite our reputation for quality health care we live in a country where since 2013 there’s been no strategy to address one of the most significant health care challenges of our time—the diabetes epidemic. Canadians living with diabetes are feeling the brunt of it, which is why Diabetes Canada has been urging all governments to take strong steps to address the epidemic of diabetes—a disease that already affects one in three Canadians directly and is growing at a rate of 40 per cent per decade. More specifically, we are recommending Diabetes 3600, a nationwide strategy that brings together metrics, best practices and continuous improvement expertise through partnership with the provinces, territories and municipalities to address key needs for people with or at risk of diabetes.  

Let’s look at what’s happening in Canada when it comes to managing diabetes. We have significant problems with affordable access to diabetes medications, devices and services. Variation in public, private and out-of-pocket payments creates a patchwork quilt of coverage across the country that affects not only medication but test strips, syringes, needles and the latest glucose monitoring devices. Those gaps in access lead to suboptimal treatment and, in turn, a heavier burden of complications such as blindness, amputation and kidney failure.

The announcement from the U.S. administration indicating plans to import Health Canada-approved prescription drugs raises concerns of potential drug shortages on this side of the border and has prompted some much-needed attention from Canadian policymakers. 

The U.S. government’s choice of the path of least resistance to addressing drug prices comes with significant risk to Canadians with diabetes. At the local level, the “insulin caravans” threaten to clear out supplies at small border-town pharmacies. Fortunately, reports of such supply shortages have been very limited so far but the stakes are high for those with Type 1 diabetes for whom a gap in access of even a day or two can be life-threatening. Should dozens of states start importing insulin in bulk—as pending legislation would allow—the risk goes up substantially. As we said in a recent letter co-signed by a number of Canadian health and consumer organizations, the Canadian drug supply is not sufficient to meet the demand of a market 10 times larger. If medications manufactured for a Canadian marketplace are somehow diverted by demand from south of the border, the cost to Canadians could be incalculable. Now is the time for Canada to develop a strategy that will prevent potential drug shortages, rather than waiting for this inevitable situation to occur.

Of course, while Canadians with diabetes need assurance that their government will protect their access to insulin and other essential medications, that reassurance will not be enough. Addressing isolated issues in response to a threatened crisis, as in the case of U.S. importation of insulin, neglects the greater need for a comprehensive approach to address this epidemic and the unsustainable burden it creates for individuals and health care systems. A priority issue for all federal election candidates to tackle is the need for an integrated strategy to address diabetes, from prevention, through screening to treatment and all within a measurement framework that will demonstrate that ambitious targets are being met. The collaboratively developed Diabetes 360º framework represents just such a strategy and Canadians with and at risk for diabetes deserve no less.  

Dr. Jan Hux is the President and CEO of Diabetes Canada. She holds an MD from the University of Toronto and a Masters in Epidemiology from Harvard.