Evidence of meeting #144 for Finance in the 44th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was health.
A video is available from Parliament.
Bloc
Gabriel Ste-Marie Bloc Joliette, QC
Thank you.
What reasons does the government give for not including these new drugs in its insurance plan? Is cost the issue? Do you think its arguments are persuasive?
Doctor, BC Diabetes Foundation
To my knowledge, they haven't made any arguments. They just decided to strike it off. It's an outrage. Speaking as a diabetes specialist, I have several thousand people on this drug and there's nothing quite as good.
There are other flavours from other manufacturers. Novo Nordisk has Ozempic and Eli Lilly has Mounjaro. Other companies will be coming up with better drugs in the future. It's a competitive market. Prices will go down in Canada. Of course, if our procurement process could get better prices for the nation, as in Germany, then it would be a no-brainer.
Bloc
Gabriel Ste-Marie Bloc Joliette, QC
That is very clear. Let us hope that the government hears you. Thank you and thanks to Ms. Hosak for your presentation.
It was very touching, Ms. Hosak.
Thank you, Mr. Chair.
Liberal
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Thank you to all the witnesses for being here on such short notice.
Dr. Elliott, can you give us an idea of what a typical Canadian living with diabetes might spend out-of-pocket each year to manage their condition today?
Doctor, BC Diabetes Foundation
In type 1 diabetes, for someone like Ramya, before she had her extended medical benefits, it would be, say, eight dollars for the sensor, $10 for the pump and six dollars for insulin. With a bit here and a bit there, it would add up to $28. If I multiply $28 by 365, it's $10,220. That's someone with uncomplicated type 1 diabetes, someone who doesn't have major complications.
If you have type 2 diabetes, let's say it's $12 to $15 per day. That's $4,400 a year. If you're an overweight type 2, of whom two-thirds are, you need to be on Ozempic and you need to be on metformin, which is inexpensive. You need to be on one of the SGLT2 inhibitors at three dollars a day, a cholesterol pill at 50¢ and a blood pressure pill at another dollar, and maybe insulin. That's where the $12 to $15 per day comes from.
NDP
Don Davies NDP Vancouver Kingsway, BC
Dr. Elliott, in a March 2024 CBC News article, you noted that one of your patients was hospitalized last year because he could not afford to buy medication after paying for groceries. How frequently does cost-related non-adherence to treatment result in the hospitalization of Canadians with diabetes? Can you briefly outline the impact of such a hospitalization on patient health and well-being?
Doctor, BC Diabetes Foundation
I hear a story like that two or three times a year. British Columbia has the most generous provincial pharmacare program.
Bloc
Gabriel Ste-Marie Bloc Joliette, QC
I have a point of order, Mr. Chair.
I am sorry to interrupt you, but the interpreters have stopped working, given the poor sound quality.
Liberal
The Chair Liberal Peter Fonseca
I apologize. I didn't catch that.
The interpreters are having some connectivity trouble with Mr. Elliott.
Doctor, BC Diabetes Foundation
I wish I could speak in French. I could fumble in French.
Liberal
The Chair Liberal Peter Fonseca
Ms. Hosak, can you participate? Maybe you can answer some of the questions. If Dr. Elliott turns off his screen, that might help the connectivity.
BC Diabetes Foundation
I hear stories like this from my peers all the time as well, with hospitalizations from high blood sugar, but also from low blood sugar. I think the real benefit of the automated insulin delivery system that I spoke of is that you're alerted. Let's say you're driving and you're not able to stop and physically prick your finger to test your blood. It alerts you, it wakes you up and it temporarily suspends your insulin. It gives you an alert so that you know you're going low.
Sleeping is one of the biggest problems. You can imagine that you would be terrified to go low in the middle of the night, but so are parents. We hear this quite a bit too. They're worried about their children, who are running around and sleeping. They don't know how they're feeling.
Hospitalization is very traumatic. It's very scary. I can tell you from my perspective, as I said, that after 2016, it took me many years to feel comfortable again. I have heard of diabetics going into seizures as well. All this stuff has a cumulative toll on the person, and of course, as we know, hospitalizations are very expensive.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you, Ms. Hosak.
This gives me a chance to point out that as part of the pharmacare deal negotiated by the NDP, the federal government agreed to provide $275 million per year to establish a fund to support access to the full range of diabetes devices: continuous glucose monitors, insulin pumps, testing strips, syringes and needles. The idea is that every person with diabetes in the country whose provincial government signs an agreement with the federal government will get free access to all of the devices they need.
I take it you would be in support of such a program.
BC Diabetes Foundation
I would be one hundred per cent in support of such a program, but I would also ask for the consideration of an automated insulin delivery system. The game-changer with that is the Dexcom glucose CGM, which will talk to your pump. You have an artificial pancreas that's working for you, and when they talk to each other, the magic happens.
NDP
Don Davies NDP Vancouver Kingsway, BC
Yes. It's my understanding that those are covered.
I don't know if we have Dr. Elliott back or not, Mr. Chair. Can I ask a question of Dr. Elliott?
Liberal
The Chair Liberal Peter Fonseca
I don't think he's on right now. He has to open his mic and video. We are not able to do it, and the interpreters need the video to see the body. He's not on, MP Davies.
NDP
Don Davies NDP Vancouver Kingsway, BC
In the absence of having Dr. Elliott confirm this, I just want to point out that the formulary negotiated for pharmacare includes pretty much every insulin required for type 1 diabetes. In fact, it mirrors one hundred per cent of the coverage offered in British Columbia so that every person living with type 1 diabetes will be able to get the insulin they need.
In terms of type 2 diabetes, it covers all of the metformins, including the combination metformins, which you generally have to try and then fail before you go to semaglutide, which is Ozempic. The reason Ozempic is not covered is that it's only available in brand name in this country right now and is extremely expensive. About a third of B.C.'s expenditures on type 2 diabetes are on Ozempic, and there is also a problem right now with off-label use, but it could be covered in the future. We're well aware of the importance of semaglutide. SGLT2 inhibitors and secretagogues are also covered for type 2 diabetes as well as all the devices.
I just want to put on the record that there's a full complement of all of the medications and devices that people with diabetes type 1 and type 2 need in Canada, save for and except Ozempic, which we hope will be covered in the future, as Dr. Elliott pointed out. I just wanted to state that for the record.
Liberal
The Chair Liberal Peter Fonseca
Thank you, MP Davies. That I'm sure is very helpful for those watching and for the record.
That is the time. Now we're going into our second round.
Members, I'm looking at the time. We don't have a lot left, but what we're going to do is two to three minutes for each party.
We'll start with MP Morantz.
Conservative
Marty Morantz Conservative Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
Professor Dehejia, last time you were here, you had an exchange regarding the carbon tax. One of the members mentioned the open letter that many Canadian economists signed on to. You didn't have a chance at the time to respond to that comment in person.
I know that you did submit something in writing, but I think that since you're back and you're here in person, I'll give you a chance to let the committee know your thoughts on that open letter.