Thank you for the opportunity to speak with you today about a matter that touches us all, access to medicines for all Canadians.
I'm the chief science officer at the Canadian Diabetes Association, and I speak to you in that capacity, because having access to medicines is essential for more than three million Canadians who've been diagnosed with diabetes.
People with diabetes rely on medications to manage their disease and to achieve better health outcomes and quality of life. Unfortunately, not all of these patients have access to prescribed medication because of cost. This is problematic for the individual, their family, the health system that has to manage the health impact of poorly managed diabetes, and also to our society. We've become a country where access to essential medicines is determined by the place you live and how much money you have.
A survey in 2014 shows that 32% of people with diabetes took three to four drugs, 40% took five to nine drugs, and 12% took 10 or more medications. As you know, public coverage varies widely, depending on an individual's age, the amount and type of medication required, and their income. With private insurance such as employer insurance plans, drug access also varies considerably.
Hefty out-of-pocket costs can force people to have to choose between paying for food and rent or buying medication and supplies. People with low incomes but above the threshold for social assistance, those who work part-time, and those who are self-employed are the ones most impacted by out-of-pocket costs. We hear stories about people who have to make tough choices to pay for medication and the resulting impact that has on their physical and mental health and on their families. There are parents with type 2 diabetes who forgo their medication because their children need things like clothes and school supplies.
Drug costs are particularly difficult for chronic disease patients and those earning a low income. One study showed that 23% of people with chronic disease skipped medication due to cost compared to 10% in the overall population. In the diabetes population, our 2015 survey showed that 25% of people with diabetes reported that their adherence to prescribed therapies was impacted by cost. In another study, people with diabetes who lacked insurance were five times more likely to skip medication compared to those with insurance. Some individuals cut their dose in half just to make the medication last longer. The risk for medication non-adherence is greater for an asymptomatic condition like diabetes because, if the person skips the medicine today, they may not feel any different; however, over the long term, medication non-adherence increases the risk of the complications of diabetes such as blindness, amputation, and heart disease.
More and better treatments for diabetes have become available, and they are leading to better health outcomes for those who take them. Over the last two decades the rates of major complications of diabetes, such as heart attack, amputation, and stroke, have been cut in half, and that improvement is attributed almost entirely to the use of evidence-based therapies. Unfortunately, not all Canadians stand to benefit from these advances because they can't afford them.
There have been studies that have shown that a national pharmacare program or drug plan, one that replaces the current mix of public and private plans, could reduce public and private spending on prescription drugs. I'm not here today to advocate for a specific model, because there are benefits and costs to each of the different approaches, and these have not been clearly laid out for Canadians to understand. It is clear that getting people the medicines they need by removing cost barriers is something that resonates with Canadians.
This brings me to our first two recommendations: first, that the Government of Canada study the benefits and costs of various approaches to national pharmacare that would offer universal access to Canadians and publicly report on the results; and second, that the Government of Canada should adopt an approach to national pharmacare with a goal to reduce out-of-pocket costs for people with diabetes, to eliminate costs as a barrier to optimal drug therapy and better health outcomes.
It's critical that people with diabetes be active participants in the design, development, and implementation of a system that will ultimately be serving their medical needs. Patients must be at the centre of changes to the system. Our next recommendation is that people with diabetes be included as active participants in the development and implementation of the government's approach to national pharmacare.
As a clinician, I know that getting patients the right medication for their condition is partly the responsibility of the health care provider, so a national approach to pharmacare that is about improving access to needed medications should include supporting optimal clinical practice. One of the most effective ways to promote appropriate prescribing behaviour is with the assistance of proven technologies such as the electronic medical record.
Decision support tools encourage evidence-based prescribing by health care practitioners to help ensure individual patients receive the most clinically appropriate, safe, and cost-effective treatment for their disease. Providing health care practitioners with best practice information at the point of care to support their decision-making has been shown to improve outcomes, specifically for patients with diabetes. This support is an important component of leading the charge to ensure the right patients get the right drugs. So our final recommendation is that the Government of Canada take a leadership role in implementing support tools for diabetes management by incorporating electronic medical records into health systems within their jurisdiction and encouraging the provinces to do the same.
Again, thank you for your interest in this vitally important topic and for the invitation to speak with you. I look forward to our conversation.