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Concerns over lack of details, increased costs around changes to Alberta’s Type 1 diabetes insulin pump coverage

Click to play video: 'Changes to Alberta’s Type 1 diabetes insulin pump coverage trigger concern over lack of details, increased costs'
Changes to Alberta’s Type 1 diabetes insulin pump coverage trigger concern over lack of details, increased costs
Albertans with Type 1 diabetes are raising concerns after the provincial government announced changes to its insulin pump benefits program, that may leave patients paying more out of pocket. Nicole Stillger looks at the potential impact – May 3, 2022

Albertans with Type 1 diabetes are raising concerns, after the provincial government announced changes to its insulin pump benefits program that may leave patients paying more out of pocket.

Insulin pump therapy is a diabetes management method that uses a pump — a small, battery powered device about the size of a pager — to give small continuous amounts of insulin to patients instead of multiple daily injections.

“Being on an insulin pump changes my life,” said Lesley Thompson, a woman with Type 1 diabetes. “It’s a day and night change. Without a pump, you’re on multiple (insulin) injections a day. You’re testing your blood sugars, you’re figuring out all the things you need to do; every time you eat you have to figure out the math of how much insulin you would take.”

Previously, patients in Alberta could get their insulin pumps — which in Canada, can cost between $6,000 and $8,000 without coverage — paid for with the province’s Insulin Pump Therapy Program.

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However, this week the government said that program would be discontinued and those using it would be transferred to “government-sponsored health benefit plans” on Aug. 1. That change means that those without health plans from an employer will be required to sign up for government health coverage plans.

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The government says it will allow patients to access newer, more advanced models of pumps.

But Thompson, who has had Type 1 diabetes since she was 16 years old, says the announcement didn’t provide enough information — and that many employer benefit plans do not cover the pumps.

“(The release says) if you have employer-backed insurance it will cover it,” Thompson said. “But the thing is, a lot of employer-backed insurance doesn’t cover this, because (the Insulin Pump Therapy Program) covered it.

“And even before this program existed, (some) employer-backed insurance didn’t cover it. They considered it cosmetic. You can get by with multiple (insulin) shots a day, and good for you.”

Alberta’s Health Minister Jason Copping said Tuesday that the changes were made in response to the rising cost of managing Type 1 diabetes. In 2015, the government spent $9.5 million on the program; but in the 2020 to 2021 period the Insulin Pump Therapy Program cost more than $20 million.

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“This change actually allows us to be able to cover more expensive insulin pumps,” Copping said.

“For those who don’t have private coverage, they can get coverage through Blue Cross. But really this is setting us up for success down the road… we want to make sure that we can cover the cost for the greatest number of people.”

Click to play video: 'Edmonton mom worried about upcoming end to Alberta’s Insulin Pump Therapy program'
Edmonton mom worried about upcoming end to Alberta’s Insulin Pump Therapy program

According to the Alberta government, about 4,000 people in the province currently receive their insulin pumps, equipment and supplies through the Insulin Pump Therapy Program.

The changes are the final phase of a three-phase plan from the government that it says are meant to enhance care for people with diabetes. In Phase 1 announced in August 2021, coverage was provided for diabetes test strips and supplies. Phase 2 gave funding for continuous glucose monitors for patients under 18.

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The CEO of Diabetes Canada endorsed the changes to the pump coverage program, saying the organization looks forward to improving treatments for Albertans with the condition.

“Diabetes Canada looks forward to working with the government for continued improvements to access diabetes supplies, medications and devices that will help improve the quality of life for all Albertans living with diabetes,” Laura Syron said in the news release.

Diabetes Canada said it has heard concerns from Albertans about the change in coverage and it will continue to seek clarification on the details.

“It is also extremely important for individuals to have fair and equitable access to diabetes medications, supplies and devices and cost should not be a barrier to managing diabetes,” said Joan King, director of government relations with Diabetes Canada.

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But for Thompson, she worries about having to make a switch away from the pump if the new coverage isn’t adequate.

“Without this program, it’s financially concerning. Because insulin pump therapy is expensive.”

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Bernie Sanders joins group of Americans with diabetes to purchase cheaper insulin in Windsor, Ont.

“Not having 100 per cent coverage through this program means I (may) have to go back to multi-daily injections,” she said. “I will be on four plus shots a day, I will be on a long-acting and short-acting insulin. I will have less flexibility in my life.

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“It would be great to give people details, because right now a community of us — of 4,000 of us — that are on this program are really stressed because we don’t know what the future holds.”

Official Opposition health critic David Shepherd agreed there are concerns over the lack of info on how much the new system will cover.

“I would like to see some further details on how this process is going to work,” Shepherd said. “(We) want to make sure it is a smooth and easy transition for folks — to be able to access the supports through plans like Blue Cross, and that they are not going to be caught in a position where they have co-pays and other things that present barriers to them being able to access supplies necessary for their health.”

Alberta Blue Cross has told patients that letters were sent out May 2 to those enrolled in the Insulin Pump Therapy program with more information.

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