Mary Comeau has spent $1,300 on her diabetes medication and supplies so far this year.
The 25-year-old Vancouver Island resident was diagnosed with Type 1 diabetes at age nine. Her pancreas does not create insulin to control her blood sugar levels. She wears an insulin pump that continuously injects insulin into her body and a continuous glucose monitor, a small device that updates her on her blood sugar levels.
Her medical supplies cost hundreds of dollars a month. The B.C. government covers 70 per cent of those costs — but only after she has paid an annual deductible of $1,100. Comeau is self-employed — she runs a YouTube and TikTok channel devoted to living with Type 1 diabetes — and does not have private health coverage.
The recently announced national pharmacare program could change that with its promise of universal diabetes medications coverage for certain types of medicine.
“Insulin is a necessity,” Comeau said. “I can’t live without it.”
She is not alone — 3.7 million Canadians over the age of one have been diagnosed with Type 1 or Type 2 diabetes. In Type 2 diabetes, the body does not make enough insulin to control blood sugars. Type 2 diabetes can be typically managed through diet or medication. According to the Public Health Agency of Canada, six per cent of Canadian adults are pre-diabetic, which means they are at-risk of developing Type 2 diabetes.
That means Comeau is one of many Canadians eagerly waiting to see what a national pharmacare program looks like.
The federal government announced legislation Feb. 29 to create a national pharmacare program. It plans to begin the program by providing diabetes medication coverage and contraceptive coverage, including birth control pills, intrauterine devices and vaginal rings.
It is not yet clear how the national pharmacare program would interact with existing provincial drug coverage programs. It is also not yet clear how this program would interact with private coverage. Alberta and Quebec have said they plan to opt out of the national program.
‘Tragically ironic’
People have been discussing including diabetes and contraceptive medication in pharmacare for years, says Steve Morgan, a professor at the School of Population and Public Health at the University of British Columbia. Both types of medicine are supported by policy reasons and symbolism, says Morgan, who has studied pharmacare for decades.
It is “tragically ironic that Canada has not been providing equitable access to insulin,” he said, given it was discovered in Canada by researchers Frederick Banting, Charles Best, J.J. R. Macleod and J.B. Collip who sold the patent for insulin for $1 each to ensure everyone who needed it could have it.
Contraceptives may not save lives like insulin does, but they are still important, he says. Including contraceptive coverage in the national pharmacare program could show that the government sees the right to health care as “being fairly inclusive of the spectrum of health needs that Canadians might have,” he said.
Advocates for patients with diabetes and women’s health have praised the government’s decision.
“We are at the precipice of making very significant changes for people who are living with diabetes,” said Glenn Thibeault, Diabetes Canada’s executive director of government affairs, advocacy and policy. The charity has advocated for years for diabetics to have “timely and full access” to medications and supplies, he said.
While not part of the pharmacare legislation, the government said it will create a separate fund to cover the cost of diabetes supplies, such as syringes and test strips to monitor blood sugar levels.
Access to devices is key, says Thibeault, who has had Type 2 diabetes since 2016. Diabetes Canada hears weekly from people who ration their insulin or medications because they cannot afford them. Just providing insulin is not enough, he says. People need to be able to get it into their bodies.
Coverage varies depending on private insurance plans or provincial and territorial health coverage. A national pharmacare program to provide the same coverage across the country would give diabetics more options, he says.
Women’s health advocates say providing contraceptives, especially highly effective intrauterine devices, will increase women’s equality.
“We got what we wanted,” said Dr. Diane Francoeur, CEO of the Society of Obstetricians and Gynecologists of Canada.
Access to intrauterine devices is particularly important, she says, because they are more effective at preventing pregnancy than birth control pills. But many women cannot afford them, says Francoeur, even though over time, they cost less per month than buying birth control pills. Intrauterine devices cost between $300 and $550, according to Planned Parenthood, and can prevent pregnancy for between three and 10 years, depending on the type.
The government has said gender equality was a driving reason for including contraceptives in the initial stages of its national pharmacare program. At the Feb. 29 pharmacare announcement, Health Minister Mark Holland called bodily autonomy “a matter of fundamental justice.”
Dr. Wendy Norman, a family doctor and researcher at the Contraceptive Access Research Team at the University of British Columbia, says controlling the timing of pregnancy can help women access more work and education.
Unintended pregnancies
British Columbia started providing contraceptives coverage last year.
As part of the Contraceptive Access Research Team, Norman studied the cost savings of providing contraceptives to women in British Columbia. The 2018 study was based on surveys that asked women, among other things, about their pregnancy intentions and use of contraceptives.
The research found that 40 per cent of pregnancies in British Columbia were unintended and that a third of all births in the province were from unintended pregnancies.
The main reason women do not use more effective forms of birth control — or any birth control — is because they cannot afford it, says Norman. Women who are disadvantaged — for example, women who are poor, young or in abusive relationships — have a harder time getting contraception, her research says.
“It appears that our most disadvantaged individuals are much more likely to end up with an unintended pregnancy,” she said.
Contraceptives, as a whole, are not very expensive medicines when compared to other types of drugs, says Morgan at the University of British Columbia. “Diabetes is vastly more expensive than contraceptives,” he said.
In 2022, public drug plans in Canada spent $868 million on diabetes medication, representing 24 per cent growth in public drug spending. In total, public spending on drugs was $17.2 billion in 2022, a report from the Canadian Institutes for Health Information says. The Parliamentary Budget Officer has estimated a national pharmacare program that covers all medications will cost nearly $40 billion a year.
Comeau knows the cost of drugs well. The provincial government does not cover everything. She regularly needs more than the 200 blood strips the government will cover.
On her YouTube and TikTok channels Comeau focuses on educating people about the good parts of living with diabetes and that life with the chronic disease is not necessarily bad. But she’s honest about the cost: it is hard. She looks forward to seeing what coverage for medication and supplies will be provided through the national pharmacare program.
“It would be really, really huge,” she said.
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