Insurance Coverage For Prescription Drugs
Under Canadas publicly funded universal health care system, Medicare, all Canadian residents have access to medically necessary hospital and physician services without paying out of pocket. Health care insurance plans are administered by the provincial and territorial governments . Canada is considering implementing a National Pharmacare program that would standardize prescription drug coverage across the country, but for now, prescription drug coverage varies by province/territory.
After Health Canada has approved a new drug for use in Canada, provinces and territories decide if the drug will be eligible for reimbursement under their public drug plan. This decision-making process happens through the Canadian Agency for Drugs and Technologies in Health Common Drug Review . The CADTH evaluates the clinical and economic evidence of the drug and then provides recommendations to Canadas public provincial drug plans .
All provincial drug plans have insulin coverage, but coverage for different insulin formulations varies . Some provinces also have specialty programs to help provide other diabetes supplies such as insulin pumps, often for specific populations like seniors and youth.
In addition to public coverage, approximately two-thirds of Canadians have complementary private insurance that can help cover the cost of prescription drugs like insulin and other diabetes supplies . It is also important to note that in Canada, you can purchase insulin without a prescription.
Something Has To Give
Think about it this way, drug manufacturers are supposedly interested in offering their best price when they are the only option in a competitive therapeutic category . This is because when they are the only product out of many options, they know that they have secured for themselves the largest market share for that category and thus are willing to give the lowest price point to the payer. In general, rebate offers get worse, or a higher net price for the payer is realized, when manufacturers are offering rebates as a one-of-two, or one-of-three preferred products in a category. And this supposedly makes sense because the manufacturer will not secure as much market share for their product when there are more therapeutic options being covered.
With that in mind, what justification would explain what we observe in Canada? Why wouldnt Eliquis or Pradaxa forgo participating in the Ontario market? And why instead of forgoing participation are they lowering their net price to the same level as Xarelto? Said differently, why are they willing to offer a price 80% cheaper in Canada, despite being in a competitive therapeutic category with other brand, and not in an exclusive one-of-one position? And since the manufacturers are willing to lower their price to compete in Canada, shouldnt these same market forces exist in the U.S.?
To be clear, we do not know, but the math doesnt add up. And we know math.
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About Vancouver Coastal Health
Vancouver Coastal Health is responsible for the delivery of $4.1 billion in community, hospital and long-term care to more than one million people in communities including Richmond, Vancouver, the North Shore, Sunshine Coast, Sea to Sky corridor, Powell River, Bella Bella and Bella Coola. VCH also provides specialized care and services for people throughout B.C.
How To Safely Order Insulin Online
With the increase of online buying, its no surprise that buying insulin online from Canadian pharmacies has become a more preferred option for diabetics in the US.
Its important to do your due diligence when deciding to purchase form an online pharmacy.
Websites such as Buy Canadian Insulin provide medication that is supplied by an accredited pharmacy by the Manitoba International Pharmacists Association .
For those looking to purchase insulin vials and other diabetes supplies must still provide a valid prescription from their doctor and may only receive up to 3 months supply.
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Stop The Ride I Want To Get Off
Of course, one of the pieces missing from our current equation may be the ever elusive and ephemeral PBM role in the U.S. drug transaction. We need look no further than the recently released insulin investigation from Senators Chuck Grassley and Ron Wyden to see how PBMs can push the price of a drug higher and higher, year over year, despite what otherwise may be market competitive forces which would lower the price.
For those unaware, Sir Frederick Banting, MD, the man we previously mentioned who discovered and gave away insulin, just so happens to be a Canadian. And whether you call it coincidence, happenstance, or fate, we cannot help but pause and reflect that just as the previously mentioned mothers story had reached us, we were already in a position to compare diabetes treatment costs in Canada and the U.S. And there is more coincidence with the release of that stomach-churning Grassley/Wyden report, as well as Joshua Cohens recent Forbes piece that highlights how patient out-of-pocket expenses for insulin are rising, despite net costs to PBMs decreasing.
The release of our new Brand Drug List Price Change Box Score created a bit of a stir this month. Thanks to everyone who has used the tool and provided feedback on it. We already made a few tweaks to improve its functionality and usefulness, and much of it was done based on your feedback.
Researchers Working On Injection
In a person with type 1 diabetes, the body mistakenly attacks pancreatic cells that produce insulin, a hormone responsible for regulating blood sugar.
Without insulin, serious and eventually fatal symptoms will occur. Yet, imagine if, instead of needing daily insulin injections, people with diabetes could have insulin-producing cells placed back into the body, fixing the problem at its source. This is the vision of a Medicine by Design-funded research team.
The approach is not without its challenges.
Scientists are able to generate pancreatic cells from stem cells in the lab, and they can be transplanted to someone who has lost pancreatic function, but theyll be reattacked by the immune system, says Juan-Carlos Zúñiga-Pflücker, senior scientist at Sunnybrook Research Institute and professor of immunology in the Temerty Faculty of Medicine. What our work is meant to do is enable those transplants to be broadly acceptable so anyone can benefit from transplanted therapies. But the barrier of the immune system is a difficult thing to overcome, and even more so in the context of autoimmunity.
The cells are attacked because the immune system recognizes them as harmful invaders instead of helpful therapies. It is a complex problem that demands a complex strategy and that strategy is an emerging area of research called immunoengineering, which uses bioengineering techniques to manipulate the immune system.
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How To Get Diabetes Medications For Free
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Why Is Insulin Cheaper In Canada
In Canada, The Patented Medicine Prices Review Board ensures the price of patented medicine sold in Canada are affordable. However, it doesnt have control over mark-ups by retailers and also doesnt regulation the price of generic drugs.
The United States has no regulations over pharmaceutical pricing which is why you have insulin prices that end up costing patients 2-6 times more than Canada.
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Symptoms Of Type 2 Diabetes
The classic symptoms of diabetes are the following:
- fatigue
- unusual thirst and
- unexplained weight loss.
In type 1 diabetes, the symptoms usually progress quickly and are often dramatic. In type 2 diabetes, symptoms are slower to progress. However, it is important to note that many people who have type 2 diabetes may have no symptoms. These people may find out they have type 2 diabetes when they go to the doctor for another, unrelated problem.
Trulicity Pen Design Based On Needs Of Patients
Toronto, ON, February 16, 2016 Eli Lilly Canada announced the approval of TrulicityTM , a once-weekly glucagon-like peptide-1 receptor agonist indicated for the treatment of adults with type 2 diabetes to improve glycemic control. GLP-1 is a naturally occurring intestinal hormone that is released when people eat, causing reduced appetite and the release of insulin.1
Trulicity is delivered in a pre-filled, single-use pen with a pre-attached hidden needle, and can be used in combination with diet and exercise, metformin , and mealtime insulin.2
The Health Canada approval of Trulicity is based on data from the AWARD clinical trial program, designed to evaluate the safety and efficacy of dulaglutide in adults with type 2 diabetes. This data demonstrates that Trulicity reduces blood sugar and may provide a weight benefit when used as indicated.3 The most common adverse events reported with Trulicity include nausea, diarrhea and vomiting and were reported more frequently than with placebo-treated patients.4
In a recent Canadian survey, over half of those surveyed who currently use an injectable diabetes treatment say they would change something about their medication.5 Among those, 70 per cent say they would prefer not to have to administer a daily injection.6
About Diabetes
About Eli Lilly Canada Inc.
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What The Research Tells Us
Compared with other treatments for diabetes, GLP-1 agonists combined with insulin consistently and significantly improved blood sugar levels without increasing the risk of low blood sugar. And not only did the drugs prevent further weight gain, they actually contributed to weight loss .
This is a promising finding, because if blood sugar can be controlled more effectively, and if low blood sugar and weight gain are no longer among the frustrations associated with the condition, diabetes management may become easier for millions of people.
More recently, newer versions of GLP-1 agonists have become available that only need to be taken once a week . Research shows that these weekly medications might be more effective in controlling blood sugar levels than some GLP-1 agonists that have to be taken more frequently, while causing similar weight loss and side effects .
The evidence behind GLP-1 agonists, regardless of the frequency that they need to be taken, has been highly encouraging. Further research will need to address questions about the long-term effectiveness, safety, and side effects of GLP-1 agonists.
Nhp For The Prevention And Treatment Of Diabetes And Its Complications
In Canada, NHP are defined as vitamins and minerals, herbal remedies, homeopathic medicines, traditional medicines, such as traditional Chinese medicines, probiotics, and other products like amino acids and essential fatty acids . They are regulated under the Natural Health Products Regulations, which came into effect in 2004. In general, the current level of evidence for the efficacy and safety of NHP in people with diabetes is lower than that for pharmaceutical agents. Trials tend to be of shorter duration and involve smaller sample sizes. Concerns remain about standardization and purity of available compounds, including their contamination with regular medications and, in some cases, toxic substances . Various NHP have been studied to evaluate their impact on the development of both type 1 and type 2 diabetes, glycemic control in people with diabetes, and on the various complications of diabetes.
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Nhp For The Treatment Of The Co
A number of NHP have been evaluated for the various co-morbidities and complications of diabetes, including lipids and blood pressure in diabetes, as well as CVD, nephropathy, retinopathy and peripheral neuropathy. As with the studies of glycemic control, most had small sample sizes and meta-analyses had marked heterogeneity of included studies, making strong conclusions difficult.
Randomized controlled trials demonstrating a benefit on lipid parameters in diabetes include: Ayurvedic polyherbal formulation , Hintonia latiflora and magnesium . In postmenopausal women with type 2 diabetes, vitamin D supplementation for 6 months reduced serum triglycerides without effect on other lipid parameters , while a meta-analysis with high heterogeneity showed benefit on lowering total cholesterol and TG . Other studies have failed to show significant benefit of vitamin D supplementation on lipids in people with diabetes . A meta-analysis of Berberine showed it to reduce TG and increase high-density lipoprotein cholesterol more than traditional lipid-lowering drugs, with no difference on total or low-density lipoprotein cholesterol . Berberine was also shown to reduce total and LDL-C and increase HDL-C combined with traditional lipid-lowering drugs compared with those drugs alone.
Other Complementary And Alternative Approaches For The Prevention And Treatment Of Diabetes And Its Complications
A number of complementary and alternative approaches have been studied to some degree for diabetes and its complications, others have not. Included here are studies of yoga, traditional Chinese medicine and reflexology. Other modalities of CAM, such as chiropractic or osteopathic manipulation, homeopathy, shiatsu, registered massage therapy or craniosacral therapy do not have studies specific to diabetes.
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Medications For Type 2 Diabetes
There are many types of medications used to treat type 2 diabetes. Here is a list of medications that are available and commonly used in Canada:
- acarbose
- sitagliptin – metformin
- tolbutamide
You may have to try different types of medication before finding the right one for you. Medications for type 2 diabetes work in different ways. Some stimulate the pancreas to release insulin , while others reduce insulin resistance . Some decrease the amount of sugar made by the liver , while others help increase the amount of insulin made in the pancreas and reduce the amount of sugar released by the liver . Insulin is often prescribed when adequate glucose control with other medications has not been achieved.
Some things to keep in mind about medication for type 2 diabetes:
- Diet and lifestyle changes have to be continued.
- Each person is unique, so different combinations of medications may need to be used.
- Insulin may be prescribed.
- Ask your pharmacist how your medication works to control your condition.
- Know when to take medication with regard to meals. Most medications for diabetes need to be taken before eating.
- If you are told to take your medication with food, make sure you eat.
- Talk to your pharmacist or physician about any side effects you may be feeling.
- Continue to check your blood sugar levels.
- Hypoglycemia is a potential complication of medications – talk to your physician or primary health care provider about your risk and what to do if you experience hypoglycemia.
Is It Legal To Buy Insulin In Canada
The legalities of buying insulin from Canadian pharmacies is much of a gray area and certainly has its loopholes.
Its illegal to buy insulin from Canada, but luckily its legal for Canadian pharmacies to ship medications directly to residents in the US.
The Food and Drug Administration forbids Americans from purchasing their medication from Canada in order to properly regulate imported drugs.
This law can be quite hypocritical since the same drugs are manufactured in Canada, are sold by pharmacies in both countries and Health Canada is a lot more stringent than the FDA when it comes to the safety and efficacy of medication .
Despite the illegality to shuttle prescription medication across the border from Canada, most custom officials typically dont bat an eye for patients picking up drugs for personal use.
Of course this doesnt mean that they cant seize a package if they wanted to, so those who are buying insulin from Canada need not worry too much. There also has not been a single case of anyone going to jail for ordering personal prescription medication from Canada.
According to an official statement by Health Canada in 2004, shipping prescription insulin to the US is legal and will continue.
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