Ontario to cover prescription drugs (including insulin) for under 25s

The groundbreaking decision by the Ontario government to cover the costs of 4400 prescription drugs (including insulin) for all young people under the age of 251 has left Ontarians and the type 1 diabetes (T1D) community hopeful about the future of diabetes care.

Effective January 2018, all drugs listed on the Ontario Drug Benefit (ODB) formulary will be funded. Although insulin is available both with and without a prescription, it is on the ODB and thus is covered. JDRF welcomes the news, which will be an enormous benefit for families of children and Ontarians in their early 20s living with T1D. 

“This decision finally allows all of our young patients with diabetes to have access to insulin as a life-saving therapy and will help close the gap we see in our clinic between those who  have additional benefits/insurance coverage and many who do not,” explains Dr. Farid Mahmud, a pediatric endocrinologist at The Hospital for Sick Children (SickKids). 

Impact on children and teenagers with T1D

Not everyone is covered by a third-party plan. Currently, some families make cuts in their food costs and other expenses if they have to buy insulin.

Now they won’t have to make that difficult choice.

“This is wonderful and will help many families a great deal,” says Virginia Lockyer, the mother of a teenager living with T1D. “I’m excited for the coverage to start and I am glad the government is finally addressing our needs.”

“Covering drugs for young people makes perfect sense,” says Wahed Boutahar, father of 11-year-old Anwar, who lives with T1D. “In our case, this will make a big difference because even with our insurance plan, we still have co-payments and deductibles.”

Impact on young adults with T1D

For teens transitioning into adult care, this decision helps reduce the financial barrier during a challenging time of juggling school, work and keeping up with their diabetes care, says Dr. Mahmud.

The funding announcement may be especially helpful for young adults who are just coming off their parents’ insurance and accumulating other expenses as they make their way into the world.

Funding insulin and other prescription drugs for young adults helps them to better manage their condition, which can help prevent complications in the long run.

What’s next?

The Ontario government’s move is clearly an important step in the right direction, and people living with T1D and physicians remain hopeful that the funding will expand to include other diabetic supplies. 

Looking at what is covered and what could be, Dr. Mahmud makes an important point: Prescription drugs represent just a fraction of the costs involved with T1D and ideally coverage would also include test strips or additional costs related to insulin pump and continuous glucose monitoring (CGM) technology.

Ontario families will continue to be out-of-pocket for the costs of other diabetes supplies if they are not covered by a private or employer health plan. Those between the ages of 25 and 65 will continue to be out-of-pocket for the same costs, as well as that for  of insulin. Still, the move is a step in the right direction.

What are other provinces doing?

The Government of Canada has recently announced that it is taking action to protect Canadians from high prescription drug prices.2 

Currently, however, coverage for insulin, diabetes supplies and devices varies across the country, with all provinces providing some level for seniors. Most cover the costs of insulin pumps for children, but this ends either at age 18, 19 or 25, depending on the province. Only Ontario, Alberta and the territories cover the costs of pumps for all ages. British Columbia, Prince Edward Island and the three territories also cover basic insulin at 100% for all ages. In PEI, a small co-pay is charged for each prescription. The Yukon has an annual deductible. British Columbia has both a deductible and limits on coverage based on family income. Saskatchewan’s Children’s Drug Plan covers insulin with a small co-pay for children under 14 years. 

In the meantime, Anwar is grateful that children in Ontario who live with T1D and do not have an insurance plan will no longer have to go without insulin if their parents cannot afford it. 

“This decision is fantastic, and I wish that all other children in Canada and in the world would have the same access,” he says.

References:

1. Ontario to Provide Free Prescription Drugs for Children and Youth. Ontario Government press release Apr 27 2017.
2. Government of Canada taking action to protect Canadians from high prescription drug prices. Health Canada press release May 16 2017.

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