The province held a telephone town hall last week after considerable backlash over a program announced earlier this month that proposed changes to diabetes coverage in Alberta.
Close to 300 people attended the town hall on May 19, many of whom had questions or issues over a proposal that would alter an insulin therapy pump program. The new program would have been implemented on Aug. 1, but was paused May 12 due to widespread public concern.
Chad Mitchell, the assistant deputy minister of the pharmaceutical and supplementary benefits division of Alberta Health, said the town hall would provide additional information and explain why the province is proposing the changes. The format of the town hall included answers to live or previously sent in questions.
“For years now, Albertans living with diabetes having [been] asking for more options for insulin pumps, newer pumps, and advanced glucose monitoring devices such as continuous glucose monitors," said Mitchell. "Those transitions of the insulin pump therapy program into a government-sponsored health benefits plan [are] intended to help us to begin to provide more [of what] Albertans are asking for,” he said.
The province began to implement a “three-phase approach to improve access to diabetes management supplies and technology, while at the same time helping manage the long-term sustainability of these benefits,” said Mitchell.
Phase three, which was to be implemented in August but has been paused, was intended to increase access to more and newer insulin pump models by the transition of the Insulin Pump Therapy Program benefits to Alberta’s government-sponsored health benefits plans.
Under the proposed model, people currently enrolled in a low-income health benefit plans will continue to have no cost for pumps and supplies.
Those enrolled in the non-group coverage for a senior’s plan would pay a co-payment of 30 per cent to a maximum of $25 to each product claim.
Insulin pumps and supplies would not be counted against the dollar limits placed on other diabetes management supplies.
“You will still have access to up to $2,400 in coverage with no co-payment for supplies such as blood glucose test strips, lancets, needles, and syringes,” he said.
When it comes to people not currently members of a government-supported plan who access their insulin pumps and supplies through the Insulin Pump Therapy Program and pay for their insulin out of pocket or through an employer-sponsored or private health benefit plan, Mitchell said the province recommends they consider enrolling in a government-sponsored health benefits plan.
“Non-group coverage is available to all Alberta residents under 65 years of age and their dependents and will cover pre-existing health conditions. This plan has monthly premiums of $63.50 for a single person and $118 for a family. Subsidized premiums of $44.45 and $82.60 for singles and families are available for those who qualify,” he said.
David, a participant in the town hall, asked if there was a plan for a family like his who can't afford the $118 plus co-pay and dispensing fees.
In response, Andrea Nagle, the executive director of the pharmaceutical and benefits supplementary benefits division in Alberta Health, who also attended the town hall, said the province does have low-income plans for those who qualify and there are exceptions if a household income and circumstances have changed significantly in the last year.
Participant Kim also had a question about the cost for families, as they seem high compared to a single person.
“In my [family] situation, I'm the only person that's diabetic. And yet the premiums [are] quite a bit higher, where versus if I was just a single person, quite a bit low,” she said.
Nagle said the amount is in pre-existing legislation and the ability to sign up as a family versus a single person is also in legislation.
Christine said her family has two employee coverage plans and neither of them covers pumps. Only one person in their family has diabetes.
“At this time, the family plan is the way that you would need to enrol for the non-group plan given the legislation that it's in place,” said Nagel.
Marianne asked if the government is planning to go ahead with the changes regardless of concerns from Albertans.
Mitchell responded they are pausing the proposed changes to answer questions, to receive feedback, and to evaluate the feedback so they can address it.
“We're going to continue to work with you and our stakeholder groups on that and we are committed to getting back to Albertans as soon as possible,” he said.
