It was an historic announcement, with diabetes medications and a device fund included in the first phase. For over four million people diagnosed with diabetes in Canada, this looked like a turning point, and a chance to finally break down cost barriers to life-saving treatments.

But hope is fragile and that cautious optimism is already under threat. Now we need to act to make sure pharmacare in Canada doesn’t leave millions of Canadians with diabetes behind.

Diabetes Canada welcomes the government’s recognition that people with diabetes need better access to medications and devices. We know this is urgent. For many, the cost of treatment is the difference between good health and severe complications.

However, there are serious issues that need to be addressed in the current, and any future pharmacare agreements with the provinces and territories.

First off, the government’s proposed list of covered medications is misaligned with our modern clinical practice guidelines. Many of today’s most prescribed, proven and guideline-recommended diabetes medications are simply missing. In their place: older, less effective products.

This is a “lowest-cost” list. Not a “best-care” list.

If the bilateral agreements continue to move ahead unchanged, uninsured and underinsured Canadians — the very people pharmacare is meant to help — will still face unacceptable gaps in coverage. They’ll be left choosing between what their doctor recommends and what the public plan will pay for. This risks creating a two-tier system where those that can pay for the right medication for their condition can, while everyone else is left with second-best.

That’s not equity. That’s entrenching inequality.

Others, who have been fortunate enough to have their medications covered by private insurance or employee benefits, are seeing their doctor-prescribed medications disappear from their plans as insurers/employers step away from diabetes drug coverage, assuming that these medications will now be covered by pharmacare.

This is all because pharmacare is currently built as a single-payer model, meaning there is one government-administered public plan that covers one list of approved medications. While on paper this may sound great, in practice it risks jeopardizing people’s existing coverage.

There is still time to get this right.

The government can deliver true universal pharmacare, ensuring everyone is covered by either a public or private plan, by moving away from a rigid single-payer design and toward a multi-payer system that works with, not against, existing public and private coverage — protecting patient choice, expanding access and doing no harm.

This is how to make pharmacare work for people with diabetes:

1. Close the gaps: Include all medications recommended by Diabetes Canada’s clinical practice guidelines, which are developed through a rigorous and transparent process, including the review, appraisal and synthesis of thousands of published research studies, including an evaluation and grading of their relevance and quality. 
    
2. Do no harm: Guarantee that people with existing coverage for their medications don’t lose access to what they already have.
    
3. Focus on equity: Prioritize uninsured and underinsured Canadians so nobody is left behind.
    
4. Build in continuous improvement: Require regular updates to the medicine formulary so newer, more effective treatments are added as they become available.
    
5. Listen to lived experience: Engage patients, clinicians and advocates in designing and and finalizing the bi-lateral agreements.

Canada now stands at a crossroads. Pharmacare can be bold, modern, and equitable — ensuring people get the right medications at the right time, no matter their income or insurance status. Or it can be a limited, outdated program that looks good on paper but fails in practice.

We should take this opportunity to get it right, because a pharmacare program done right could change the story of diabetes in Canada.

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Glenn Thibeault is the Executive Director of Government Affairs, Advocacy and Policy for Diabetes Canada.  He is also a former MP, National Caucus Chair, MPP and Minister of Energy in Ontario.