Diabetes Test Strips

Jun 20, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Drinking water on a moving bus is a choking hazard." I wasn't sure I heard my son correctly, when he told me that. Eric and his class went on a field trip to Winnipeg. The morning before he left, he was packing his back pack. Eric was deciding if he should bring 1 or 2 water bottles. I told him if he had room, why not bring 2? He had a 4 hour bus trip there and back, and he might get thirsty. That was when Eric told me he wasn't allowed to drink anything on the bus because of the choking hazard. I'm obviously for rules that keep my kids safe. But isn't Eric much more likely to die in a bus crash on the way to Winnipeg, or by being hit by a car when he rides his bike to school than he is to choke on water in a moving bus?

"But I check my blood sugar three times a day. Which one does the government think I should stop?" You might have wondered if you heard that correctly if you were a fly on the wall when our pharmacist, Pat, was talking to a diabetic patient. As pharmacists, we talk to diabetics about how to stay healthy a lot. Of course, doctors, diabetes nurse educators, and dieticians talk to diabetics too, but as the most accessible health care provider around, I'd argue that pharmacists do more diabetic teaching than any health care professional. We teach people how to use their insulin pens, blood sugar machines, medications, and we talk about diet a lot. Since we talk to diabetics so often, we are getting the brunt of the complaints from a change in Manitoba Health policy. But we aren't the only ones who noticed the change.

"Diabetes Canada is disappointed the government did not meaningfully consult with Manitobans living with diabetes." This statement dated June 7, 2017, is from the Diabetes Canada website. What did the Manitoba Government do that disappointed Diabetes Canada? They changed how Manitoba Health is going to pay for blood sugar testing strips.

Diabetics with high pharmacare deductibles start yelling at me, no Manitoba Health doesn't pay for all diabetes test strips for all diabetics in Manitoba. If you are diabetic, and you spend more on medications in a year than your pharmacare deductible, Manitoba Health will start paying for your diabetic test strips once you are over your pharmacare deductible. Or, if you are on social assistance, Manitoba Health will pay for your diabetic test strips. There used to be no limit to how many blood sugar strips Manitoba Health would pay for in a year. As of June 15, 2017 that changed. And this change, with zero public consultation, is what Diabetes Canada was upset with.

As of June 15, 2017, after a person reaches their pharmacare deductible:

  • If a diabetic person is using insulin, Manitoba Health will pay for up to 3650 strips per year. That is up to 10 tests per day.
  • If a diabetic person is using an oral medication for diabetes that has a higher risk of causing low blood sugar, Manitoba Health will pay for up to 400 strips per year. That is about 1 test per day. Manitoba Health considers glyburide, gliclazide, repaglinide, chloropropamide, tolbutamide and glimepiride as oral meds at high risk of causing low blood sugar.
  • If a diabetic person doesn't use a pill that increases risk for low blood sugar, or if they control their blood sugar with diet and exercise, Manitoba Health will only pay for 200 strips per year. That means testing every 2 days or 3-4 tests per week.

For example, the diabetic patient Pat was talking to was on glyburide. She used to test her blood sugar 3 times a day. Now Manitoba Health will only pay for her to test once per day. Not surprisingly, that really, really upset her.

Why do we test blood sugars? Whether you are diabetic or not we want your blood sugar to be between 4-7 mmol/L when you have an empty stomach. How can you tell if your blood sugar is between 4-7 mmol/L? Without testing your blood sugar, you can't. I have people come into the pharmacy and asked me to checked their blood sugar all the time. I've had people have a blood sugar of 25 mmol/L and they didn't know anything was wrong. Although some diabetics say they can accurately feel what their blood sugar is, some obviously can't. If testing your blood sugar at home is the only quantitative way for a diabetic to know what their blood sugar is, why would Manitoba Health be looking to limit the number of tests they will pay for? To save money.

CADTH, the Canadian Agency For Drugs and Technologies in Health, is an agency that looks at how well medications work versus how much they cost. In 2010 they estimated that if all home blood sugar testing was limited similarly to what Manitoba Health is doing now, that would save $150 million dollars across Canada every year. They also said in Type 2 diabetics who don't use insulin over 50% of the costs of medications and supplies for these patients was eaten up by blood sugar test strips. CADTH also points to studies that say it is debatable how much benefit a Type 2 diabetic who doesn't use insulin gets out of testing multiple time per day.

Let's look at the diabetic who talked to Pat again. Most blood sugar strips cost about $1 each. Our diabetic doesn't use insulin but does use glyburide. She was testing 3 times a day, that is about $1000 per year on blood sugar strips alone. Under Manitoba Health's new rules, she would only get 400 strips paid for per year. That would be an $600 savings for Manitoba Health.

Weird rules are sprung upon us all the time. From drinking water on a moving bus being a choking hazard, to Manitoba Health saying we aren't paying for you blood sugar testing strips. Whether you agree with them or not, it is important to know who to yell and who not to. So, out of pure bald-faced self-interest, please refrain from yelling at your pharmacist when we tell you your strips are no longer free. You pharmacist is there to make your life better. We didn't reduce the number of strips Manitoba Health decided to pay for. We just get to be the bearer of the bad news. If you think this strip limit is unfair, please call Manitoba Health at 1-800-297-8099 and yell at them instead.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

Diabetes Canada Response to MB Health Change in Test Strip Policy - http://www.diabetes.ca/newsroom/search-news/changes-to-manitoba-s-public-coverage-of-self-moni

CADTH - Assessment of Blood glucose monitoring - https://www.cadth.ca/media/compus/pdf/C1109-OT-Newsletter-Web-e.pdf


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