Supports that can help with the high financial cost of diabetes. Presentation to Type 1 Conference September 2018

Transcription

1 Supports that can help with the high financial cost of diabetes Presentation to Type 1 Conference September 2018

2 Outline 1. The economic burden of living with type 1 2. Financial supports available Provincial/territorial Federal 3. The link to Diabetes Canada s advocacy 4. How YOU can get involved

3 Diabetes is a huge economic burden to Canada

4 The great economic burden to individuals Living with T1D can cost up to $15k out of pocket each year Most Canadians with diabetes pay more than 3% of their income or over $1,500 per year for prescribed medications, devices and supplies out of their own pocket. Out-of-pocket costs that exceed 3% or $1,500 of a person s annual income are defined as catastrophic drug costs by the Kirby and Romanow Commissions on healthcare. 25% of Canadians with diabetes report that these costs affect their adherence to their prescribed treatment regimens, which risks their short- and long-term health

5 Financial supports vary Significant variability in coverage for: Medications Supplies (test strips, syringes, etc.) Devices (pumps, CGM) Co-pays/deductibles Coverage also varies by age and income

6 Example: Programs in Ontario Monitoring for Health Program (MFHP) Coverage for test strips, lancets and blood glucose monitors for individuals who use insulin (type 1 or type 2) or have gestational diabetes, and have no other coverage for their supplies Ontario Drug Benefit (ODB) Coverage for prescription drugs and blood glucose test strips for seniors 65+, social assistance recipients (OW/ODSP), children & youth 24 and under (OHIP+) and Trillium Drug Program clients Trillium Drug Program (TDP) helps Ontarians who have high prescription drug costs in relation to income; annual deductible set based on household income and size

7 Example: Programs in Ontario Ontario Disability Support Program (ODSP) Insulin and test strips covered by ODB Other diabetes supplies covered through Mandatory Special Necessities (MSN) benefit -- e.g. needles/syringes, alcohol swabs, lancets, insulin pump supplies CGM also covered through MSN benefit Assistive Devices Program (ADP) Insulin Pump & Supplies Program covers 100% of cost of pump once every 5 years and $2400 per year for pump supplies Syringes for Seniors program -- $170 grant per year to help with cost of needles/syringes for seniors 65+ who use insulin

8 Example: Coverage in Ontario Insulin Item Individuals under 65 via TDP with deductible Seniors Low income Social assistance Lancets 75% MFH 75% MFH 75% MFH 75% MFH / ODSP Monitors 75%/5 yrs MFH 75%/5 yrs MFH 75%/5 yrs MFH 75%/5 yrs MFH / ODSP BG test strips Ketone strips TDP with deduct. OR MFH Via ODSP Needles Via ADP Via ODSP Pumps Via ADP Via ADP Via ADP Via ADP Pump supplies Via ADP Via ADP Via ADP Via ADP/ODSP CGM Via ODSP

9 Federal Programs 1. Disability Tax Credit Provides a non-refundable tax credit to those who due to their disability face significantly higher costs than the average Canadian Reduces your tax burden on average by $1,500 per year 2. Child Disability Benefit Up to $230 per month (income adjusted) for parents of children under age 18 who qualify for DTC 3. Registered Disability Savings Program Savings vehicle for those eligible for DTC; value varies 4. Medical Expense Tax Credit Refunds 15% of eligible medical expenses up to a stated maximum

10 DTC Eligibility Criteria People with T1D generally qualify under the category of Life- Sustaining Therapy Requires that an average of at least 14-hours per week is spent administering therapy Time parents spend caring for kids with T1D can be counted in the 14 hours per week requirement. Eligible activities: checking blood glucose levels preparing and administering insulin calibrating necessary equipment testing ketones keeping a log book of blood glucose levels Ineligible activities: Carbohydrate counting Recovering from therapy (e.g. lows) Exercising Doctors visits & buying supplies

11 DTC eligibility criteria and how T1Ds can meet them Test blood sugar (avg. 8 6 mins per) Dose insulin (avg. 5 8 mins per) Treat high or low blood sugars (avg. 5 mins per) 48 mins 40 mins 15 mins Test ketones (avg. 1 x/d) 5 mins Log blood sugar readings (daily) 15 mins Analyze trends in readings and adjust dosing (daily) 15 mins TOTAL 138 mins/d

12 DTC Application Process Your health care provider (HCP) must complete form T2201. You mail it in. Here are instructions on how to fill it out The form found here may help your HCP Some clinics ask patients to keep a log of time spent on eligible activities The CRA then reviews your application and may ask follow-up questions of your HCP If you are deemed eligible, your tax returns for your period of eligibility will be reassessed and a refund will be remitted

13 Child Disability Benefit Tax-free benefit for families who care for a child under the age of 18 who is eligible for the disability tax credit You must file a tax return to receive this benefit Indexed to income: < $66k = $230/month $100k = $140/month > $150k = $0/month

14 Registered Disability Savings Plans (RDSPs) Allow people to save for their futures in a tax protected fund The government contributes grants and bonds to these Plans on a multiplied matching basis The DTC is a gateway program to determine eligibility for the RDSP. Eligible Canadians must open an RDSP at a financial institution to attract applicable government grants and bonds A calculator can be found here. Once someone becomes ineligible for the DTC, they must close their RDSP. The government may then claw back tens of thousands of dollars of contributions.

15 2017 Change in DTC Eligibility Stakeholders raised alarms in mid 2017 that the Canada Revenue Agency (CRA) had begun denying almost every person with type 1 diabetes, whether they were applying for the first time or reapplying for a credit they d already been receiving for years. Ultimately, Diabetes Canada determined that a procedural change implemented by the CRA on May 2, 2017 effectively blocked all adults with type 1 diabetes from accessing the Disability Tax Credit or Registered Disability Savings Plan (RDSP). Our lobbying got the government to reverse their procedural change and create the Disability Advisory Committee

16 Current State Half of us got approved on review: The CRA reports that between December 8, 2017 and May 2018 they reviewed 2,267 applications from PWD and approved 1,326 of them (58%) The remaining 941 (42%) applicants may not be notified that they were denied again on review Nearly all children and many adults with T1D are being approved Assessments are taking 3 to 6 months right now, and remission of funds for eligible Canadians is taking 6+ months Less than 2% of Canadians with T1D have the DTC, so we need to raise awareness of the availability of the program Some medical practitioners are reluctant to complete the forms. The tool for health care providers found here may help.

17 Ongoing Issues 1. Eligibility criteria in the Income Tax Act should be clarified to remove the ambiguity around calculating carbohydrates 2. Eligibility criteria should be modernized and amended such that doctors can certify their patient has T1D and is following their prescribed regimen, but does not require certification of activities performed by the patient in a non-clinical setting. Reconsider the ongoing relevance of the 14 hour per week requirement. 3. People with type 1 diabetes should not lose their RDSP just because they cease to be deemed eligible for the DTC. Contributions made to the RDSPs of people with type 1 diabetes while they were deemed eligible for the DTC should not be withdrawn if and when eligibility criteria are changed.

18 Senate s June 2018 Report Includes a total of 16 recommendations for improvements to the administration of the DTC Agreed with our recommendations You can support it by visiting:

19 Diabetes Canada s advocacy Currently advocating actively for: Diabetes a national strategy to address the epidemic Fair access to the Disability Tax Credit Provincial policies to support T1D kids in schools Provincial coverage for drugs, devices and supplies The Healthy Eating Strategy and a manufacturers levy on sugary drinks The right approach to national pharmacare

20 Diabetes 360 at a glance Diabetes 360 Targets: 1. Prevention: 90% of Canadians live in an environment that preserves wellness and prevents the development of diabetes 2. Screening: 90% of Canadians are aware of their diabetes status 3. Treatment: 90% of Canadians living with pre-diabetes or diabetes are engaged in appropriate interventions to prevent diabetes and its complications 4. Outcomes: 90% of Canadians engaged in interventions are achieving improved health outcomes.

21 Diabetes 360 and T1D

22 Diabetes 360 can help

23 How YOU can get involved Add your voice to our advocacy Participate in lobby days Write your elected officials e.g. join the letter-writing campaign at Blog or tweet YOUR story Follow us on social media to stay up to date on specific campaigns Have questions or need help? Call BANTING