Reimbursement reform of antidiabetics still under discussion: Study evidence needed

Experts on diabetes call for a detailed study on the effect of the changes in the reimbursability of antidiabetics on diabetes control.

The change in the reimbursement status of antidiabetics which came into force at the beginning of 2017, still confuses patients. Some diabetics cannot afford to buy non-insulin based medications. It is exactly these medicines that dropped into the special reimbursement class of 65% from the previous 100% reimbursement class.

Hannu Järveläinen, professor of internal medicine at the university of Turku, has heard of such cases.

– I know that some people with limited means have left expensive medicines on the pharmacy shelf, at least until they have reached the annual deductible limit by purchasing other medicines, he says.

According to him, undermedication of diabetes poses a serious threat to the patient’s health.

– If the blood glucose level is high for a long time, it will finally lead to complications, such as diseases of the heart, kidneys and the eyes, as well as foot problems. Diabetics have become payers of the new reimbursement system, and, for some of the patients, this will lead to associated diseases and extra costs caused by them.

Effect of living habits is emphasised

Hannu Järveläinen stresses that currently there are no societal studies on the effects of the reimbursement reform, effective from the beginning of this year. Instead, according to the professor, there is new evidence on the medicines and their effects, and this should be considered when making changes in the reimbursement status.

– I am absolutely of the opinion that all antidiabetics that have been shown to reduce the late complications of diabetes, belong to the 100% reimbursable medicines. The complications include, for instance, cardiovascular events, he continues.

According to Järveläinen, a positive effect worth mentioning about the reimbursement reform would be the importance of living habits as part of treatment.

– I think that since the price of the medicines went up, many patients with type 2 diabetes have started to understand the importance of taking care of adequate physical exercise, weight control and healthy eating habits.  If you cannot afford to buy all medicines, you can imitate the beneficial effect of pharmaceuticals by improving your living habits, he argues.

Will this lead to increased use of insulin?

In any case, the change of the reimbursement status of non-insulin based antidiabetics causes stress to the patients. According to him, society should consider the data available on the purchased and non-purchased quantities of these medicines, and whether doctors have started to prescribe insulin to patients who do not yet need it.

– Just the other day I called a large pharmacy to ask whether they have seen a transfer to insulin. They said that such a phenomenon has not been seen, at least not clearly, says Järveläinen.

However, Järveläinen has heard from pharmacies that due to the new reimbursement model, talking about money has become the focus of medicinal guidance.

– This is a shame. I think that pharmacies have an important role in giving statutory medicinal guidance and in maintaining the correct administration of medication as well as treatment motivation associated with medication, he sums up.

Total effects should be considered

Specialist Irene Vuorisalo from the Finnish Diabetes Association, calls society for clarifications on the effects that the changed reimbursement status of antidiabetics has caused during the current year. She says that there has been alarming feedback from the members to the association.

– It is clear that some of the patients have changed the dose of their medication of their own accord in order to save in medicinal expenses, and some have not purchased their prescribed medicines at all, or have sacrificed the medication for some other disease in order to buy their expensive diabetes medicines, she mentions.

Vuorisalo reminds that patients with type 2 diabetes often have comorbidities. Many of them have a disease associated with diabetes.

– Now is the time to investigate how this change of reimbursement status has affected the patient’s use of other medicines and the total well-being. This should not only be measured on the basis of actual purchases of antidiabetics, but should also consider all purchases of pharmaceuticals. This year’s medicines purchases should then be compared to previous years, she plans.

If untreated, type 2 diabetes leads to multiple organ failures – therefore the decisions on reimbursement, as well as health politics should be comprehensive.

– What to my mind was forgotten in the reimbursement reform, was the actual purpose of antidiabetic medicines. If the diseases associated with diabetes start to increase because of poor medicinal treatment, society will have to bear multiple costs.

Text: Essi Kähkönen