Over four million Canadians live with diabetes – with many more undiagnosed – and that number continues to climb. This chronic condition affects almost every family and stretches our healthcare system in ways that are both urgent and preventable. 

While the federal government took a promising first step by implementing the Framework for Diabetes in Canada in October 2022, the work is far from over. What Canada needs now is political will, targeted investment and a commitment to three fundamental priorities: alignment, accessibility and affordability.

Without strategic alignment between federal, provincial and territorial governments, the promise of the national framework remains aspirational. Accessibility to timely care, medications and life-saving devices remains uneven across jurisdictions. And with inflation and international pharmaceutical tariffs looming, affordability is becoming an even more precarious reality for Canadians who rely on critical diabetes supports.

If we are serious about reducing emergency room visits, preventing amputations, improving quality of life and managing the financial burden of diabetes on our health system, we need a comprehensive approach rooted in these three priorities.

The federal government has a strong role to play.

Aligning systems, standards and support

Healthcare may be a provincial jurisdiction, but chronic disease management requires consistency nationally. Diabetes doesn’t respect provincial borders, and neither should our response.

The Framework for Diabetes in Canada outlines a strong foundation, but implementation has been uneven and under-resourced.

For example, access to medications and continuous glucose monitors (CGMs) differs vastly between Nova Scotia, British Columbia and Northern Ontario. Some provinces have signed bilateral agreements under the new pharmacare initiative that expands access and affordability while many other regions are still waiting for similar agreements. 

This patchwork approach leaves too many Canadians behind.

What we need is federal leadership that goes beyond coordination toward action, including meaningful funding to incentivize provinces and territories to implement the framework fully and consistently. It also means building mechanisms to share best practices and evaluate outcomes so that a person in rural Newfoundland and Labrador receives the same standard of care as someone in downtown Toronto.

Improving accessibility to medications, devices and care

Accessibility to medications and life-saving technologies is another critical piece of the puzzle. CGMs, insulin pumps and personalized medications are more than conveniences – they are life-changing for people living with diabetes. They help prevent complications, reduce hospital visits and empower individuals to manage their conditions with dignity and control.

The recently announced national pharmacare program has the potential to dramatically improve access to medications, particularly for those without private insurance. However, the preliminary formulary does not yet reflect the reality of living with diabetes. A one-size-fits-all approach is insufficient. The federal list must include a broader range of medications and devices to accommodate individualized care plans developed between patients and their healthcare providers.

Some provinces are moving in the right direction – Manitoba’s agreement added 18 additional medications to the federal background list, for instance – but this is not yet standard. Without inclusive formularies, patients are forced to ration medications or rely on less effective alternatives, jeopardizing their long-term health and adding stress to an already
overwhelmed health system.

Another critical area to address is the structure of the federal diabetes device fund, which was announced alongside pharmacare agreements. While welcome, the funding is time-limited and unclear in scope. What happens after four years, when the money runs out? 

Without sustained investment, we risk pulling the rug out from families who depend on these devices for day-to-day survival.

Prioritizing affordability in an uncertain global market

Affordability must be a guiding principle across all diabetes policies. Rising inflation, shifting pharmaceutical markets and international trade dynamics threaten access to affordable medications for millions of Canadians.

Consider the potential impact of pharmaceutical tariffs. Many essential diabetes medications and devices – such as Ozempic, insulin pumps and test strips – are either manufactured in or processed through the U.S. With growing uncertainty around American policies, including the possible rollback of insulin price caps under this U.S. administration, people living in Canada may face steep price increases and reduced availability. 

Generic drugs may offer long-term relief – Canada could approve generic Ozempic alternatives by 2026 – but immediate protections are still necessary. The federal government must act now to shield Canadians from the fallout of global pharmaceutical disruptions. 

When people can’t afford their medications, they don’t take them. They cut doses, delay refills or go without entirely. The results are predictable: hospitalizations, amputations, complications and premature death. 

A Call for Leadership

It is encouraging that the federal government has shown initiative by launching the diabetes framework and pharmacare program. But implementation without alignment, access without equity, and affordability without sustainability are not enough.

The costs of inaction, both financial and human, are far too high. Canada has the tools. It now needs the political will to finish the job. 

By Glenn Thibeault
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.