Medical treatment of type 2 diabetes has seen some dramatic improvements in the last ten years, as two new types of medicines have been shown to be of great benefit to large cohorts of patients. The new drugs rely on glucose inhibitors and intestinal hormones, and are superior to former medicines in that they help patients lose weight and prevent cardiovascular disease.
"They are just as good at decreasing blood sugars as the old medicines, but much better at reducing body weight. This is an unrivaled benefit," says Markku Laakso of the University of Eastern Finland's diabetes research team.
The new medicines are more expensive than their predecessors. A government decision in 2016 to clamp down on soaring benefit expenses in several areas cut medicine reimbursement costs. When the out-of-pocket portion of the payment grew at the start of 2017, many patients discovered they had troubles paying.
From 4.50 to 135 euros
Finland's Diabetes Association estimates that drugs that cost the patient 4.50 euros in 2016 now cost 135 euros. Type 2 diabetes is most common among pensioners, many of whom have a very low income.
Leena Rosenberg of the Kuopio-based diabetes association Puijo says that some local residents have been forced to choose between buying food, paying their electric bill or topping up their diabetes medication.
"This is a real problem that doesn't affect people with decent incomes. But it does have an influence on older people and the unemployed," she says.
A ceiling is in place to prohibit prices spiraling out of control. If total medicinal expenses exceed 605.13 euros per year, the patient has the right to apply for added reimbursement. Once the ceiling has been met, patients only have to pay 2.50 for every new dose.
Fearful of the added expense
The austerity-minded government decided to scale back its system of medicinal expense reimbursement this year in response to ballooning costs. Close to every tenth Finn has either type 1 and 2 diabetes, and a full 15 percent of the money that the state's benefit administrator Kela awards for medicine expenses goes towards treatment of the disease. The lion's share is directed towards treating complications resulting from the disease, however, and not drug therapy.
Another rationale was to make the reimbursement rates equal to that offered for drugs to treat cardiovascular diseases. A report found that the decision was justified, especially because type 2 diabetes can also be treated with healthier lifestyle choices.
Kela's latest figures show that the government was apparently successful in its efforts, as expenses have grown by just one million euros this year, to 76 million euros.
The two new drugs – which are not suited to all patients – were added to Finland's official guidelines for diabetes treatment last year.
"The only downside is the price. The change to Finland's system of medical expense reimbursement has slowed down their adoption," says Laakso.