With this series we will bring you the latest news in diabetes advocacy and policy. This week we cover news updates in insulin affordability, government and legislation, and stigma and society.
The Endocrine Society recently published a position statement advocating for federal legislation to combat the rising price of insulin. The position statement outlines ways that the federal government can address insulin access, including government negotiation of drug prices, limiting price increases, eliminating rebates, updated Medicare payment models, and expedited approval of insulin biosimilars.
Why it matters: Insulin prices nearly doubled between 2021 and 2016 and continue to rise. The average annual insulin cost for a person with diabetes is $6,000. Federal and state-level policymakers need to find ways to make insulin more affordable and the Endocrine Society position statement is a promising start.
The Senate Committee on Finance released findings from a two-year investigation on the role of insulin manufacturers and pharmacy benefit managers (PBMs) in the rising cost of insulin. The Committee reported that insulin prices are a result of cooperation between the two sectors. Insulin manufacturers and PBMs are refuting the report.
Why it matters: Insulin manufacturers and PBMs, among other stakeholders, benefit from high insulin prices. However, many people with diabetes need insulin to survive and cannot afford it. Policymakers are beginning to understand the illogical process of insulin pricing and we hope to see insulin manufacturers and PBMs held accountable.
Government and Legislation
Medicare Part D drug plans do not have a cap for out-of-pocket spending except for very low-income beneficiaries. Nearly 70% of seniors are in favor of an annual out-of-pocket drug spending cap.
Why it matters: Roughly 25% of Medicare beneficiaries have diabetes. Medications for diabetes and its complications can be expensive and unaffordable for many seniors. Fortunately, there is a spending cap on insulin for Medicare beneficiaries.
What's next: The Biden administration is in favor of a Medicare drug spending cap, but there is some disagreement on who should cover those costs. As the new presidential administration and Congress begin to address healthcare affordability, we hope to see a focus on Medicare spending.
California Governor Gavin Newsom proposed $12 million to expand Medi-Cal CGM coverage. This funding proposal is the start of an ongoing focus on CGM access in California, according to Newsom’s office.
Why it matters: An estimated 55% of people in California have prediabetes or diabetes. Widespread access to CGM could help curb the diabetes epidemic in California and help people avoid diabetes-related complications. Currently Medi-Cal only covers CGM for children who meet certain criteria.
What's next: The California legislature will determine whether the budget request is enacted and if approved, the proposal will take effect at the start of 2022.
Starting in 2023, Medicare Part D plans will be required to offer a benefit-comparison tool. This will help beneficiaries understand their out-of-pocket costs in advance, learn about lower-cost alternative therapies, and hopefully lower cost sharing for the most expensive prescription drugs.
Why it matters: Medicare out-of-pocket drug costs can be difficult to anticipate and unaffordable for many beneficiaries. This benefit-comparison tool will help people understand their drug spending in advance and then help identify more affordable and similarly effective medications.
This article from Beyond Type 1 outlines some potential health policy changes that impact people with diabetes. This includes new leadership for Health and Human Services, federal health policy related to the Affordable Care Act and a public healthcare option, drug pricing and regulation, and state-level insulin pricing.
Why it matters: Matters of healthcare access and affordability are vital for the health and wellbeing of people with diabetes. In light of the COVID-19 pandemic, the new presidential administration has made public health a priority and we are eager to see how these health policy changes impact people with diabetes.
As part of the Biden administration’s COVID-19 relief plan, also known as the “American Rescue Plan,” they aim to increase and extend subsidies for The Consolidated Omnibus Budget Reconciliation Act (COBRA) and Affordable Care Act premiums. It is estimated that subsidizing COBRA premiums could cost $57 billion over three years and it would reduce the number of uninsured.
Why it matters: COBRA allows people and families who lose their health benefits due to job loss to remain on their health plan, though it can be expensive to do so. If COBRA premiums are subsidized, the millions of Americans who are unemployed because of the COVID-19 pandemic can more easily afford healthcare.
Stigma and Society
People with type 1 diabetes were excluded from Phase 1c of the CDC’s vaccine distribution plan despite evidence that people with type 1 diabetes are similarly at risk for severe COVID-19 complications than people with type 2. This differs from the U.K. vaccine distribution plan which prioritizes both people with type 1 and type 2 diabetes.
Why it matters: Research shows that people with diabetes are 2-3 times more likely to die from COVID-19 than people without diabetes. Type 2 diabetes should be prioritized because it is much more common and disproportionately impacts people of color and low-income communities. However, the risks of COVID-19 for people with type 1 diabetes should not be ignored in vaccine distribution.
What you can do: If you want all people with diabetes to be included in Phase 1c of the COVID-19 distribution plan, send a letter to your state representatives through the Diabetes Patient Advocacy Coalition.
COVID-19 has taken a significant toll on people with diabetes. The ADA survey demonstrates that many people with diabetes could not afford their medications and/or devices, delayed healthcare to avoid contracting COVID-19, and had less access to healthy foods.
Why it matters: Not only are people with diabetes at a higher risk for COVID-19 health complications, they have also been impacted by the economic strain and isolation of the COVID-19 pandemic. This data helps inform health policy interventions to alleviate stressors on the diabetes community.