While diabetes is a unique disease, it has something in common with many other chronic conditions – high costs. One in four people with diabetes have been forced to ration their insulin due to cost barriers – a medication they need to live. The skyrocketing price of life-saving medications is a reality for many chronic conditions including heart and kidney disease, and other complications of diabetes. 

The diaTribe Foundation has joined the Patient Pocket Protector Coalition (PPPC) to help improve access to life-saving medications for the over 133 million people in the US living with chronic conditions.  

The PPPC is an initiative recently launched by the Diabetes Patient Advocacy Coalition to introduce and advocate for patient-first policies to reduce the out-of-pocket cost of drugs. The Coalition is focused on pharmacy benefit manager rebate reform, also referred to as rebate pass-through legislation.  

“We are pulling together on behalf of the millions of Americans struggling with chronic illness with the common interest to remove any barrier that distracts or impedes equitable access to treatment, medication, and care,” said Erin Callahan, PPPC director.

What are rebate pass-throughs?

Rebates are discounts on the list price of a drug. These discounts are negotiated for health insurance plans on behalf of the patients. However, instead of passing these discounts to patients to help them afford their medications, pharmacy benefit managers (PBMs) and health plans get the rebates as a form of payment.  

PBMs act as the “middlemen” between payers and drug manufacturers. They are hired by insurance companies, large employers, and other payers to negotiate with drug manufacturers over prescription drug benefits. PBMs can determine the total drug costs for payers, and they control which drugs are included on an insurance company’s formulary, which is its list of approved medications. Look here for more information about rebate reform.

Many health plans argue that the rebates they receive help them keep their insurance premiums low. However, studies show that if rebates were passed on to the patients instead of the health plans and PBMs, insurance premiums would increase by less than a half percent. 

PBMs and health plans do not need these discounts to afford life-saving medications, but people with diabetes and other chronic conditions do. Rebate passthrough legislation would ensure that people with chronic conditions would get these rebates instead of PBMs to make their medications more affordable. 

According to the PPPC website, “It’s time to tackle the financial toxicity impacting out-of-patient costs.” The coalition is advocating for rebate pass-through legislation that would give Americans with chronic diseases at least 80% of a drug’s rebates. 

diaTribe Change is committed to helping people with diabetes access affordable healthcare. To take this work a step farther, we joined forces with the PPPC to help all people with chronic conditions get the rebates they deserve. Learn more about the PPPC here.