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With this series we will bring you the latest news in government and legislation. This week we cover updates to Medicare, California Medicaid CGM coverage, and anticipated policy changes from the Biden administration. 

For more news in diabetes advocacy and policy, check out our Stigma and Society News and Insulin Affordability News. This week's news updates are compiled here.  

 

No cap on Medicare drug costs leaves seniors with mounting drug costs

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 proposes expanding Medicaid access to CGM; CA governor adds $12 million to the state budget for CGM

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.

 

CMS offers benefit-comparison tool to help improve coverage and access for Medicare Part D and Advantage plans

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.

 

Anticipated health policy changes from the new presidential administration

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.

 

Biden administration plans to expand insurance premium subsidies

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.