100 Years of Diabetes Access
1916: Dr. Elliott Joslin, the first doctor in the U.S. to specialize in diabetes, publishes The Treatment of Diabetes Mellitus.
1923: Frederick Banting, MD, and his then student assistant, Charles Best, MD share the Nobel Prize in Physiology or Medicine for their work in the discovery of insulin. That same year, Eli Lilly (working with the University of Toronto) begins commercial production of insulin.
1949: The American Diabetes Association approves a standardized insulin syringe and Becton Dickinson and Company begins production.
1953: Tablets for testing glucose levels in urine are made widely available, and urine test strips also become more common.
1955: Sulfonylureas – oral medication designed to stimulate the pancreas to release insulin – is introduced.
1964: The Ames Company introduces color-coded blood glucose testing strips. A drop of blood is placed on a paper strip for one minute, then washed off. The color is matched on a chart to provide a rough indication of blood glucose levels.
1970: The Ames Company introduces the first glucose meter (the Ames Reflectance Meter). It costs approximately $500 and is not intended for home use. Dick Bernstein becomes the first person to have a prescription written for the device. (Source)
1978: Portable insulin pumps are available (though they are still quite large and not suitable for most patients). It costs approximately $400. (Source)
1982: The Food and Drug Administration (FDA) approves human insulin produced by genetically altered bacteria.
1987: The first blood glucose biosensor system is launched. (Source)
1989: The American Diabetes Association releases their first Standards of Care.
1997: The Balanced Budget Act provided the first comprehensive coverage for blood glucose monitors, testing strips and provided for outpatient diabetes self-management training. (Source)
1998: Diabetes Insurance coverage expanded to a program called Durable Medical Equipment Regional Carriers. This is when insurance providers started using terms such as “medically necessary”. (Source)
1999: Medicare covers insulin pumps only for people with type 1diabetes. In order to qualify you must prove you have diabetes and no longer produce insulin, take educational classes and have C-peptide results within the allowed range. In addition Medicare requires proper self-management care such as completing an education program, injecting insulin at least three times a day for the past six months, know how to adjust mealtime doses, test your blood sugar at least 4 times a day for the past two months and have a medically-documented need for a pump. (Source)
1999: UnitedHealth Group and Express Scripts established as leading Pharmacy Benefit Managers.
2000: Insulin pumps are covered under Medicare for certain type 1 diabetics. (Source)
2003: Medicare Prescription Drug Improvement and Modernization Act (MMA) expands coverage for prescription drugs, biological products and insulin, including supplies associated with injection. (Source)
2003: DMEPOS (durable medical equipment, prosthetics, orthotics and supplies) competitive bidding program was mandated. This is a new methodology to set payment amounts to reduce out of pocket expenses. It establishes a competition between suppliers and those who offer the best price are awarded a contract. This disrupts patient’s access to supplies not covered by Medicare. Because of the inability to test their blood sugars, there was an increase in hospitalizations, higher out of pocket costs and more mortality for people with diabetes. (Source)
2005: Through the Medicare Modernization Act, Medicare begins coverage of diabetes screenings for those at risk of diabetes.
2007: CVS Caremark changed the function of Pharmacy Benefit managers and payers created a formulary requiring health plan participants to use preferred products to treat their conditions.
2010: Affordable Care and Patient Protection Act signed into law which eliminates rising costs because of preexisting conditions such as diabetes, eliminates lifetime limits that insurance companies spend which is helpful to diabetics because the cost of management is high and guarantees preventative care particularly useful for those in the pre-diabetes category.
2011: Emblem Health will only cover blood glucose meters and testing supplies for Abbot Diabetes Care products.
2011: 11% of diagnosed diabetics under the age of 65 were uninsured.
2012: Pharmacy Benefit Managers such as UnitedHealth Group, Express Scripts and CVS Caremark begin excluding drugs entirely from their formulary, no longer utilizing the tiered system. Insurance providers now require prior authorizations for products that previously did not need it.
2013: Insurance companies restrict number of test strips allotted to patients. Impacting the amount of times they can test their blood sugar each day, sometimes as little as one time per day.
2013: Express scripts publishes list of 48 medications and supply brands that are not excluded. Including test strip brands such as Abbott and Accu-chek, and insulins like Apridra and Novolog. Many patients with diabetes are forced to switch from Novolog to Humalog insulin or vice versa. Payers, such as Anthem, require the patients to contact their doctor’s office ahead of time for each refill.
2014: Job plans and individual plans are not allowed to deny coverage, charge more or refuse to cover treatments due to a pre-existing condition, such as diabetes. (Source)
2014: Express Scripts, one of the industry’s largest pharmacy benefit manager, drastically restricts the diabetes med and supplies that are accessible to its members. They cover the cheaper option that works “just as well”, removing patient choice from management.
2014-present: Medicare does not currently cover continuous glucose monitors (CGMs). CGMs have a wide range of benefits and overall tighten blood glucose control. In fact, multiple studies and statements from the Endocrine Society, the American Association of Clinical Endocrinologist and the American Association of Diabetes Educators support the fact that CGMs were superior to other glucose monitoring and insulin delivery systems. Current regulations prevent a person with diabetes over the age of 65 and use Medicare, your CGM will not be covered.
2015-present: Four states (Alabama, Idaho, Ohio, and North Dakota) have state Medicaid plans that do not require coverage of diabetes. (Source)
2016: UnitedHealth Care establishes preferred agreement with Medtronic to no longer cover non-Medtronic insulin pumps.
If we do not take action now and tell insurers that #DiabetesAccessMatters, the future holds more restricted access to treatment plans prescribed by physicians following the 2016 ADA Standards of Care.