News and Social Media
Organizational Statements on Diabetes Access
20 diabetes organizations sent a letter to UHC on June 14, 2016 about restricting access to insulin pumps prescribed by physicians.
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.
In The News
Health insurers, big employers and other bill payers have been trying for years to rein in costs and improve care by steering clients to certain doctors and hospitals. They’ve also restricted options for some prescriptions and lined up deals for smaller-ticket items like diabetes test strips or items patients don’t chose, like heart stents.
Limiting choice for medical equipment that a patient usually selects is uncharted territory. UnitedHealth rivals Aetna and the Blue Cross-Blue Shield insurer Anthem say they haven’t done this. But experts say it could become more common.
Because cost and lack of insurance coverage are common reasons for patients to discontinue pump use, and others include problems that may be resolved with a pump switch, we are concerned that patients who experience these problems on the preferred pump and are not given the opportunity to switch without additional cost may simply choose to discontinue insulin pump use altogether.
The move comes at the precise moment when multiple, competing projects are closing in on the “artificial pancreas,” a technical feat that would allow those with diabetes to go about their daily lives with algorithm-driven technology to monitor blood glucose levels and dose insulin accordingly. Advocates for those with T1D have noted that the presence of multiple projects would likely offer many choices in AP technology and perhaps lower prices.
“To take away beneficiary choice over economics is not a good thing,” said Dan Gooch, owner of Pal-Med in Columbia, S.C., which offers pumps from Medtronic, Animas and Tandem. “I think we are going to see more and more of that, and more and more of the niche DME companies making a deal for a little better pricing for exclusive access to those lives that are insured.”
At the Minneapolis-based Allina Health System, doctors don’t recommend the Medtronic pump over competitors, but instead include the company’s product alongside all other options, said Dr. J. Ward Godsall, a specialist in diabetes and endocrinology.
In the last five years, we watched as competitive bidding decimated the test strip market, forcing Medicare beneficiaries to choose products of poorer quality and resulting in increases in mortality and complications. Then we watched as private payers and pharmacy benefit management companies whittled down their formularies to exclude all but a single option per category in insulins, test strips, SGLT-2s, GLP-1s, etc. Time and again, patient advocates were told that it was a battle we would not win, the clinical data didn’t bear out, that it was an illusion that any given patient might perceive benefit from the therapy that was currently working for them.
Between competitive bidding and formulary exclusion, many people with diabetes are frightened and fed up with being told that they can’t have the therapy they choose or the therapy that their healthcare team has prescribed. While the elimination of choice brings down costs on the side of the payer, forcing a patient to a one-size-fits-all therapy significantly reduces the likelihood that patients will benefit from the outcomes-based, tailored precision care that we strive toward. And they may be less likely to adhere to the therapy.
We can all relate to the need to save money—nobody wants to pay more than necessary for anything. But when it comes to healthcare, decisions can’t be based solely on price.
I could be mad at a healthcare system that allows health insurance companies to practice medicine and mandate care decisions for their subscribers. But mostly I am sad.
The Real Access Issues (Health As A Human Right)
For some time now I have been rather frustrated with the larger issues of access, the ones that don’t get talked about as much and don’t have popular hashtags, the ones that aren’t sexy but are often more critical. And those include basics like access to dental care and eye care and mental health care – (and I know this will piss many off) but what I think are the real access issues.
But I am dismayed that there is a need for so much fighting. Living with diabetes is hard enough without having to battle red tape, bureaucracy and corporate hacks who are so out of touch with what living with a chronic condition is about.
No One is Hiding a Cure for Type 1 Diabetes (Insulin Nation)
When it comes to the pharmaceutical industry, there is a lot of good, bad, and ugly – if you don’t like the way things are done, get people together to try and force change.
Even Small Medical Advances Can Mean Big Jumps in Bills (New York Times)
In the United States, each patient with a chronic disease must make the cost-benefit analysis of each new high-priced treatment, weighing symptoms, disposable income and insurance coverage. They are often wrenching decisions.