Access

Show Your Support on Gag Clause Legislation to the Senate HELP Committee

TWITTER BLITZ “HELP” Needed!

The Senate HELP (Health, Education, Labor & Pensions) Committee will meet at 10am on Wednesday, July 25th to vote on legislation outlawing gag clauses which prevents pharmacists from telling you if a prescription drug you are picking up may cost less if you pay retail price than going through your insurance.

If you’re unfamiliar with what a Gag Clause is, you can learn more by reading here…

Or watching this quick video…

The bill is S. 2554 and it needs your help!

Fire up your Twitter account and send a message of support to all Senate HELP Committee members, asking them to vote YES and help patients.

DPAC has an email that you can send to your Senators, but this Twitter blitz will go only to the Senate HELP Committee members…and it needs to go out now – the meeting is Wednesday morning!

Simply click on each “Click to Tweet” and it will do all the work for you…

YOU CAN CLICK ONE – or CLICK THEM ALL!

Please support bill S. 2554 Patient Right to Know Drug Prices Act, @GOPHelp and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @HELPCmteDems and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenAlexander and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenatorIsakson and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenatorEnzi and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act,@PattyMurray and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenPatRoberts and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @RandPaul and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenToddYoung and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenBennetCO and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenatorBurr and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @OrrinHatch and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenatorTimScott and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenWarren and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenTinaSmith and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenSanders and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenatorBaldwin and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @timkaine and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act,@SenDougJones and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenBobCasey and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @ChrisMurphyCT ‏ and vote YES for patients on 7/25. #StopGagging Click To Tweet Please support bill S. 2554 Patient Right to Know Drug Prices Act, @SenatorHassan‏ and vote YES for patients on 7/25. #StopGagging Click To Tweet

Thank you for helping raise the diabetes community’s voice on this issue!

CVS Caremark Formulary Change Makes Many Patients Switch Medications

CVS Caremark, a pharmacy benefit manager for many insurance plans, has changed its formulary as of July 1. The change comes in the middle of the year, when policyholders have no opportunity to choose a different insurance plan that may cover the drug or supply they use. This means that many patients who are stable on their medications and devices will now have to switch to a comparable product. This practice is forced non-medical switching at its worst.

A woman holds her head in frustration.

What CVS Caremark Changed

CVS Caremark has announced drastic changes to its formulary, or list of prescription drugs, devices, or supplies that they will cover. Some popular diabetes supplies affected by this change include all Humalog products (replaced with Novolog), Apidra (replaced with Fiasp), Lantus and Toujeo (replaced with Basaglar, Levemir, or Tresiba), all blood glucose test kits and test strips (replaced with OneTouch), and Jardiance (replaced with Farxiga or Invokana). See the full removal list here. 

The Impact of Forced Non-Medical Switching

Non-medical switching negatively impacts patients by disrupting their care and does not generate cost savings for the patient or the insurer. A recent NIH study found that patients who had been switched off their preferred medication had more doctor office visits, experienced new or worse medication side effects, and had problems with their new prescriptions not working.

Non-medical switching is even more complicated for people with diabetes because insulins on the market are not identical. When a patient is switched from one insulin to another, the patient’s dosing and administration requirements may change. DPAC has done several posts on non-medical switching. You can read DPAC’s statement, read a patient’s view on non-medical switching, and read a guest blog by Christopher G. Parkin.

Make a difference today!

MyMedsMyChoice logo

So what can you do? Several states have taken legislative action, and you can write a letter of support through DPAC if you live in Illinois, Pennsylvania,  or New York. (These states have bills in the state legislature that would change non-medical switching practices.) Just click on the state name to be taken to the action site!

If you’re not in one of those states, you can still do something! Consider contributing your story of being non-medically switched to My Meds My Choice, a survey for patients, caregivers, and healthcare professionals that will provide data on non-medical switching.

Finally, if your state is not considering legislation to ban non-medical switching, you can make a huge difference by setting meetings with your representatives and asking them to introduce legislation on this issue! You can use  DPAC’s statement as a jumping off point.

 

Access Granted

BREAKING NEWS: CMS TO ALLOW SMART DEVICES FOR CGM DATA

From the Centers of Medicare & Medicaid Services website, published today (Monday, June 11, 2018):

Based on input from patients and other stakeholders, The Centers for Medicare & Medicaid Services (CMS) is announcing important changes in its written policies regarding how Medicare covers continuous glucose monitors (CGMs). These changes are consistent with the Agency’s approach of putting patients first and incentivizing innovation and use of e-technology.

CGMs are items of durable medical equipment (DME) that provide critical information on blood glucose levels to help patients with diabetes manage their disease. In January 2017, CMS issued a ruling providing for Medicare coverage of therapeutic CGMs. The ruling was followed by a policy article issued by the Durable Medical Equipment Medicare Administrative Contractors on March 23, 2017 to provide coverage guidance for these devices.

CMS heard from numerous stakeholders who shared their concerns that Medicare’s CGM coverage policy limited their use of CGMs in conjunction with their smartphones, preventing them from sharing data with family members, physicians, and caregivers.

After a thorough review of the law and our regulations, CMS is announcing that Medicare’s published coverage policy for CGMs will be modified to support the use of CGMs in conjunction with a smartphone, including the important data sharing function they provide for patients and their families.

The Durable Medical Equipment Medicare Administrative Contractors will issue a revised policy article in the near future, at which time the published change will be effective.

This is a win for the entire diabetes community, and it couldn’t have been done without the thousands of patients, caregivers, and healthcare professionals who contacted Congress and CMS to share their concerns about this safety issue. 

We’ll keep you updated on the revised policy article, but in the meantime, we encourage you to send thanks to the Centers of Medicare & Medicaid Services (CGM) for listening to the community!

Thank you, @CMSGov for listening to the #diabetes community on the usage of smart devices with Continuous Glucose Monitors (CGM) to help keep Medicare beneficiaries with diabetes safe! #CGMSavesLives Click To Tweet

Access Granted

How Closed Formularies Hurt Patients

How Closed Formularies Hurt Patients

Insurance providers have a problem: how do they balance the cost of drugs to patients versus the cost of drugs to themselves? Drug costs can pile up quickly on either side of the scale (or both!). To try and find the balance, many healthcare plans opt to reduce their costs by implementing a drug formulary method. But drug formularies hurt patients when they deny access to important medications. 

A picture of a man in a suit holding a sign that says "no"

What is a closed formulary?

Drug formularies are lists of medications created by medical professionals that correspond to certain diseases or conditions. Formularies can be open, limited, or closed.

  • Open Formulary: drugs that are “non-formulary” can still be accessed by patients, but they require a larger copayment.
  • Limited Formulary: has components of both open and closed models by using cost levels. For instance, you may find that the insurer will allow you to purchase different brands of test strips, but they may have a “preferred” brand that is the lowest co-payment or co-insurance cost to a patient. Other test strips may be listed, but you will pay more to access them. If you wish to use a brand of test strip not found on the formulary, you will pay out of pocket. 
  • Closed Formulary: access to medications used for a particular condition are restricted. The drug list (formulary) can be limited to specific prescribers, geographic areas, or severity of condition. This means you either use the brand/generic listed on the formulary or you pay out of pocket. Often, you may have only one or two choices for a drug. 

Closed formularies became popular in the 1990s, died out, and are now making a comeback in many states across the nation because they are popular with drug manufacturers. Some manufacturers see cost savings of 10 – 25% with formulary management services.

The resurgence of the closed formulary model is especially notable for diabetes drugs. According to Managed Care Magazine, some payers were not willing to limit options for diabetes patients as recently as a few years ago. Now, however, times have changed. Closed formularies are becoming increasingly popular for diabetes medications (and test strips).

A photograph of a doctor's hand giving a prescription

How does it affect patients?

Closed formularies may sometimes force patients to frequently change drugs, and they may not be able to get their preferred medications. Closed formularies are based on the assumption that all drugs will act the same with anyone who has a particular affliction. But as we know, diseases do not affect each person in the same way. A drug that effectively manages one person’s condition may not work for another individual with the same diagnosis.

Closed formularies also disable a patient’s ability to work with their physician to freely choose the best treatment for their particular symptoms. Remember, part of the formulary design is categorization by prescriber, by area, or condition, so there may not be an obvious reason to who has access to certain medications.  A patient living in one area may have access to a drug that helps their symptoms, but if he or she moves to a home on the other side of town, it may be barred from them. And the patient of one endocrinologist may not have access to drugs that another endocrinologist could prescribe for them simply because their endocrinologist is not on the formulary list. 

Which states have closed formularies?

As of February 2018, Montana, Texas, Oklahoma, Arizona, Ohio, New York, and Tennessee have adopted closed drug formularies within certain state programs. California is also slated to implement a closed formulary in 2018. Closed formularies are spreading as well; already four more states have made moves to implement the system, and two are considering it.

An outline of the United States of America filled in with a dollar bill

  • Indiana: S.B. 369 (authored by state Senator Randall Head) would require adopting a closed drug formulary for injured employees by 2019. It would also require insurance prior authorization for any drug not on an employer’s formulary.
  • Massachusetts: As of February, Massachusetts has a pending waiver that would allow adoption of a closed formulary for Medicare patients statewide. What is horrifying is they wish to restrict their formulary to one drug per class of medications. (Think one brand of basal insulin and one brand of rapid insulin. One brand of test strips. One brand of cholesterol drugs.)
  • Arizona: As of December 2017, Arizona’s state Medicaid Agency requested a waiver from the Centers for Medicare & Medicaid Services that proposes implementation of a closed formulary.
  • Pennsylvania: S.B. 936 was introduced in February 2018 and would require a closed formulary for the state’s Workers Compensation program.
  • Florida and Louisiana are also considering implementing closed formularies as well, mainly due to increasing statewide pressure to limit opioid prescriptions.

What is being done to fight closed formularies?

There has been public pushback across the country to stop states from implementing closed formularies. California is the best example of the effectiveness media campaigns can have on state legislation or requests for Medicare waivers. The state has promoted multiple periods of public comments and a highly structured stakeholder feedback event, resulting in changes to the proposal and delay of implementation.

If you are in one of the states mentioned above, where they’re trying to or considering putting a closed formulary in effect, make your voice heard! Contact your state delegates (click here to find your state delegates’ contact information) and tell them how harmful closed formularies can be for their citizens!

 

Drug Importation Isn’t The Long-Term Solution

 Drug Importation Isn’t The Long-Term Solution

Though drug importation may seem like a logical solution to a very real drug pricing problem, importing drugs from Canada or other foreign sources is not good for individual consumers or the American economy. There are two main reasons:

When drugs flow through Canada (or other countries) into the U.S., there’s no regulatory body making sure that the medicines someone orders are the medicines they receive. In fact, 85% of drugs sold on “Canadian pharmacy” websites are not actually from Canada. Instead, these drugs come from countries that lack strict safety guidelines. This means drugs may be stored at unsafe temperatures, formulated with unsafe ingredients, or may be completely counterfeit with no therapeutic ingredients at all.

Two people standing next to one another, one holds a heart and the other holds a stack of money

(You may be wondering, “What about drugs imported from Canada? Doesn’t the Canadian government check the drugs to make sure they’re safe?” Yes, but only for Canadian citizens. When a drug flows through Canada and into the U.S., Canada does not regulate or certify the safety of that drug. And the FDA also does not regulate these drugs, since it is left out of the supply chain completely.) There is no agency, government or otherwise, that can certify that the drug is what it says it is and is safe. 

 

Counterfeiters have gotten sophisticated.

Many people think counterfeit drugs have tell-tale packaging or labels. However, improvements in counterfeiting technology has made it cheaper and easier to produce fake packaging and labels, making it nearly impossible for consumers and even authorities to detect counterfeits.

Life-essential medications, like diabetes prescription drugs, are counterfeited more often because of the high price counterfeiters can charge for them.

And it’s not just diabetes drugs. In 2006, more than a million counterfeit test strips were sold to U.S. consumers in 35 different states. Nobody along the U.S. supply chain was able to tell the counterfeit strips from the real ones. It’s easy to imagine the harmful effects that ineffective diabetes medicines or supplies could cause. These counterfeit drugs have deadly consequences, as was the case when a woman in Nigeria died of hyperglycemia after being treated with fake insulin.

Exportation Limits

People in favor of legalizing drug importation often say it would strengthen the drug markets or free trade. Generic drugs make up 90% of U.S. drug sales, and generic drugs already cost less in the U.S. than in other developed countries. Importation would not reduce all U.S. consumer costs in meaningful ways. And for drug reimportation, there are exportation issues from outside the U.S.

a one hundred dollar bill with the word "healthcare" written on a scrap of paper

Drug reimportation is when U.S.-manufactured drugs are exported for sale to other countries and then sold back to U.S. consumers at the price negotiated between the government of the other country and the manufacturers. Contracts between the other country and the manufacturer may impose export limits or regulatory caps on the amount of drugs given to that country. If there is a significant increase in the sales of certain prescription drugs, the country may choose to discontinue any exportation of those drugs to ensure there is enough for their own citizens.

We need to keep looking for other solutions.

Drug importation is not a long-term solution to address the pricing of prescription drugs in the United States. DPAC is committed to continue working with stakeholders to find both short- and long-term solutions that will keep people with diabetes safe and provide access to affordable prescription drugs. 

Read our Drug Importation Statement for more information.

 

Affordable Insulin Project Helps People Advocate!

The new year brings some wonderful things: renewed optimism for the future, resolutions that may or may not be abandoned by February, and plans for a year that seems full of potential. But the dreaded deductible reset also accompanies the new year for many people. Paying for insulin, drugs, and devices at the beginning of the year is often difficult for people whose insurance deductible resets on January first.

Most people get their insurance through their employer, and they may feel that they have to “take or leave” the insurance plan that is presented to them. There are other options, however, and the Affordable Insulin Project can help people advocate for an exemption to the insulin deductible from their employer. Read on to see how what such an exemption does and how to advocate for one or jump to the Affordable Insulin Project page!

What is an Insulin Deductible Exemption?

A picture of hands using a calculator and writing in a notebook.

Many workers are covered by high-deductible insurance plans, which means they are paying deductibles between $1,300 and $7,150 for single coverage and between $2,600 and $14,300 for family coverage. Having a high deductible means that the insurance company may not cover the cost of the worker’s insulin until the they have paid at least $1,300. That can be crippling for some people using insulin.

It doesn’t have to be this way. Insurance plans and employers can exempt some medications from the deductible, meaning some or all of the cost of insulin would be covered by the insurance company regardless of whether the person has met their deductible yet. It may seem like insurance companies and employers have no reason to exempt insulin from deductibles, but in reality the cost of insulin is less than the cost of someone not having access to it and experiencing complications. For instance, if a person with diabetes does not have access to insulin, they could have to go to the emergency room and miss work, and that could cost their employer more than providing the insulin in the first place.

Advocating to Your Employer

A picture of a hand stamping "approved" on a piece of paper. The Affordable Insulin Project helps people make this argument to their employer. Employers can make this change to the insurance program they offer any time in the year, so there’s never a bad time to advocate for a change in policy. Most employers do not understand the costs associated with diabetes, so the Affordable Insulin Project includes a Worksheet that provides a place for you to fill in your medical costs and show your employer how difficult it is to afford insulin with such high deductibles. There is also an Employer Guide that you can give to your employer, benefits manager, or HR representative directly, which presents statistics and arguments for an insulin deductible exemption specifically for them. There’s never a bad time to advocate for lower insulin costs. Remember that if you bring this information to your employer, you’re not only helping yourself, you’re helping everyone in your organization who uses insulin.

For Those Without Employer-Based Insurance

People who buy their health insurance off the markets or those who do not have insurance coverage at all are not left out of the Affordable Insulin Project. The site has a page dedicated to copay cards and discount programs for major insulin companies: Lilly, NovoNordisk, Sanofi, and MannKind. These cards and programs can help make insulin more affordable (though you may need to jump through a few hoops!). The Affordable Insulin Project is the first site to put all these resources together, and for many it is invaluable information.

Check Out the Affordable Insulin Project Today!

The Affordable Insulin Project Logo

MyMedsMyChoice logo

Forced Non-Medical Switching and Why It’s Hurting People with Diabetes

Forced Non-Medical Switching:

Practicing Medicine Without A License

Health insurers are forcing many people with diabetes to switch from their current medication to another for non-medical reasons. This practice is referred to as “forced non-medical switching”. As a result, many Americans with diabetes are having difficulty obtaining their prescribed medications and/or medical devices.

This insidious practice not only places additional financial burden on people with diabetes and their families but jeopardizes patient safety and long-term clinical outcomes. A recent study found that forced non-medical switching was associated with negative effects on economic outcomes (e.g., medical or treatment costs) and medication-taking behaviors, particularly among individuals with stable, well-controlled disease.

Non-medical switching graphic showing increases co-pay and off formulary arrows

Forced non-medical switching can happen in one of two ways:

  • The insurer stops covering the medication or medical device, forcing patients to pay out-of-pocket for the medication/device that is already working well for them.
  • The insurer increases patient co-pays, resulting in additional financial hardship for a disease that is already too expensive.

In both scenarios, individuals must choose between continuing with their current treatment at an increased out-of-pocket expense or switch to treatment that may not be as effective (or even dangerous), which could lead to worsening diabetes control.

What You Can Do To Help Stop Non-Medical Switching

To put a stop to this practice, we need to know if you have experienced forced non-medical switching data, either as a patient or healthcare professional. If so, we need to know how it has impacted you. This information will allow us to put pressure on insurers, legislators and regulatory agencies to reform the practice of non-medical switching.

Children with Diabetes (CwD) is a 501(c)(3) non-profit organization that provides education and support to individuals and families living with type 1 diabetes. The organization has recently established a website (www.MyMedsMyChoice.org) to gather basic information from with all people with diabetes (or their caregivers) and healthcare professionals about their experiences with non-medical switching. The website links to two short surveys: Patient/Caregiver and Healthcare Professional.

 

Click here to take the survey and help gather this important data!

Link to MyMeds My Choice website for non-medical switching

 

The Diabetes Patient Advocacy Coalition (DPAC) supports this initiative and urges you to go to the website and complete the short Patient/Caregiver or Healthcare Professional survey. DPAC’s statement on non-medical switching can be found here. 

I think we can all agree that addressing the rising cost of healthcare should remain a high priority for everyone. However, the practice of forced non-medical switching in individuals who are stable on their current diabetes medications and medical devices is dangerous, indefensible and shameful.

I believe that anyone whose diabetes is stable or well-controlled should be allowed to continue with the medication, treatment and self-management devices that is allowing them to succeed without the burden of non-medical switching. Treatment and medications should be designed, recommended and prescribed by the patient and his/her medical team — not by an insurance company for economic reasons.


Christopher G Parkin guest post author on forced non-medical switchingChristopher G. Parkin is President of CGParkin Communications, Inc., a consulting firm that specializes in diabetes education development. During the past 30 years, Chris has authored numerous articles on diabetes technology and management and has assisted several medical organizations in the development of clinical practice guidelines, position statements and consensus conference reports regarding diabetes management. Chris received a Master of Science degree in education and instructional design in 1996 from Indiana University, Bloomington and served as Adjunct Professor at Indiana University.


To learn more about non-medical switching and how it hurts people with diabetes, watch this video:

We are DPAC Diabetes Patient Advocacy Coalition

DPAC Statement on Access

Patients with Diabetes MUST have Access to Affordable Medications, Technologies and Diabetes Management Care

 

DPAC’s Statement

The Diabetes Patient Advocacy Coalition (DPAC) is an alliance of people with diabetes, caregivers, patient advocates, health professionals, disease organizations and companies working collaboratively to promote and support public policy initiatives to improve the health of people with diabetes. DPAC’s guiding principles focus on 3 key areas:

  • Safety (enforce established safety standards on devices, medications and practices for diabetes care)
  • Quality (advance the standards of care for diabetes management)
  • Access (access to health care and quality diabetes products for all 29M Americans with diabetes)

 

Given the rising costs of diabetes in America, it is critical that Americans have affordable access to ALL components of diabetes training and treatment programs that adhere to the American Diabetes Association standards of care for patients with diabetes to prevent costly hospitalizations and complications.  An estimated 30.3 million people of all ages had diabetes in 2015 (9.4% of the population).  Average medical expenditures for people with diagnosed diabetes were about $13,700, 2.3 times higher than expenditures for people without diabetes.  

DPAC believes that every patient with diabetes has a unique relationship with his/her healthcare professionals and treatment team and that each one should have access to all medications, technologies and treatment programs that enable them to actively manage and control their diabetes.  For those estimated 8 million patients with diabetes on insulin, including the 3 million people with Type 1 diabetes that need insulin to survive, access to affordable insulin is critical.  Even though insulin was developed in 1921 and the last major innovative improvements were introduced over 16 years ago, insulin prices have soared in the past decade, creating major issues for patients with diabetes whose lives depend on this critical drug.  A recent study in the Journal of the American Medical Association confirmed that the cost of insulin nearly tripled between 2002 and 2013.

The increase in high-deductible health plans and coinsurance pharmacy plans has directly impacted patients with diabetes, especially those patients that are uninsured or underinsured.  At least 40% of employees are now covered by high-deductible health plans.  For the 8 million patients that use insulin in the United States, many patients are forced to pay list price during the deductible phase, which can average over $500/month for insulin alone.  Adherence is reduced when patients have to pay more than $75/month for long-acting insulin and $40/month for rapid-acting insulin.  Non-adherence to insulin therapy can lead to serious, costly complications including heart disease, kidney failure, retinopathy and lower-limb amputation.  Too many patients are increasingly faced with unexpected, high costs at the pharmacy when accessing insulin and must decide whether to skip or ration doses of insulin that will eventually lead to poor health outcomes.  

Medicare patients also face unexpected high costs at the pharmacy.  The Medicare Part D drug benefit design structure results in significant out of pocket costs for the Medicare patient, especially once they reach the doughnut hole and are responsible for 45% of the costs .  This places a significant cost burden on Medicare patients, most of whom have a fixed income.  The Affordable Care Act does gradually close the donut hole by 2020.

DPAC joins other leading diabetes organizations, such as American Diabetes Association (ADA), Juvenile Diabetes Research Foundation (JDRF), The American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and National Diabetes Volunteer Leadership Council (NDVLC) to strongly recommend that insulin must be more affordable for patients with diabetes and that patients with diabetes must have affordable access to ALL medications, technologies and diabetes management programs.  We realize that this is a very complex issue in the U.S. healthcare environment and call on all stakeholders, including manufacturers, health plans, pharmacy benefit managers, healthcare professional organizations and patient advocacy groups to engage in discussions for solutions that help decrease this burden for patients with diabetes.

Click here for a complete list of DPAC’s official statements.

bill-to-law

Congress Asks: Why Can’t Seniors Have Accurate BG Meters?

Trusted versus Unknown

If you had a choice between using a trusted blood glucose meter that you know is accurate and one that you had never used before (and never heard of before) that you don’t know is accurate, which would you pick? 

Most of us would choose the accurate one, for obvious reasons. However, for Medicare beneficiaries who want to use the National Mail Order Program to receive their testing supplies, that’s not often an option.

H.R. 3271 and S. 1914 (both known as the Protecting Access to Diabetes Supplies Acts of 2017) force the Centers for Medicare and Medicaid Services (CMS) to change the way that the Competitive Bidding Program (CBP) is applied to diabetes testing supplies.

DPAC has been speaking in support of H.R. 3271 and S.1914 (Protecting Access to Diabetes Supplies Acts of 2017) for some time now –  just see DPAC’s CEO Christel Marchand Aprigliano’s testimony on the bill in front of the E&C Subcommittee on Health as one example!

Now we have a chance to get new momentum behind the bill.  

The Congressional Diabetes Caucus recently sent a letter to the acting secretary of HHS asking him why Medicare beneficiaries with diabetes are receiving blood glucose meters that aren’t accurate. If H.R. 3271 or S. 1914 becomes law, CMS must do two main things: (1) strengthen the 50% rule, which would lead to Medicare beneficiaries being able to use the accurate blood glucose meter they trust, and (2) strengthen and codify the anti-switching rule, which would change the refill process to give the beneficiary more choice and knowledge from the supplier when they buy a blood glucose meter.

We have Congress’s attention. Now we need to ask them to act!

Keep reading for details or click HERE to send a letter

to your Representative and ask them to cosponsor H.R. 3271!

Currently, Medicare pays for the cheapest blood glucose meters, so the most trusted blood glucose meters on the market are not available to beneficiaries. Additionally, as the Congressional Caucus on Diabetes wrote, a recent study showed that only six of the eighteen blood glucose meters in the study were accurate to DA Standards. Many of the meters offered through the National Mail Order Program are not accurate.

The bills require CMS to make sure that an entity that enters the competitive bidding process has the ability to actually get their products to people with diabetes when the person needs it. The bills also let CMS terminate a contract with a bidding entity if it is unable to get supplies to beneficiaries when they need them. In addition, the bill specifies that an entity furnishing such products to beneficiaries:

  • an entity selling diabetes testing supplies must give the Medicare beneficiary the brand of test strips that they want, and that match the blood glucose meter that they want,
  • the entity may not try to influence or incentivize a beneficiary to switch the brand of either their diabetic test strips or their blood glucose meter, and  
  • the entity must refill prescriptions within fourteen days.

(House Summary) DPAC has blogged about this in detail before, and that blog can be found HERE.

This month, the Congressional Diabetes Caucus took up this issue when they wrote a letter to the acting secretary of HHS, Eric Hargan, asking him why Medicare beneficiaries only had access to certain blood glucose – most of which did not give accurate results! The Caucus asked HHS what steps, if any, CMS and the FDA are taking to ensure seniors with diabetes receive products that work as intended? In its letter, the Caucus wrote:

“Given the importance of blood glucose measurement to manage diabetes, we are concerned about the study implications on patient health and safety. Some stakeholders have even suggested that CMS suspend the National Mail Order Program in light of these and other potential problems that are limiting seniors’ access to quality products. We therefore urge you to take action to implement and enforce product performance standards for diabetes testing supplies. Seniors should be able to rely on the accuracy of the blood glucose testing systems obtained from Medicare. Taxpayer dollars also should not be spent on products that are inaccurate, unsafe, of dubious quality or that are mislabeled or misbranded.”

CMS has until January 29th to give an answer to the Caucus’s questions. You can learn more about the Congressional Diabetes Caucus HERE.

H.R.3271 and S.1914 will let Medicare beneficiaries with diabetes use the blood glucose meter that they and their doctor decide is best for them, and will make sure that no company can try and get a beneficiary to switch brands for no medical reason.

We need to help Medicare beneficiaries with diabetes get quality equipment.

You can send a letter to your Representative asking them to cosponsor H.R.3271 HERE.

Let’s protect our community on Medicare with diabetes!

bill-to-law

Watch with Us: Congress Hears from Patients about Affordable Drug Pricing

This week, both the House and Senate will tackle the issue of drug pricing- and they’ll be hearing from patients. In a House Energy and Commerce Subcommittee hearing on Wednesday morning at 10am, officials will hear testimony on the drug supply chain, specifically how ‘middle men’ like wholesalers, distributors, and payers impact affordable access to prescription drugs. (Politico)

For the first time, Congress will hear patient voices alongside industry leaders.

David Mitchell, the Founder and President of Patients for Affordable Drugs will present patient stories he has collected, including his own experience with cancer medications, alongside facts and figures on drug pricing at the Wednesday hearing. The Senate also heard from Mitchell on Tuesday, when they reviewed the National Academy of Medicine’s November report on making medicines more affordable. (Politico)

Watch the hearing along with us here! Then say what are you hoping will be the outcome from this meeting in the comments below! DPAC will be following along and posting what impact the hearing could have on people with diabetes in the upcoming days.

 

Skip to toolbar