Blog

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.

 

DPAC and Lions Clubs International Announce New Partnership!

DPAC and Lions Clubs International (LCI) are proud to announce a new collaborative partnership!

DPAC and LCI have signed a memorandum of understanding to collaborate on bringing diabetes policy issues to the U.S. national agenda.

Lions Clubs International held a Centennial Celebration in 2017-2018, and as part of that celebration announced diabetes as a new global signature cause. LCI will partner with DPAC in order to provide diabetes grassroots advocacy programming, education, and resources to over 1.4 million club members worldwide.

The Lions Club International Logo

Aligned Goals

Both DPAC and LCI are dedicated to expanding access to diabetes supplies, services, and education to address the growing global epidemic. Christel Marchand Aprigliano, DPAC’s Chief Executive Officer, is excited for the partnership. “We are honored to formally acknowledge our work with Lions Club International through this memorandum. Our commitment to share our knowledge and expertise in diabetes policy issues with passionate, dedicated Lions and Leos service members will bring new ideas and effective advocacy opportunities.”

A speech bubble with the words "we are dpac" inside

According to LCI president, Ms. Gudrun Yngvadottir, “Lions are uniquely qualified to take on the challenge and growing epidemic of diabetes. With over 1.4 million members around the world, we can make an impact by helping to increase public awareness, screening for diabetes, and providing one-on-one peer counseling to young people, in addition to working with partner organizations.”

To see the official press release, click here.

H.R. 5768 and S. 6633 Increase Access to Diabetes Self-Management Training!

On May 10th, Reps. Reed and DeGette introduced the “Expanding Access to Diabetes Self-Management Training Act” (H.R. 5768) to Congress. The Senate followed with S. 6633, introduced by Senators Shaheen and Collins, on August 22nd. These bills would provide avenues for people with diabetes to receive more diabetes self-management training (DSMT) through Medicare, and change the way DSMT is delivered. 

What is diabetes self-management training?

A woman testing her blood sugar

DSMT is a program covered by Medicare Part B designed to teach beneficiaries how to manage their diabetes. The training covers healthy eating, being active, monitoring one’s blood sugar, taking necessary medication, and reducing risks. The training is delivered by a doctor or qualified trained medical professional, and involves both individual and group sessions. Currently, Medicare covers 10 hours of DSMT per beneficiary, including 1 hour of individual training and 9 hours of group training. A beneficiary may also quality for up to 2 hours of follow-up training each year if it takes place in a calendar year after the year they got their initial training. In order to get DSMT covered by Medicare, the beneficiary must have a written order from their doctor.

What does H.R. 5768 & S. 6633 change?

approved rubber stamp

The bills would drastically increase Medicare beneficiaries’ access to DSMT services.

  • Referrals: The bills would permit physicians and qualified non-physician practitioners who are not directly involved in managing an individual’s diabetes to refer them for DSMT services.  
  • Hours: The bills would also allow the initial 10 hours of training during the first year to remain available until used up, and would allow 6 more hours of DSMT during the first year. After the first 10 hours are used, the bill would allow for 6 additional hours of DSMT each year.
  • Nutrition: The bills would also remove a current restriction that prevents DSMT from being delivered at the same time as Medical Nutrition Therapy. It makes sense to talk about diabetes and food at the same time!
  • Cost: The bills would exclude DSMT services from Part B cost-sharing and deductible requirements.
  • Community: The bills would change the Medicare Benefit Policy Manual to allow DSMT services to be provided in a community-based location instead of only medical offices.
  • Innovation: The bills would establish a 2-year demonstration of virtual DSMT, which could lead to Medicare coverage of virtual DSMT in the future.

Take Action!

These bills are a giant step forward in delivering DSMT to people who need it. The bills need cosponsors! Write to your representative and senators and ask them to support people with diabetes and cosponsor H.R. 5768 and S. 6633!

Click here to write a letter to your representative!

Click here to write a letter to your senators!

ANNOUNCEMENT: DPAC Policy Training Meeting Applications Accepted

DPAC is now accepting applications for the inaugural DPAC Policy Training Meeting, which will take place in Washington, D.C. from September 29 to October 1, 2018. Individuals impacted by diabetes who have a passion for policy advocacy and wish to have advanced training are encouraged to apply.

Why?

DPAC was founded to fill a gap in our community: a patient-first diabetes policy advocacy organization that focuses on safety, quality, and access. While we collaborate closely with other nonprofit organizations that help our community, the patient voice needed to be elevated. Over the past few years, DPAC has provided tools and resources to make policy advocacy easy to understand (and fun while learning about it!).

It’s time for the next step. The in-depth meeting will offer social media and public speaker training alongside education on policy issues our community currently faces and how to effectively advocate on a state and federal level. We’ll be bringing in experts and sharing best practices before we head up to Capitol Hill for our very first joint Hill Day.

Joint Hill Day

The Endocrine Society’s endocrinologist advocates will team up with our DPAC advocates to meet with members of Congress and their staff. Rather than research funding (which is what JDRF and ADA do best, so why reinvent the wheel?!) meetings, this Hill Day’s focus will be on policy issues and upcoming bills in Congress. By bringing patients and medical professionals together in the same meeting, it shows that we are united in our efforts to help all patients with diabetes.

What’s Involved?

Speaker Giving a Talk at Business Meeting. Audience in the conference hall. Business and Entrepreneurship.

For those who have shown an interest in policy advocacy and are selected to attend, DPAC will provide travel and lodging to Washington, D.C. to attend the meeting. Saturday and Sunday will be intensive training days (sorry – no time to sightsee!). Monday will be our Hill Day, and attendees will depart from the Hill to head back home.

 

And Then What?

The fun (and we hope it will be fun for attendees) doesn’t stop after the DPAC Policy Training Meeting. DPAC will be providing additional training and resources throughout 2019 to help these determined policy advocates in their own state. They may also be asked to speak in their state legislature (or come back to D.C.) on a diabetes issue. Diabetes policy advocacy isn’t a quick fix; we’re in this for the long-haul!

How Do I Apply?

Click here for the application.

Please take note of the application requirements and take your time answering the questions.

Applications will be accepted until FRIDAY, AUGUST 2nd.

DPAC will announce the first DPAC Policy Training Meeting attendees the week of August 13th. 

We hope you’ll consider applying and joining us in Washington, D.C. to advocate for our community!

Margaret Mead quote about changing the world,

5 Takeaways for Diabetes from the Blueprint on Prescription Drug Prices

A man holds his head in his hands with question marks above his head.

On Friday, May 11, 2018, HHS Secretary Alex Azar and President Trump gave quick speeches about how the United States would address drug pricing. At the same time, the Trump Administration published a their ideas: “American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.” You don’t need to read all 44 pages (DPAC did this for you!) to know that none of the ideas proposed will help people with diabetes immediately, in the long-term, or at all.

Four Challenges & Four Strategies (According to the Administration)

The blueprint claims HHS has identified four challenges for the U.S. drug market:

  • High list prices for drugs
  • Seniors and government programs overpaying due to lack of negotiation “tools”
  • High and rising out-of-pocket costs for consumers
  • Foreign governments getting a “free-ride” off of American investment in innovation

And HHS has proposed four key strategies to reform:

  • Improved competition
  • Better negotiation
  • Incentives for lower list prices
  • Lowering out-of-pocket costs

5 Takeaways that Show the Blueprint Won’t Help The Diabetes Community

“Prices will come down.” – Donald J. Trump

  1. Prices will not come down any time soon, even if all of the immediate actions or “further opportunities” come to fruition within the next year (which will be impossible, with many of the actions needing legislation). The two single items that will help with out-of-pocket costs would be the elimination of the pharmacy gag clauses imposed by Pharmacy Benefit Managers (which DPAC supports – you can learn more AND send a message to Congress about this issue) and including information about price increases and alternatives in Medicare Part D explanation of benefits.
  2. “Increasing competition” for HHS means generic drugsnot the newer biologics, insulins, and brand name drugs that people with currently use. (Metformin, a popular diabetes oral medication, is already a generic drug that is inexpensive  – $4 at Walmart). Spurring competition for generic drugs does nothing to help the diabetes patient community with additional options.
  3. “Better Negotiation” is only for government programs, not individual or employer-a woman rubs her temples in frustrationbased insurance plans. If you’re on Medicare, next year’s budget will include a “closed formulary” which will require a minimum of one drug per category rather than two (which means less access to the drugs currently available, not more access). There is nothing in the blueprint about better negotiation for the U.S. population that does not have insurance (and doesn’t qualify for Medicaid) or has non-governmental insurance.
  4. The solutions for “Incentives for Lower List Prices” does not involve those in the supply chain responsible for list prices. The blueprint proposes a broad modernization of Medicare Part D (including a cap on the out-of-pocket maximum for Medicare Part D, which is good for many Medicare beneficiaries), and improving the 340B program. Again, nothing for the non-insured or non-governmental programs. Nowhere in the documents does it reference manufacturers, drug wholesales, insurance companies, pharmacy benefit managers, employers, or… patients. The U.S. government does not control list prices and does not offer incentives for anyone in the supply chain.
  5. There is no proposal to reduce out-of-pocket spending for most of the U.S. population. Once again, the focus is on the 340B drug program (which does not help the average consumer – it helps hospitals), applying “some” manufacturer rebates for Medicare, and getting those who are receiving Medicare low-income subsidies to receive biosimilars at a lower cost. In fact, with a push for moving many medications that are currently under Part B to Part D, prices for insulin negotiated by Medicare will be higher.

We’ll be watching to see how all of the proposed steps will shake out, but the first pass at helping the average American with the cost of prescription drugs is a miss.

 

Illinois Bills would Protect Patients from Non-Medical Switching!

Illinois is taking steps to limit insurance companies from forcing patients to switch doctors and medications based on cost.

H.B. 4146 prevents insurance plans from making you switch doctors mid-contract year. It amends the Managed Care Reform and Patient Rights Act to ensure that insurance companies cover the doctors they say they cover when you choose and buy a plan. This bill has passed both houses and is awaiting the governor’s signature to become law. 

H.B. 2694 also amends the Managed Care Reform and Patient Rights Act. It would prohibit a health care plan from ceasing to cover a prescription drug during a contract year if a patient is stable on their medication. On May 31, 2018, H.B. 2694 was sent to the House Rules Committee a second time. The synopsis of the bill says: 

“…the health care plan shall not modify an enrollee's coverage of a drug during the plan year if the drug has been previously approved for coverage by the plan for a medical condition, the plan's prescribing provider continues to prescribe the drug for the medical condition, and the patient continues to be an enrollee of the health care plan.

A doctor holding a heart and a businessman holding money

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. This issue is further 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 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

Show your support for H.B. 4146 and H.B. 2694!

Click here to send a letter to Gov. Rauner asking him to sign H.B. 4146!

Click here to send a letter to the Illinnois House asking them to support H.B. 2694!

Click here to send a thank you letter to the Illinois House and Senate for passing H.B. 4146!

Pennsylvania Bill Would Protect Patients from Non-Medical Switching

Pennsylvania is taking steps to limit insurance companies from forcing patients to switch medications based on cost.

H.B. 2113 would prohibit a health care plan from ceasing to cover a prescription drug during a contract year if a patient is stable on their medication by amending the Unfair Insurance Practices Act of 1974. In February of 2018, the bill was referred to the Consumer Affairs committee, and it remains under committee review now. Section 5(a) of the bill prevents an insurance company from: 

“Altering the coverage provided by a health insurance policy, including, but not limited to, raising the premium, copayment, coinsurance or deductible or denying or otherwise failing to provide continued coverage for a health care benefit that was included in the insured’s health insurance policy and when the insured has already received the health care benefit.”

A doctor holding a heart and a businessman holding money

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. This issue is further 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 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

Show your support for H.B. 2113!

We need to send a message to get this bill out of committee!

If you are living in Pennsylvania…

Click here to send a letter to the Pennsylvania House asking them to support this bill!

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

Why I Advocate: Moira McCarthy Stanford

We are thrilled to kick off a new blog series called Why I Advocate. Over the next few months, DPAC will share stories from members of our community to learn why they choose to speak up. Our DPAC Patient Advisory Board members will be the first to share what makes them passionate diabetes advocates. 


Moira McCarthy Stanford

My first watershed moment in diabetes advocacy came just a day after my then small child was diagnosed; long before I even knew diabetes advocacy was a thing. We were at the hospital still, my tiny kindergartener laying in a hospital bed while a team of doctors spoke to me across that bed. Out of nowhere – it seemed – my little girl sat up and schooled us all.

“Stop talking over me,” she said, looking at the doctors and then at me. “Talk to me. I am the one with diabetes here. Stop talking like it’s not about me.”

Out of the mouths of kindergarteners.

Moira and her daughter on bikes.

She was right, and sage enough at the tender age of six to understand that while we did have to focus on integrating all kinds of new tools into our lives: needles and insulin vials and meters and more; there were two tools we had to hone our skills with even more: our brains and our voices.

Following her remarkably mature lead, I did just that. In the near 21 years since that moment in time, I’ve found myself learning and thinking; then speaking up and educating. I’ve been on the floor of Congress, in the offices of world leaders, at the desk of folks working on possible diabetes solutions, and in more rooms than I can count organizing, planning, teaming up with and supporting so many folks in the diabetes community.

And in 21 years, I can honestly say using my brain and voice has helped push forward change. Day to day diabetes treatment is improving in giant leaps. Funding for crucial research programs both public and private have led to some incremental breakthroughs toward what causes this blasted disease. I’ve had the honor of leading 150 kids from around the world to storm Capitol Hill as ChairMom of JDRF’s Children’s Congress, and I’ve been lucky enough to fight battles for funding and coverage that have not only been won, but done good for our community. I keep my mind open, learning and studying constantly to stay on top of what is happening as more to the point—what needs to happen.

Moira and her daughter.

Because there’s so much more to do. That little girl is now a successful and healthy adult making her way in Washington DC. She’s thriving. But she still – albeit quietly – drags along the anchor of diabetes. Fights with insurance. Stress about being able to afford the tools and meds she needs to simply stay alive. Lows on the Metro. Highs just before a big presentation. She blends it all into life in a way that’s makes it look seamless to most. But I know: every person with diabetes fights an hourly battle that needs to be won once and for all.

That’s why I am thrilled to be joining DPAC to continue honing my skills with those two basic tools – my brain and my voice – to fight for better not just for her, but for all. If a six year old got that so clearly, so too can I.

 


Moira McCarthy Stanford

Moira McCarthy has been an active advocate in the diabetes space since shortly after her then six-year- old daughter, Lauren Stanford, was diagnosed with Type 1 Diabetes in 1997. Since they she has served as National Chair of Grass Roots Advocacy for JDRF, ChairMom of JDRF’s Children’s Congress, and was named JDRF International Volunteer of the Year in 2007, much for her work on Capitol Hill.

She has also served on the board of the Barton Center for Diabetes Education, the Diabetes Education Camp Association, and as Chairman of the Board of the Diabetes Scholars Foundation. She speaks nationally and internationally on family diabetes topics, and is the author of numerous books on the topic. She lives in Plymouth, Massachusetts with her husband, Sean, and is an avid skier, tennis player, runner and grandmother.

New York Bills Would Protect Patients from Non-Medical Switching

New York is taking steps to limit insurance companies from forcing patients to switch medications based on cost.

S. 5022 and A. 2317 would prohibit a health care plan from making prescription drug formulary changes during a contract year. S. 5022 was introduced in March 2017 and A. 2317 was introduced in January 2017. Currently, the A. 2317 has passed the Assembly and is waiting for S. 5022 to catch up. S. 5022 is in the Committee on Insurance. The sponsor memo for the bill says: 

Section 1 creates a new section 4909 of the Insurance Law to state that a health care plan which provides essential health benefits under the federal affordable care act may not remove a prescription drug from a formulary during the enrollment year. If the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the enrollment year. The plan may also not add new or additional formulary restrictions during the enrollment year. A health care plan may move a prescription drug to a tier with a larger copayment, coinsurance and different deductible if an AB-rated generic equivalent drug is added to the formulary at the same time.

A doctor holding a heart and a businessman holding money

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. This issue is further 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 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

Show your support for S. 5022 and A. 2317! We need to send a message to get this bill out of committee!

Click here to send a letter to the New York Legislature asking them to support these bills!

Skip to toolbar