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Help Fee-For-Service Medicare Beneficiaries Access Eye Exams

Medicare has covered an annual diabetic eye exam by an optometrist or ophthalmologist since 2002. Unfortunately, most people with diabetes do not get that exam because it requires them to make and attend an extra doctor visit. Now, there’s a way to get that annual exam in the primary care setting that’s proven to help people get their eye exam – except it’s not available to everyone.

No Access in Primary Care Settings

Fee-For-Service Medicare beneficiaries cannot get an exam in the primary care setting because of a Medicare policy (one that’s not mandated by law) that says only an optometrist or ophthalmologist may conduct a diabetic eye exam. This rule is outdated in this era of telemedicine. Diabetic retinal exams can be safely and effectively performed in primary care settings by utilizing digital retinal imaging with remote eye specialist interpretation. In this exam, primary care providers use a special camera to acquire high resolution retinal images, which are then sent electronically and evaluated remotely by board-certified, state-licensed ophthalmologists. Then, if there’s indication of a problem, the beneficiary can follow up with an in-person visit with an ophthalmologist.

Eye Exams for Beneficiaries Who Live in Rural Areas or Cannot Access a Second Appointment

Now, imagine you live three hours from the nearest doctor. Chances are you’d at least make the trip go once a year to your primary care provider to make sure everything is ok, right? But how likely is it that you’d go back a week later to follow up? Not too likely. When a beneficiary gets their eye exam provided in primary care, they don’t need to go back unless there’s a problem indicated. The numbers speak for themselves: evaluating retinal health in primary care settings during regular office visits achieves up to 90% diabetic retinal exam compliance in a single year.

By The Numbers

Here are some more numbers: Diabetic retinopathy is the leading cause of vision loss and blindness among adults 20 to 75 years of age, and will soon be an even bigger problem within the Medicare population. According to the CDC, 25.2% of Medicare-aged adults had diabetes in 2015. The CDC predicts that these numbers will double or even triple by 2050. Additionally, more than 80% of people living with diabetes will eventually develop diabetic retinopathy. That creates a massive group of Medicare beneficiaries who are affected by diabetic retinopathy that will only increase in number as years go on. And, unfortunately, 24,000 Americans go blind from retinopathy each year, 75% of whom are Medicare-age. Luckily, with early detection, 95% of vision loss cases can be prevented.

Eye Exams for Some, but Not All

Fee-For-Services Medicare beneficiaries are missing out on this service, but other government programs have had great success implementing this digital retinal imaging with remote eye specialist interpretation. The U.S. Veterans Administration and the Indian Health Service have both used this model of care to significantly increase the percentage of diabetic patients who receive retinal exams each year. Additionally, 82% of patients in Medicare Advantage plans are currently covered for annual diabetic retinal exams in primary care settings. Fee-For-Service Medicare beneficiaries also deserve access to this convenient and effective vision-saving technology.

Take Action! Ask Your Rep to Support H.R. 6639!

H.R. 6639 would clarify that ALL Medicare beneficiaries with diabetes have access to annual diabetic retinal exams in primary care settings using digital retinal imaging with remote eye specialist interpretation. Ready to speak up for Fee-For-Service Medicare beneficiaries? Take action today!

Click here to send a letter to your representative asking them to support H.R. 6639 and give Medicare beneficiaries the care they deserve!

Californians: Ask CCS to Return CGMs to Kids with Diabetes!

California Children’s Services (CCS) has made a policy change to reflect the current Medicare coding process for CGM at a significantly lower reimbursement rate, which will kick thousands of kids with diabetes off their CGMs. CCS made this policy change without asking for public comment or making a clinical evaluation– the impact to patients was not considered.

Taking away a child’s CGM has negative consequences.

As anyone who has had a CGM can tell you, diabetes management is drastically changed when a patient uses a CGM. CGMs are medical devices that measure, report, and track glucose levels and trends in real time. FDA has approved modern CGMs to make diabetes care adjustments. Scientific evidence shows CGM usage can improve diabetes management, alarming individuals of dangerous glucose levels so immediate and proactive action can be taken.

Published clinical studies have shown that when patients go off CGM, their HbA1c values increase. Higher HbA1c values are associated with increased hospitalizations, higher overall healthcare costs, and increased absenteeism from school.

Further, CGM systems are not interchangeable, especially for children. Based on FDA product labeling, only Dexcom systems are approved for kids as young as 2 years. If CCS switches a child to a less expensive CGM system, they’d be encouraging off-label use.  Off-label use may pose risks or have unintended consequences for the patient. 

CGMs help reduce risks associated with taking insulin. A recent JAMA article estimates that insulin, a self-administered survival drug, puts 97,000 Americans in the emergency room annually. CGMs provide an extra layer of safety and protection by showing the patient’s blood glucose. Additionally, some CGMs have a ‘sharing’ capability that allows a caregiver to see a patient’s blood glucose remotely. This lets parents keep an eye on their children’s health while the child focuses on other things, like enjoying their childhood. 

Take action now!

Patients, especially children, MUST have access to the products best suited for them to help manage their diabetes! Treatment decisions should not be based on a financial, arbitrary internal policy. Click below to write a letter to officials in the California Department of Health Care Services asking them to reverse this policy and focus on patients for future policy decisions!

Click here to write a letter to CCS!

Why I Advocate: Vikki Riggle

Why I Advocate: Vickie Riggle

I’m Vikki Riggle, a Type 1 diabetic diagnosed late in life, at age 41.  People are quick to tell me that I’m mistaken, that Type 1 is “juvenile” diabetes so I must have the other, adult-onset Type 2.  “Nope,” I tell them, “I’m a Type 1.” Then I explain how I know this to be true.

About a year ago, I even had to prove my Type 1-ness to Medicare to get them to pay for the supplies I’ve been using for 25 years.

I also have to see my physician at least every 90 days to keep my Medicare benefits active. My physician and I try hard to laugh about Medicare and their onerous, unnecessary requirements but honestly, it’s a waste of my time and their money.  I’m fond of telling people that I find dealing with Medicare frustrating and often confusing even though I hold a Masters degree and have 40+ years of administrative experience. What, I ask these people, do less savvy people do? I suspect many of them don’t do well at all. I suspect they don’t use the most up-to-date technology.  I suspect they don’t have access to diabetes education. I worry they may not even know about the various insulin therapies or the biologicals that now exist. I wonder how they manage to pay for their care if they live on a limited income. I envision the elderly, struggling to take care of themselves and living lives harder than they need to be living.  

This is what brings me to advocacy.  I am in constant educator mode. When I encounter a person who will listen, I tell them what life with diabetes is really like.  I wear my medical jewelry and technology with pride, hoping someone will ask me about it. In the olden days, when I was still on the needle, I never hid to take my mealtime injections. I checked my sugar and injected my medicine, discretely, right at the table.  Once in a while I would encounter a needle phobic person who invariably would say, “I could never do that!” My answer was always the same: “Oh, I don’t know. If it was the only way you had to stay alive, I bet you could learn.”

Now that you know I’m not a shrinking violet, I can tell you that my days of advocacy go all the way back to high school.  The causes I’m actively involved in may change somewhat from time to time, but my passion to educate never fades. Things are easier now, with email and social media instead of hand-written letters and phone calls.  It’s easier to learn who to contact about an issue. It’s easier to find the CEO of a company and to reach that person. It’s easier to do the research to create a position statement. Unfortunately, it’s not easier to impact people’s opinions.  

Sometimes, I think it’s harder in the divisive world we live in, but it’s just as important as it ever was. So I keep on keeping on. I want to be the bee in the bonnet, the stone in the shoe. I want to get the attention of people who think they don’t care and I hope, really, truly hope, that I can find the magic words to have an impact on that person’s attitude.  This is why I advocate, to bring the realities of life into the view of those who have the power to do something about it. Won’t you join me?

 

Why I Advocate: Lucy Trankina

Why I Advocate: Lucy Trankina

As a person with type 1 diabetes for almost 11 years, I have been advocating for myself for some time now. It is so reassuring to know DPAC is there for me too. I love the work DPAC does and want to help others like myself. Diabetes is hard enough without constantly having to fight for your rights. If I can help make this path any smoother for others and myself, I am there. Because, as I learned recently on my honeymoon, you can’t take a vacation from diabetes.

I was diagnosed with Type 1 Diabetes when I was 15 years old. It’s a pretty scary diagnosis for any age, but thankfully my doctor put me on an insulin pump one month after I left the hospital. It made the transition a lot easier and has allowed me to live a relatively normal life. I have traveled abroad, went to college, and led a very fulfilling career in nonprofit.

In June of 2018, I got married to my college boyfriend, Tyler, and we went on our honeymoon to Jamaica. Plans for our trip had been in the works for months. After making a million little decisions about the wedding, we were looking forward to spending quality time together and not having to think.

We stepped off the plane on a Sunday night and explored the resort. We couldn’t wait for all the fun things we were going to do that week, like Dunns River Falls waterfall hike, a rum distillery tour, and Luminous Lagoon bio luminous swim experience. We had a really relaxing beach day on Monday, jumping through the ocean waves without a care in the world. My sore feet were really happy to get a break from standing. It was a really great day and we turned in early to rest up for the remainder of our big week.

I had no idea how much I was going to need the rest. Tuesday morning, we stayed dry, people watching and listening to the ocean before heading to Dunn’s River Falls. I don’t know what possessed me to do this but I brought with me my CGM and pump PDM remotes. The waterfall was in full force and we were fully submerged. I didn’t realize the full extent of how wet we were going to get but we got soaked! Which meant all of my equipment got soaked. It turns out the PDM remote does not enjoy taking baths. It shut down, ensuring a panic attack by me. A lovely Jamaican woman had to hold me and calm me down. I felt out of control and like I was going to die.

Shots and I have never got along. My doctor put me on a pump so fast I really never had an opportunity to feel comfortable with them. Shots and using an insulin pump require completely different mindsets. Dealing with this whole different mindset of how to keep me healthy and alive is stressful enough in the most comfortable circumstances. On vacation, in a foreign country, adds a whole other level of stress. I am not a trained physician or nurse and do not trust myself enough to know what I am doing. But my only choice was to suck up my fear and do what I needed to do in order to survive the week. I was very cautious about what I ate and swimming. I was so worried it was really hard to enjoy all the activities we had planned.

I clearly chose the right person though, because Tyler was so helpful. He gave me shots, helped monitor my blood sugar, and most importantly kept my spirits up. He kept me going when I wanted to quit. He reminded me how special I was when all I could see was how happy the non-diabetic people on the beach were. He got me through this ordeal and I am very thankful he will be there to support me through all the ups and downs of diabetes to come.

There are a lot of highs and lows that come along with diabetes – and I am not just referring to blood sugars on the meter. There is a large emotional toll it can take on a person. Most days, I am grateful for the lessons I have learned through this adversary. It has taught me to recognize the important things in life and how to let go of the little things. I advocate because I want people to know what diabetics experience on a day to day basis. Every single day we prepare, count carbs, calculate and inject.

You can’t take a vacation from diabetes. It comes with you across the world. To beaches, ski slopes, cruises, and remote jungle villages. You can be as prepared as possible but there is always a chance something can go wrong. Ultimately, I hope one day this won’t be a reality for me or anyone else. No one else will have to miss out on their honeymoon or any other joyous life experiences. Until then, I will continue to do the work!

Proposed Medicare Competitive Bidding Program Rule Would Hurt Patients

Earlier in July, CMS released a proposed rule that makes some drastic changes to the Medicare Competitive Bidding Program (CBP). The CBP is flawed, and unfortunately the proposed rule that is meant to fix it would only make things worse for beneficiaries with diabetes.

What’s wrong with the CBP?

Medicare written on clipboard in front of computerThe CBP applies to certain durable medical equipment, including self-monitoring blood glucose supplies via mail order. When the CBP was created in 2011, the Centers for Medicare and Medicaid Services (CMS) thought that CBP would reduce out-of-pocket expenses for fee-for-services Medicare beneficiaries and would save the program money.

The CBP did drop prices (reimbursement for test strips dropped 72%), but over 95% of mail order diabetes suppliers were eliminated. This meant that beneficiaries had far fewer options for suppliers. CMS did not find there were any negative health consequences to having fewer suppliers, however, beneficiaries experienced difficulty in getting their supplies on time or at all.

Fast forward to 2014, when the National Minority Quality Forum (NMQF) performed a study to try to confirm CMS’s conclusions that Medicare patients with diabetes that are using insulin were not negatively impacted by implementation of the CBP. The NMQF study found that the number of beneficiaries who experienced disruption in receiving testing supplies rose by 58%. And if beneficiaries couldn’t get their testing supplies, then they couldn’t test their blood sugar, which could lead to serious consequences.

In the markets where CMS implemented the CBP, the NMQF study found that there were 42 additional deaths and twice as many hospitalizations as in unaffected markets. Clearly, the NMQF study found that CMS’s report (the one that said everything was fine) was incorrect.

Even with all this research that showed the CBP was harmful to beneficiaries with diabetes, in July 2013, CMS implemented CBP nationally for mail order supplies AND supplies obtained from retail channels. This move eliminated over 98% of suppliers that provide mail order diabetes supplies. Things haven’t gotten better since the program was implemented nationally. A preliminary study shows that disruption in supply availability has continued in all markets, and over ⅓ of beneficiaries on insulin are not acquiring testing supplies at all.

These beneficiaries are forced to make insulin treatment decisions

without knowing what their blood sugar is.

You can read DPAC’s statement on the CBP here.

Why Doesn’t the Proposed Rule Fix the CBP?

Testing blood sugarThe rule proposed in July of this year would, unfortunately, only make the problems worse. The rule would suspend the CBP on January 1, 2019. While the CBP does need to be reevaluated with a removal of diabetes testing supplies from competitive bidding altogether, the solution presented currently is not the answer.

When the program is suspended, the rule provides that any willing qualified supplier may continue to provide diabetes testing supplies. Suppliers of the best testing supplies will not be willing to operate “willingly” if they do not have more information about the return of the program, how they will be paid, and/or who they will be supplying long-term.

Because suppliers of the most accurate and trusted testing supplies will not continue supplying beneficiaries with their needed diabetes testing supplies, beneficiaries will lose access to testing supplies that they have been trained upon. Moreover, the likelihood of their existing mail order supplier continuing to provide these supplies is slim, creating yet another disruption of access.

What Can I Do?

CMS is accepting comments on the CBP proposed rule now. DPAC has done the hard work for you and written out a statement that you can alter and submit with just a few clicks. CMS needs to hear from patients that the competitive bidding program is not perfect, but stopping it under the proposed rule’s parameters makes it worse!

Click here to submit a public comment!

Time To Act

Congressional Diabetes Caucus Presses CMS on Testing Supply Accuracy

On August 27, the Congressional Diabetes Caucus sent a letter to the Centers for Medicare and Medicaid Studies (CMS) asking them to respond to the Caucus’s earlier letter addressing the accuracy of diabetes testing supplies.

This letter isn’t the first one.

The Congressional Diabetes Caucus, led by Congressman Reed and Congresswoman DeGette, first wrote to CMS in December of 2017. They asked then-Acting Secretary of HHS Eric Hargan to look into how accurate commonly used blood glucose meters were. The question was based off a report from the Office of the Inspector General which found that 61% (!) of test strips furnished to Medicare beneficiaries failed the study’s accuracy standards. The Caucus’s December letter asked Acting Secretary to look into what steps CMS and the Food and Drug Administration (FDA) were taking to make sure Medicare beneficiaries were receiving products that actually work. It also urged the Secretary to take action to implement and enforce produce performance standards for testing supplies.

Acting Secretary Hargan responded to the Caucus’s letter in January of 2018, but the response was pretty lackluster. The response letter outlined steps that FDA was taking to ensure product reliability, but did not go into any steps that CMS is taking to protect beneficiaries. In fact, in the response, Acting Secretary Hargan wrote that “to date [CMS] hs not detected any negative trends.” We find this difficult to believe since having inaccurate blood glucose readings can lead to incorrect medication dosing and have dangerous consequences. 

DPAC has been working on this issue for a while.The CEO of DPAC, Christel Marchand Aprigliano, gave expert testimony on Capitol Hill on July 20th, 2017 in support of bill H.R. 3271, helping to protect access to accurate meters for people on Medicare using the National Mail Order program. (There’s a separate article discussing Christel’s testimony and H.R. 3271 in detail) H.R. 3271 was rolled up into the Bipartisan Budget Act of 2018, so now CMS has to comply with providing enhanced reporting that will aid Congress and CMS in ensuring beneficiaries are receiving the diabetic testing supplies they need to manage their condition. This was a huge win, but the work is never done!

What’s new:

This follow up letter doesn’t let CMS off the hook. The Congressional Diabetes Caucus wrote that they “find it disconcerting that the agency tasked with ensuring that the nation’s elderly and disabled have access to quality healthcare items be satisfied with the furnishing of blood glucose test systems that clearly fail accuracy standards.” The letter asked CMS to “take immediate steps to ensure that CMS puts into place adequate safeguards to protect the lives and safety of Medicare beneficiaries.”

You can read the full letter here. Diabetes Caucus Letter Aug 2018

Send a thank you to the Congressional Diabetes Caucus!

We’re so glad that the Caucus is not settling for the dissatisfying answers CMS provided. This issue is extremely important as lack of access to accurate testing supplies could lead to disastrous consequences for beneficiaries. Join us in thanking the leaders of the Caucus by clicking below!

Click here to send a thank you Tweet to Reps. Reed and DeGette (Co-Chairs of the Caucus) and Reps. Brooks, Ruiz, Jenkins, and DelBene (Vice-Chairs of the Caucus)!

Why I Advocate: Laurel Garrison

Why I Advocate: Laurel Garrison

I lived to prevent other people from getting sick.  Then my toddler was diagnosed with a totally unpreventable, incurable illness. And my life was forever changed.

It was 2015.  I was enjoying a successful career as an epidemiologist at the Centers for Disease Control and Prevention (CDC).  My days were a constant barrage of emergency conference calls and last-minute trips to fight the latest outbreak. Twelve-hour days were more the norm than the exception, and I’d often leave the house before my two children awoke and return after they’d gone to sleep.  My husband performed more than his fair share of the household duties.

All the while, my preschooler, and toddler were happy, healthy, and surrounded by people who loved them.  I did all the right things. I took prenatal vitamins (with Omega-3s!), bought organic food (and sheets, and clothes!), got them vaccinated (on time!), and bought all the internet’s best learning toys.

Photo by Sarah Green Photography

Then one night in December my 16-month-old baby girl was having trouble breathing.  I had taken her to the pediatrician twice that day, and when my after-hours calls went unreturned I drove her to the emergency department.  Everyone initially thought she had a respiratory virus. It was the winter after all. I was in shock when the doctor told me she had Type 1 diabetes.

We spent 24 hours in ICU and another three days in the hospital learning how to count carbs, calculate insulin dosages, and prick her finger to check her blood sugar.  I remember the first time the nurse asked me if I wanted to give her a shot, and “no” was not an option. We came home two days before Christmas. I realized then that our lives would never be the same.  Not just her life, but ALL of our lives. I couldn’t travel and put in all of those hours at work anymore. I needed to make her and my family my priority.

I threw myself into taking care of my daughter and the rest of my family.  I joined diabetes support groups. I went to conferences and diabetes family camp and fundraisers for diabetes research.  I poured over papers touting the latest in diabetes advancements.

EVERYTHING CHANGED.  

There were big changes, like putting my career on hold to become a stay-at-home mom.  Or moving to another state to be closer to family and a good children’s hospital. There were sobering realities, for example, my daughter couldn’t go to preschool or summer day camps because they wouldn’t take her.  Normal everyday things changed too. We have to measure her food and have three well-balanced meals at the same time every day, always. We never get a break; she is with us 24/7 because we are the only ones who can administer insulin.  It’s impacted us financially as we went from a two-income household to one and now have the added cost of insulin and all the many other diabetes supplies she needs.  

The thing is, I had devoted my life to disease prevention, but there is absolutely NOTHING that anyone can do to prevent Type 1 diabetes.  Yet. And the incidence of the disease is increasing at an epidemic pace.

So until we can prevent it, I can help by giving diabetes a face and a story so people care.

I’ll tell our legislators about the everyday challenges so they can make informed decisions. I want my daughter to have the freedom to choose what she wants to do with her future without having to worry about keeping an affordable insurance plan.  I will be a champion for healthcare bills that give scientists the grants they need to do important research that will improve the lives of people living with diabetes. Maybe even one day that research will be the key to preventing it from happening to anyone else.

 

Announcing the 2018 Policy Training Meeting Attendees!

We are pleased to announce the attendees for the Fall 2018 Policy Training Meeting in Washington, DC!

These individuals will be attending an in-depth issue advocacy training and representing DPAC on October 1st for a joint day advocating on Capitol Hill along with medical professionals from the Endocrine Society. Along with members of our DPAC Patient Advisory Board, we’ll be welcoming:

[one_half last=”no” class=”” id=””]Paul U., Arizona

Mike R., Florida

Brooke B., Oklahoma

Emma G., Georgia

John C., D.C.

Cristina C., Washington

Gwen T., Louisiana

Nancy M., Florida[/one_half]
[one_half last=”yes” class=”” id=””]

Natalie B., Illinois

Leah W., Louisana

Alice D., Georgia

Nelea A., Kentucky

Daphne F., Louisana

Stephen S., Maryland

Rachel W., New Jersey

Jasmine G., Indiana

[/one_half]

We want to sincerely thank everybody who applied – we had many amazing advocates to choose from! There will be additional opportunities to represent DPAC at these programs and others in 2019!

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.

 

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