Blog

New Yorkers could Ban Accumulator Adjustment Programs!

Accumulator adjustment programs (also known as copay accumulator programs and co-pay adjustment policies) are programs that some insurance plans are instituting that limit access to diabetes medications – many of which have no generic substitute – and devices by preventing manufacturer copay assistance contributions from counting towards a beneficiary’s deductible and out-of-pocket spending requirement. Insurance plans have been implementing accumulator adjustment programs without consumer notice, which leaves patients to find out about this practice only after they incur steep prescription drug and device cost sharing mid-year. Beyond being unfair to patient consumers, these programs will have a negative impact on individual and public health.

Accumulator Adjustment Programs and Diabetes

Insulin pen.

About 2,047,000 people in New York (roughly 12.2% of the state adult population) have diabetes. People who have diabetes spend more than double on their health than people without diabetes. It makes sense, then, that people with diabetes have trouble accessing their medications when the cost-sharing burden is high. A recent study found that patients with type 2 diabetes are more likely to adhere to prescribed medication when they have lower copayments. Even a cost as low as a $5 copay can have an effect on adherence to diabetes treatments.

Copay cards enable patients to access their medication. People with diabetes expect to be able to use copay cards because of how commonplace they are, and many people budget their healthcare expenses for the year based on the availability of copay cards. Additionally, a person with diabetes may not be able to switch medicines in order to get a cheaper price. Among brands with copay coupons, a majority (51%) are for drugs with no generic substitute – including 12% for drugs with no close therapeutic substitute of any kind.

A medical professional holding a prescription. New York bills A. 8246 / S. 6303 ban accumulator adjustment programs by requiring insurance plans to apply payments from third parties on a patient’s behalf to apply to the patient’s deductible, copayment, coinsurance, and out-of-pocket maximum. The bills apply to all insurance plans sold in the state.

NY S.6303 was introduced by Senator Rivera on June 3rd. It was moved to the Rules Committee that same day. The Assembly companion bill, A. 8246, was introduced by Assemblyman Gottfried on Monday, and was referred to the Insurance Committee. The bills are also positive bans that require insurance plans to apply payments from third parties on a patient’s behalf to apply to the patient’s deductible, copayment, coinsurance, and out-of-pocket maximum. The ban would go into effect the January after the bill is passed.

Let your state representatives know that you support A. 8246 and S. 6303, and ask them to cosponsor! 

Pennsylvanians! It’s Time to Ban Accumulator Adjustment Programs!

Accumulator adjustment programs (also known as copay accumulator programs and co-pay adjustment policies) are programs that some insurance plans are instituting that limit access to diabetes medications – many of which have no generic substitute – and devices by preventing manufacturer copay assistance contributions from counting towards a beneficiary’s deductible and out-of-pocket spending requirement. Insurance plans have been implementing accumulator adjustment programs without consumer notice, which leaves patients to find out about this practice only after they incur steep prescription drug and device cost sharing mid-year. Beyond being unfair to patient consumers, these programs will have a negative impact on individual and public health.

Accumulator Adjustment Programs and Diabetes

A medical professional holding a prescription. About 1,374,000 people in Pennsylvania (roughly 12% of the state adult population) have diabetes. People who have diabetes spend more than double on their health than people without diabetes. It makes sense, then, that people with diabetes have trouble accessing their medications when the cost-sharing burden is high. A study found that patients with type 2 diabetes are more likely to adhere to prescribed medication when they have lower copayments. Even a cost as low as a $5 copay can have an effect on adherence to diabetes treatments.

Copay cards enable patients to access their medication. People with diabetes expect to be able to use copay cards because of how commonplace they are, and many people budget their healthcare expenses for the year based on the availability of copay cards. Additionally, a person with diabetes may not be able to switch medicines in order to get a cheaper price. Among brands with copay coupons, a majority (51%) are for drugs with no generic substitute – including 12% for drugs with no close therapeutic substitute of any kind.

Changes with No Notice

A woman in a yellow jacket holds her head in frustration. In addition to the increased financial burden caused by accumulator adjustment programs, beneficiaries are not being told of the change in their insurance coverage. Beneficiaries are shocked when they find out that their plans have changed because insurance companies have not adequately informed their customers of the programs. As a result, beneficiaries have planned their healthcare budget plans as they have in previous years, only to find out that their circumstances have drastically changed.

S.B. 731 Takes Action

Pennsylvania S.B. 731 was introduced by Senator Ward and 9 others on June 7th. It was referred to the Banking and Insurance Committee that day as well. It amends the Insurance Company Law of 1921 to add language that allows any cost-sharing amounts paid by the insured or on behalf of the insured by another person. The ban would go into effect 60 days after the bill’s passage, and includes all health insurance plans except accident only, fixed indemnity, limited benefit, credit, dental, vision, specified disease, Medicare supplements, CHAMPUS supplement, long term care or disability income, worker’s comp, or auto insurance.

Raise Your Voice!

Let your Senator know that you support a ban on accumulator adjustment programs so that patients can use their copay cards and pay down their deductibles!


Click here to send a letter to your senator asking them to support S.B. 731!

Know Your Issue: Spread Pricing

Pharmacy Benefit Managers (PBMs) are good at making something out of nothing. We’ve seen them turn a profit through drug rebates, accumulator adjustment programs, clawbacks, and more. The Centers for Medicare and Medicaid Services (CMS) recently issued a guidance on spread pricing, but states have been dealing with this issue for a while now.

A Brief Explanation of Spread Pricing

Spread pricing is one of the main ways PBMs make money. CMS’s guidance defines spread pricing as follows:

“Spread pricing occurs when health plans contract with [PBMs] to manage their prescription drug benefits, and PBMs keep a portion of the amount paid to them by the health plans for prescription drugs instead of passing the full payments on to pharmacies.  Thus, there is a spread between the amount that the health plan pays the PBM and the amount that the PBM reimburses the pharmacy for a beneficiary’s prescription.”

For the visually inclined among us, here’s an excellent visual representation from Bloomberg of how spread pricing works: 

For their part, CVS, a prominent PBM, says choosing to use spread pricing is up to the health plan (for Medicaid, it’s up to the state). CVS says: “Our PBM clients have options to choose from to compensate us for the services we provide…. In one model, clients agree to pay the price negotiated with the pharmacies […] along with a separate administrative fee for the services we provide. More often, we find that our clients choose a different model whereby they contract for predictable drug costs for the year and allow the PBM to keep the difference between this fixed amount and the amount paid to the pharmacy that dispenses the drugs” (AKA spread pricing). This all sounds fine, however, while most people know that a middleman has to make money somehow, they do not know the sheer volume of profit that spread pricing can create for PBMs.   

The State of Spread Pricing in States

While spread pricing can affect any health insurance plan, including employer-based plans, states have been sounding the alarm on spread pricing in their Medicaid programs. In August of 2018, Ohio found that PBMs “collected more than $2.5 billion from plans [between April 2017 and March 2018]…… Of the $2.5 billion, nearly $225 million was generated through spread pricing, including $208 million from prescriptions for generics.” In Kentucky, a February report showed that PBMs earned more than $123 million in spread pricing in 2018, an increase of nearly 13% over 2017. With Medicaid programs representing a larger and larger portion of state budgets each year, it’s no surprise that states want to decrease the occurrence of spread pricing.

States Fight Back

So far in 2019, five states (AR, LA, MT, NY, and VA) have introduced legislation to regulate spread pricing, with most bills outlawing the practice all together. Additionally, the Pennsylvania state auditor recommended the state legislature pass laws to rework the relationships with PBMs and change fee structures. Some states have used the regulatory process to stop spread pricing instead of waiting on legislation to pass.

A map of the United States.

In Ohio, where (reminder) PBMs charged Medicaid not only a nearly 9% spread across all drugs, but also a whopping 31% spread among generic drug prescriptions, the state’s Medicaid Director barred managed care plans from contracting with PBMs that engage in spread pricing. Instead, the state is allowing contracts that have “pass-through” pricing, where PBMs receive a flat administrative fee and can only bill the state for what they pay pharmacies. This rule went into effect in January of 2019, and we’re eagerly awaiting the data that comes from it. And to add to the drama, the Ohio Attorney General is now in a lawsuit with PBM OptumRx. The Attorney General claims OptumRx owes $16 million that they allegedly overcharged the state for generic drugs.  

In Kentucky, the February report recommended eight steps the state could take to curb spread pricing, including requiring an annual PBM transparency report, prohibiting PBMs from financial incentives in the forms of copayments and deductibles, and mandating pass-through contracting for all managed care organization and PBM contracts for pharmacy benefit services. Considering nearly one fourth of Kentucky’s population is receiving Medicaid or CHIP, it will be interesting to see how the state chooses to implement these recommendations. Kentucky has already initiated a probe into PBM pricing structure as of late May.

CMS Gets Involved

All the state issues with spread pricing caught the ears of two lawmakers, Senator Chuck Grassley from Iowa and Senator Ron Wyden from Oregon. In April, the two Senators asked the HHS Office of Inspector General to conduct a “federal-level analysis of PBM practices across state Medicaid programs.” They specifically asked HHS to consider spread pricing in their investigation. CMS responded in mid-May by issuing a guidance for states on how to reduce the cost of their prescription drugs by eliminating spread pricing. CMS noted that some managed care organizations are not accurately reporting spread pricing from PBMs. We’re happy that the guidance will require more accurate reporting, which will likely uncover some disturbing trends and force states to act.

State Advocacy: Where Do We Stand?

While most people have been focusing on federal issues so far this year (and it’s been pretty dramatic, so we don’t blame you!), state legislatures have been considering and passing diabetes bills across the country. Read on to find out some of the issues states have taken on, and whether we think taking time to advocate at the state level is worth it (spoiler alert: it is). 

California is educating parents about type one diabetes!

California S.B. 138 is a bill that would require the department to develop type 1 diabetes informational materials for the parents and guardians of pupils. The bill would require, on and after January 1, 2021, school districts and charter schools to make those materials available to the parent or guardian of a pupil while the pupil is enrolled in kindergarten or when the pupil is first enrolled in elementary school, and while the pupil is enrolled in grade 7. The California legislature sat on this bill for a while, but it is back on the move! On May 21st, the Senate placed the bill in the special consent calendar, and on May 23rd, the Senate passed the bill! It now goes to the Assembly for approval. Click here to send a letter to your California Assembly member asking them to support S.B. 138!

Indiana legislators now know about the dangers of accumulator adjustment programs!

Indiana H. 1307 would have prevented accumulator adjustment programs by requiring a state employee health plan, an accident and sickness insurer, and a health maintenance organization to count cost sharing payments made on behalf of a covered individual toward the covered individual’s cost sharing amount (deductible). Unfortunately, this bill did not get out of the House Committee on Insurance quick enough to pass during the legislative session. However, the groundwork has been laid, and next session we’ll expect the House to pick up the legislation again!

Kentucky is letting pharmacists give their patients the right amount of medicine in emergencies!

The seal of the state of Kentucky with a gavel. Kentucky H.B. 64 was signed into law on March 26th. This law allows pharmacists to dispense the appropriate amount of prescription medications to patients who are experiencing an emergency situation and unable to get a prescription from their healthcare practitioner.   Before this bill was passed, Kentucky pharmacists were only allowed to dispense emergency insulin in a preset, standardardized amount. But every person with diabetes has different needs, and that preset amount won’t be enough for everyone. Now, pharmacists are allowed to dispense the appropriate amount of insulin (and some other life-sustaining prescription medications) that a patient needs to get through an emergency situation. This is a great win for our community, and one more way we can ensure people who rely on insulin stay safe!

Maryland legislators had considered prohibiting copays for insulin!

Maryland S. 410 would have prohibited, except under certain circumstances, certain insurers, nonprofit health service plans, and health maintenance organizations from imposing a deductible, copayment, or coinsurance requirement on insulin after January 1, 2020. The bill was introduced in February and had a hearing in March, but did not pass out of the Senate Finance Committee before the legislative session ended. It’s too bad that this bill didn’t go further, but we’re glad that Maryland lawmakers were exposed to this idea!

Oklahoma has the chance to cap copays for insulin at $100!

Insulin pen.

Oklahoma H.B. 1130 would cap the copayment amount for insulin at $100. That would mean savings for a lot of people who have high copayments under their current insurance! This bill is still in the Committee on Insurance, and unfortunately there has been no movement since it was introduced in February. The legislative session closes on May 31st, so we have one more week to make our voices heard on this bill! Click here to send a letter to your Oklahoma representative and ask them to support H.B. 1130!

Is state advocacy worth the effort?

Definitely! With the federal legislative process running, ahem, s l o w l y, we’re looking to state legislatures to pass bills that make positive change for people with diabetes. As you can see from the list above, states are tackling a bunch of different issues – from type one education in schools, to accumulator adjustment programs, to emergency prescription access, to caps on copays for diabetes supplies. Making your voice heard in your state is an extremely effective way to advocate because often you have a more direct line to your representative, and because state representatives tend to consider more ‘out of the box’ bills. As always, you can find information on state laws on the DPAC website under ‘take action.’ And if your state isn’t addressing something that you know feel passionate about, consider contacting your representative! Can you think of an issue you think your state government should take on? 

Guest Post: Rachel Gartner Clark – Why I Advocate

In November 2003, my life changed forever at the age of 15 years old. I was diagnosed with type 1 diabetes which was a complete redirection from my teenage life. As a sophomore in high school my priorities were: homework, hanging out with my friends and going to the mall. I never thought I would end up on this long and windy journey. I am lucky to have a dad who is a pharmacist and could spot the signs and symptoms of type 1 early on, helping lead to my diagnosis. Even though I had a health care savvy dad to help me navigate my new normal, I was still completely overwhelmed by fear, anger and anxiety.

After being diagnosed, I was rushed to a children’s hospital where I had to go through survival lessons learning the ins and outs of a highly complex disease. Being a proactive person, I decided to take matters into my own hands and read as much as I could. I thought that I would be able to learn EVERYTHING as I experienced new medical advancements and navigated the different types of insulin to find out which one worked well for me.

I couldn’t do this alone.

As time went on, reality set it and I realized that I couldn’t do this alone. It was difficult for me, but I turned to my support network of family and friends and started researching different organizations who could lend resources. After living with type 1 for 16 years and counting, I’m still learning and becoming familiar with different aspects of this disease, the associated costs, and the policy pieces that impact my access to care.

More than a statistic

As time has passed one thing I’ve taken away from all of this is that everything is a numbers game. While I might be another statistic to some, I’m more than being another person that adds to the more than 30 million people living with diabetes in our nation.

I’m more than one of three million Americans to have type 1 diabetes. I’m not just another person adding into the 327 billion dollars in diabetes related health care costs. These numbers alone make me angrier than my diagnosis, but these figures have led me to my advocacy purpose.

I have discovered my voice and I’m ready to use it.

This is why DPAC is so important to me. In a short amount of time, I have learned more about the policy procedures, all of the hidden numbers that sway decisions (like how legislation gets scored), and how to have an effective conversation with our elected officials and their staff.

More importantly, DPAC fights hard to ensure the safety and quality of medications, devices and access to care for all Americans living with diabetes. I have been able to hone my story, back it up with facts and figures, while also helping others do that same due to the policy training meetings that DPAC has offered.

For me, advocacy is another way to educate those around me. It helps to teach people what it’s like to have to fight to stay alive. Advocacy has also given me the gift of finding a community that understands me in ways others can’t.

Why My Community Needs Advocacy

This community continues to educate me on things that make me a better person in my fight for affordable insulin, common sense legislation, and so much more. It’s important that we not only advocate for ourselves, but for the millions of those that will be forced into our community by a diagnosis at not fault of their own.

I believe that the more we all know then the sooner there will be real change.

Guest Post: Claire Pegg on Being A DPAC Champion

I’m Claire Pegg and I’m a DPAC Champion.

I don’t quite know how to convey what that sentence means to me. I’ve had Type 1 diabetes for 22 years. I’ve helped diagnose friends and family with diabetes by recognizing familiar symptoms. I manage care for my dad who has Type 1 and is sinking deeper and deeper into dementia. I’ve spoken up when coworkers and podcasters and news reporters made diabetes jokes that perpetuate the stigma piled on top of a chronic disease that requires my attention most every minute of every day. I’ve grown more and more frustrated at the cost that I and so many others pay for medical care, devices, and prescriptions. 

But I’ve never had a goal on which to focus my passion and the expertise I’ve gained from managing my health for so long. I’ve written letters to my Representatives and Senators but without a specific action to request I felt like a little kid, banging on the door and asking, “Could…could you guys just make things a little easier for us…somehow?”

Enter the Diabetes Patient Advocacy Coalition. I honestly didn’t know anything about DPAC when I saw a social media post asking for people to apply to be DPAC Champions. I spent some time searching online, scrolling through Twitter feeds and inadvertently learning a lot about the Durham Performing Arts Center. I submitted my application and downloaded the DPAC app. Immediately, I found concrete actions I could take, like writing my Congressional Representative to ask for his support for a bill to improve access to diabetes training for Medicare patients. The specificity of this action thrilled me. No, it wasn’t a solution to every issue affecting people with diabetes, but it was a practical solution to a particular problem. That was right up my alley.

When the email came that let me know that I had been selected as a DPAC Champion, I was humbled and excited. It felt like maybe the missing piece that I had been looking for had fallen into place. Everything about this organization appealed to me. I watched as DPAC CEO Christel Marchand-Aprigliano discussed the rising cost of insulin on CSPAN and tuned in to the House and Senate hearings on insulin cost. This was a fight I could get behind wholeheartedly. While my insulin cost is moderately affordable at $500 per year, I was seeing people with diabetes on Facebook groups having to beg for insulin because they couldn’t afford the astronomical price they were being charged to stay alive.

I flew to Washington D.C. and began a fast-paced two day training session with 25 other DPAC Champions, some new and some who had attended the previous fall. I met people with diabetes and parents of people with diabetes. I met people who had lost family members to diabetes. I spent one session in a conference room listening to the music of Continuous Glucose Monitors going off after everyone’s trip through the hotel’s breakfast buffet. 

No judgmental heads turned at every beep or alarm, and my persistent low blood sugar alert resulted in a casual offering from everyone at my table of their emergency sugar on hand. I imagine it was like what kids who go to diabetes camp for the first time must experience. Having the thing about me that makes me different be shared with that large of a group was empowering and uplifting.

The training itself was a dream come true. My favorite new thing: specificity. We Champions were briefed on bills and actions we would be asking our Congressional Representatives and Senators to support. On a bill that would improve the Medicare Diabetes Self-Management Training (DSMT,) we learned what obstacles were keeping people from accessing this training and how the new bill would address those obstacles. We learned more about Rebate Reform and how it is a critical first step to solving soaring insulin prices. 

But most importantly, we learned that we were already experts. The daily, sometimes hourly attention I have paid to managing my health for the past 22 years, complete with mistakes and burnout and good care and bad care, has made me into an authority on living with diabetes. When someone wants to know why it’s important for a person with diabetes to have access to nutrition training or to a Continuous Glucose Monitor or why Walmart insulin is not a long-term solution to insulin prices, I am indeed an expert. My story and my experiences have made me into one. 

Knowing that the people we would be speaking to on Capitol Hill were not looking for a rehearsed presentation but instead wanted to hear our stories and understand what solutions would work for us was a freeing concept.

Once our training days were completed, we spent the third day on Capitol Hill. In groups of five or six, we visited the offices of our Representatives and Senators and asked for their support on the DSMT bill, Access to Affordable Insulin legislation, and for them to join or continue to support the Congressional Diabetes Caucus. Telling my story to my Representative’s Legislative Assistant and listening to him tell me of his parent and grandparent with diabetes and his and the Representative’s desire to be involved in supporting diabetes legislation was an amazing experience. 

I felt like I was making my voice heard, not only on my behalf but on behalf of all the people with diabetes who couldn’t be there with me. I’ve never felt so useful.

 

There was so much more to the DPAC Policy Training Meeting than what I’ve spoken about here. The amazing advocates I got to know, the goosebumps of walking down the marble corridors of Senate office buildings, and the feeling of finally having a chance to speak for change and for progress will stay with me for a very long time. My hope is to continue to grow in this advocacy, returning to it whenever I and my story are needed. If this sounds like that one thing that you have been looking for, keep an eye on the DPAC Twitter and Facebook accounts for the next call for DPAC Champion applications. Maybe I’ll see you in D.C. sometime soon.

 

Guest Post: Stephen Shaul’s Reflections on DPAC’s Policy Training Meeting and Hill Day

Last week was a capital week on Capitol Hill.  Advocates joined again with Diabetes Patient Advocacy Coalition (DPAC) for another Policy Training Meeting, culminating in a stellar Hill Day advocating before Congressional staffers.

On April 30 and May 1, over 20 advocates convened to learn the latest on important diabetes issues and how to effectively bring our own stories to bear when lobbying lawmakers.  We learned a lot about the issues we were there to talk about, and a lot about how to talk about them.


What Did We Talk About?


What did we talk about?  Affordable access to insulin, of course.  It’s the hot diabetes issue right now, and we wanted to make sure that our House Representatives and Senators didn’t forget that people with diabetes need relief from the high cost of insulin now.  

We also talked about H.R. 1840 (https://www.congress.gov/bill/116th-congress/house-bill/1840/text?) and S. 814 (https://www.congress.gov/bill/116th-congress/senate-bill/814/text?), the Expanding Access to Diabetes Self-Management Training Act of 2019.  This one was introduced late in the 115th Congress, and it just didn’t have time to get through before the election.  Now it’s back for the 116th Congress.  

H.R. 1840 and S. 814 aim to remove some of the barriers in place that are keeping Medicare recipients from learning how to better manage their diabetes today, next year, and for years after that.  There’s a lot to like in this bill, and I encourage you to use the links above to find out if your Representative and your Senators have cosigned on this important legislation. If they haven’t cosigned yet, use this link (https://dpac-dev.childrenwithdiabetes.com/act-now/federal/ask-your-representative-to-support-diabetes-self-management-training-legislation/) to go to the DPAC website and ask them to put their support behind these bills today.


Your Voice Matters


Now, let me take a moment and talk to you about how important your voice is when it comes to affordable access to insulin, and a better path toward self-management training for seniors in America.  Hint: it’s super-important.

Maybe you’ve seen the tweets and Facebook posts from advocates who were in Washington last week, and thought, “I dunno, all that advocating stuff might be over my head”.  But it’s not!  
There are over 40 people who have taken part in DPAC Policy Training Meetings and Hill Days in the past seven months, and most of us weren’t too sure we could handle it either.  But we received great training from Christel Marchand Aprigliano, CEO of Diabetes Patient Advocacy Coalition; Leyla Mansour-Cole, Policy Director of DPAC; and DPAC’s Vice President of the Board, Stewart Perry.  We also received valuable lessons from Diabetes Educator and Pharmacist extraordinaire Jasmine Gonzalvo, and from Logan Hoover, Senior Legislative Assistant to Representative Tom Reed, Chair of the Congressional Diabetes Caucus.

They were able to give us the knowledge that we needed to be able to speak effectively, and the confidence to share the passion we all have for improving the lives of people living with diabetes wherever they live in the USA.

In short, you can do this, and I hope that when the next DPAC Policy Training Meeting is announced, you sign up to be a DPAC Champion too.  We need your voice. Your voice is worthy.

Do it for yourself.  Do it for a family member.  Do it because you pay taxes and they work for you.  Do it for all of the people who can’t go to Washington but will benefit from your advocacy and passion.  When you do, you will leave with a wealth of knowledge and a renewed sense that being a DPAC Champion makes a crucial difference for everyone affected by diabetes.

 

About
Stephen Shaul

Stephen Shaul has been living with Type 1 diabetes since 1991. He writes a popular blog called “Happy Medium,” is the founder of the Diabetes Athletes medal program, was a facilitator for The Diabetes UnConference, has spoken at FDA, and has been a longtime advocate for the Diabetes Patient Advocacy Coalition.  He’s currently serving as a member of the State of Maryland’s Advisory Council on Health and Wellness, where he is the co-chair of the Diabetes committee. In addition, he’s part of the 2018 Reader Panel at Diabetes Forecast magazine. He lives in Baltimore with his awesome wife, Maureen. 

In summary, Stephen rocks. 

Congratulations to our 2019 DPAC Patient Advisory Board

We would like to announce our 2019 DPAC Patient Advisory Board! 

  • Laurel Garrison (Co-chair)
  • Erin Bubb
  • Moira McCarthy Stanford
  • Mike Ratrie
  • Robert Parant
  • Daphne Ferdinand
  • Jennifer Hamm
  • Rachel Gartner Clark

All of the DPAC PAB members have intimate connections with the diabetes community and have a passion for policy advocacy. We are excited to have had so many wonderful candidates apply and look forward to building a vibrant community of advocates with our 2019 advisors!

Kentucky Legislature Passes Emergency Prescription Bill

Congratulations Kentuckians! Your advocacy has paid off. On March 26th, the Governor signed H.B. 64 into law. This law allows pharmacists to dispense the appropriate amount of prescription medications to patients who are experiencing an emergency situation and unable to get a prescription from their healthcare practitioner.  

Before this bill was passed, Kentucky pharmacists were only allowed to dispense emergency insulin in a preset, standardardized amount. But every person with diabetes has different needs, and that preset amount won’t be enough for everyone. Now, pharmacists are allowed to dispense the appropriate amount of insulin (and some other life-sustaining prescription medications) that a patient needs to get through an emergency situation. This is a great win for our community, and one more way we can ensure people who rely on insulin stay safe!

Thank you to everyone who sent a letter and shared DPAC’s call to action. Your efforts have paid off!

Diabetes Patient Assistance Programs: Insights and Recommendations for Increased Access

As prescription drug prices become unattainable for many, patient assistance programs (PAPs) are becoming increasingly important. As advocates for patients with diabetes, we wanted to learn more about how patients were using these resources. How are patients learning about PAPs? How is the application process affecting patients? Who is ultimately able to access PAPs?

PAPs exist to help people who have difficulty affording their prescription medications and/or other supplies. According to the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS), “pharmaceutical manufacturers may sponsor patient assistance programs (PAPs) that provide financial assistance […] to low income individuals to augment any existing prescription drug coverage.”1 PAPs have varying qualifications and requirements for admission that differ based on the PAP administrators’ preferences, the type of drug or supply needed, and the patient’s income level or household size, but all PAPs have one ultimate goal: to provide patients with the medications they need. Based on the conclusions from our survey, we have come up with recommendations for foundations who offer PAPs on how they can make their programs more accessible and more effective. PAPs serve an incredibly important purpose in our healthcare environment, and improvement in their operation will mean improved outcomes for the patient community.

Click below to download the full document and read the results of the survey.