World Diabetes Day 2021 theme from the International Diabetes Federation
The availability of insulin and other elements of diabetes care remains out of reach for millions who need them. People with diabetes are at risk of severe and life-threatening complications, especially if they do not receive adequate support or treatment. Complications include:
What can be done to improve access to diabetes care worldwide? It all starts with our lawmakers. We need to keep our state and federal lawmakers accountable in ensuring that our healthcare system:
🔹Provide basic health care at a reasonable cost to people with diabetes
🔹Develop policies to improve prevention of type 2 diabetes
🔹Enhance screening to ensure timely diagnosis and prevent complications resulting from diabetes
🔹Develop mechanisms to engage people with diabetes in the development of diabetes policies
As we’re voting for newly elected officials today, make sure the candidate you’re voting for is willing to support health equity for all.
Walmart’s private brand insulin brings some relief to uninsured patients
Walmart has unveiled their private brand of analog insulin, ReliOn Novolog. A prescription will still be required, and the cost is still slightly higher than what people will pay through insurance and copays. However, the list price of the insulin brand would bring some much-needed relief to those without insurance that need insulin immediately.
ReliOn Novolog, manufactured by Novo Nordisk, is a rapid-acting insulin analog used to control high blood sugar in adults and children with diabetes. Walmart promises to offer customers a significant price savings without compromising quality. A prescription is required to purchase the new insulin brand.
ReliOn Novolog will cost $72.88 for a glass vial and $85.88 for a box of five FlexPens. According to Walmart, the cost saves customers between 58%-75% off the cash price of Novolog branded products. This translates to a savings of up to $101 per branded vial or $251 per package of branded FlexPens.
ReliOn Novolog will be available in Walmart pharmacies this week and Sam’s Club will start offering ReliOn Novolog in mid-July.
Keep in mind that every patient responds differently to treatment, therefore, consult with your doctor to determine if ReliOn Novolog will work for you.
Bignews for millions of Americans with pre-existing conditions
Last week, in a 7-2 decision, the Supreme Court ruled to uphold the Affordable Care Act (ACA), preserving critical patient protections.
The ACA helps currently protects people with pre-existing conditions from discrimination, while expanding healthcare coverage for young adults, and increasing access to free and preventive health services.
A joint amicus brief- also known as a “Friend-of the-court brief,” was filed representing millions of patients with serious illnesses from various state representatives, patient groups and organizations, including the American Diabetes Association, in support of upholding the ACA.
The Supreme Court ruled the plaintiff states and taxpayers (which included the state of Texas, over a dozen additional states, and two individuals) did not have legal standing to bring their lawsuit, which aimed to get the entire health care law struck down.
If the ACA had been repealed, about 20 million Americans would have been uninsured.
As a result of the ruling, patient protections that prohibited insurance companies from denying coverage to people with pre-existing conditions like diabetes, requiring health plans to offer essential benefits, and eliminating arbitrary dollar limits on coverage will remain in place. The ruling will also keep current tax credits that keep health insurance affordable for Americans, along with federal funding to help states provide vital Medicaid coverage to low-income adults.
Let’s sound off in the comments!
1. What are your thoughts about the ruling?
2. Have you tried to apply for health insurance since your diagnosis? If so, did you experience any difficulty obtaining insurance or with the cost of insurance?
Is this future guideline a true win for all diabetics patients on Medicare?
Last Friday, the American Diabetes Association posted a late night announcement regarding a major change from the Center for Medicare Services regarding the current guidelines for for a continuous glucose monitor
This is the post in it’s entirety:
“Medicare has permanently eliminated the 4 times-a-day testing requirement to qualify for a CGM. This long-time barrier to CGM access will be permanently removed on July 18, 2021! The removal of this criterion has been an effort long-led by the ADA, on which we have been actively engaged with CMS.
PWD on Medicare will now be able to more easily access this critical piece of technology, leading to better diabetes management and better health outcomes. A big win for the diabetes community!”
It definitely sounds like fantastic news for diabetic patients! But what does it mean diabetic patients on Medicare can now go to their nearest pharmacy and get that CGM, right?
Not so fast.
While talking with a fellow diabetic support friend later that night, he enlightened me that this news is only one piece of a large puzzle.
Take a look at the following snapshot of the future CGM qualification guidelines below:
According to the future guidelines, even though the 4 times a day blood glucose monitoring will no longer be valid, the patient will still need to “be insulin treated with multiple daily administrations of insulin or a continuous subcutaneous insulin infusion pump.”
In short, in order for a diabetic patient on Medicare to qualify for a CGM, the patient not only has to be insulin-dependent, but the patient will have to take insulin three or more times a day.
This is not a win for all type 2 diabetics. As my friend expressed, the new guideline places a huge barrier for type 2 diabetics who are non-insulin dependent. Unfortunately, if you are a type 2 diabetic on Medicare, you will not qualify for a continuous glucose monitor.
There’s still a ton of work to be done in order for all diabetic patients can have equal access to the medicine and equipment without going through hoops and loops. This is a step in the right direction, and,for what it’s worth, this small step is still worth celebrating.
But tomorrow, it’s time your armor and fight again.
If you’re a diabetic on Medicare, then this news is for you!
This story just popped up on my Facebook newsfeed and I’ve decided to do a quick blog post about the announcement. I will discuss this further next week! The following comes directly from the Center of Medicare Services:
“Medicare has permanently eliminated the 4 times-a-day testing requirement to qualify for a CGM. This long-time barrier to CGM access will be permanently removed on July 18, 2021! The removal of this criterion has been an effort long-led by the ADA, on which we have been actively engaged with CMS.
PWD on Medicare will now be able to more easily access this critical piece of technology, leading to better diabetes management and better health outcomes. A big win for the diabetes community!”
Will rebate reform policysave chronic illness sufferers like us from financial doom?
Managing diabetes is already difficult and exhausting to maintain on a daily basis. But what if you are one of 34 million people with diabetes also struggling with increasing medicine costs?
You find yourself having unsuccessfully heated conversations with your doctor and insurance company because that $432.61 Lantus medication that your doctor prescribed is not covered by your insurer. To make matters worse, there’s no generic alternative for Lantus.
Or let’s say that your insurer does cover Lantus. You go to pick up your medication from the pharmacy only to find out that you’re paying more out of pocket, placing a financial burden on you.
In fact, this is actually how the current drug distribution and payment system is designed.
“The substantial costs of living with a chronic illness are compounded year over year, penalizing and marginalizing high risk patients, perpetuating medical inequity. According to the CDC, chronic diseases arethe leading causes of death and disability, driving $3.8 trillion in annual health care costs(18% of the GDP). Ultimately, people living with chronic diseases not only bear the burden of daily illness management but also predatory medical costs. Those living with diabetes perpetually pay higher costs to live, $9,600 annually, exacerbated by inflated prescription drug costs due to grossly unfair rebate practices.”
This is the foundation of rebate reform. In order to understand why this is being considered, you have to understand the key players involved; how drug rebates currently work and how this is financially burdening so many of us.
Patients Rising Now, another advocacy organization, created a great infographic showing how prescription drug distribution and payment works:
Key players in the drug distribution and payment process involves the following:
Drug Manufacturer
Wholesaler
Pharmacy Benefit Manager (PBMs)
Pharmacy
Health Plan (Insurers)
Patient (Us)
We will focus on the flow of rebate. The flow of rebate is represented by the orange line.
The key players involved in this flow are:
Drug manufacturer
Pharmacy Benefit Manager (PBMs)
Health plan (Insurers)
Patient (Us)
How Do Drug Rebates Work?
Rebates are discounts paid by drug manufacturers after the prescription has been dispensed to insurers, pharmacy benefit managers and pharmacies. These are cash payments that are sent to PBMs, which then shared with the plan sponsor (insurer) that they serve. The insurer generally uses the savings to lower the premium for the patients, rather than passing the discount to them at the point of sale.
This concept has been around for years. At first, drug manufacturers paid rebates for every brand name drug on the market. However, drug manufacturers started to consolidate the rebates into fewer products to maximize their share. Currently, rebates are attached to more expensive brand drugs and specialty medications. The more expensive brand drugs and specialty medications gives insurers and pharmacy benefit managers an incentive to include a drug on their formulary, which is a list of medications that may be prescribed that are covered by the insurer.
PBMs negotiate contracts with the drug manufacturers on behalf of the insurers. It determines the placement of drugs to specific tiers. These tiers determine how much a patient owes out-of-pocket for a prescription drug. Preferred drugs are typically have lower co-pays. The details of the contracts between PBMs and drug manufacturers are kept confidential.
The PBMs financially benefit from the rebates by encouraging fast-growing list prices for the drug. The insurers financially benefit by having us, patients, pay our share of the list price of the drug (the original price of the drug) instead of the net price (the total cost of the drug after rebate). This places a major financial burden on us, especially if we are relying on expensive medication.
Organizations like the Diabetes Leadership Council believe that patients should never have to pay more for medical products and services than their health plan pays. This is why advocacy programs are targeting congress to pass non-partisan rebate reform policies to help reduce patient costs. A rebate reform would require PBMs and insurers to pass savings to the patient, making it easier to afford to access to the medicine that they need.
Currently, there are talks in Congress surrounding rising prescription drug costs, including two hearings on the issue. My hope is this will be the traction that we need to be able to get some meaningful reform passed so we don’t have to suffer from anymore additional stress because of medical costs.
We should not be forced to choose between taking care of family or medicine we need that will allow us to do so.
The impact of changing lifestyle to improve diabetes and other connected illnesses.
A test strip can cost up to $0.75 cents per strip. It costs $3.00 if you use four test strips a daily. That’s $90.00-$93.00 a month and almost $1100 a year!
Tonight I’ve sat through two meetings about how the new and updated health care legislation would affect the diabetes community.
There are current discussions about medical drug and device rebates and co-pays. Things that so many of us diabetes can benefit from right now and not a second later. Unfortunately, the process to put the new legislation into place will take some time due to issues within the current congress administration. There are numerous vacancies in the US Health and Human Services that have not been filled since the end of the Trump Administration into beginning of the Biden administration. President Biden’s efforts to reinvigorate the American Cares Act has made some strides, but there are some issues involving Medicaid expansion and deciding on the individual mandates. Plus, the Supreme Court has halted the Trump Drug Policy that was previously passed before the end of Trump’s presidency for further review. Until these vacancies have been filled, and the court settles out the logistics of the drug policy, we may not see and major changes in the near future.
This is very sobering news because the number of new cases of diabetes has greatly increased to an estimated 1.5 million cases in 2018 according to the CDC’s National Diabetes Statistics Report for 2020.
A 2017 study on the Cost of Diabetes Care by the American Diabetes Association stated that Diabetes account for $1 out of $7 spent on healthcare in the US. That accounts for 1 in 4 health care dollars spent. The average that a person with diabetes spend was $16,752 a year. There are many of us that are not able to cover any of that cost out of pocket. This is where affordable health care could really benefit.
Until things shift, there are ways that we could do to cut down on the costs of diabetes care such as taking advantage of health savings of flexible spending accounts, enrolling in health insurance (if eligible) and other health plans provided by the state.
However, there is a better way that diabetics, specifically type 2, in this case could do that can really cut down on diabetes expenses and possibly eliminate certain expensive medications. Want to know what it is?
CHANGE YOUR LIFESTYLE!
I’m not a doctor and not qualified to give medical advice; however, I am a diabetic and I can personally attest to this! Changing the way you eat and intentional exercise can do wonders for your health. Sticking to a lifestyle will help lower your A1c to levels that may result in eliminating certain medications and eliminate other illnesses that contribute to diabetes like heart and liver diseases.
Personally, I currently eat low carb/keto and walk two miles a day; however, simply eliminating eating processed and/or refined foods along with exercising a minimum of three days a week, will still be highly beneficial. Doing our part by sticking with a healthier lifestyle could not help put a dent in diabetes debt, but lower overall health care debt.
Even though the case is vastly different for type 1 diabetes because insulin is required regardless, a healthier lifestyle change could also benefit some type 1 diabetics, resulting in less insulin injections or elimination of other medications. Pre-diabetics that change their lifestyle can lower their chances of being officially diagnosed with diabetes and other illnesses.
A lifestyle changes will give you lifelong savings from complications of diabetes including, blindness, amputations, kidney failure, heart attacks and strokes. And the best benefit of all: you will be able to live again without the stress of health care cost burdening your mind.
