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Policy Tools
Policies that Put People With Diabetes First
Affordability
12% of Americans with diabetes can’t afford their own prescriptions. Because of these growing costs, 1 in 4 diabetes patients rations their medication like insulin. There are policies that go beyond Medicare and Medicaid that can make treatments more affordable.
Access
Access to medication, devices and care providers remains a major issue for patients with diabetes. Policies that support health care provider improvements, faster diagnosis and innovations like telehealth go a long way to help diabetes patients receive the care they need.
Quality
Quality of care remains a concern for those living with diabetes. Fee-for-service insurance plans and insurance policies like non-medical switching prioritize cost over patient care. We support policies that ensure a consistent and improved quality of care for patients.
Three Ways To Affordability
Rebate Pass-Through Policies
Since the introduction of Medicare Part D in 2006, pharmacy benefit managers with insurance companies have had a carte blanche to negotiate rebates on important medications like insulin. These rebates are pocketed by the insurance company and the benefit never reaches the patient at the pharmacy counter, where they need it the most. Rebate pass-through policies bring a 0.01% increase in cost for private insurers and have little to no impact on government spending.
DLC is in support of the following legislation: DLC also supports efforts from the Federal Trade Commission (FTC) to further investigate PBMs and their role in raising insulin pricing.
Co-pay Adjustment Programs
Co-pay adjustment programs, offered by manufacturers, provide assistance directly to patients through copay assistance coupons. These coupons pass on savings that can be applied directly at the pharmacy counter or to their deductible. DLC supports these programs, which require no statutory interventions from state or federal level lawmakers.
Patient Cost-Sharing Caps
Since the introduction of Medicare Part D in 2006, pharmacy benefit managers with insurance companies have had a carte blanche to negotiate rebates on important medications like insulin. These rebates are pocketed by the insurance company and the benefit never reaches the patient at the pharmacy counter, where they need it the most. Rebate pass-through policies bring a 0.01% increase in cost for private insurers and have little to no impact on government spending.DLC is in support of the following legislation: DLC also supports efforts from the Federal Trade Commission (FTC) to further investigate PBMs and their role in raising insulin pricing.
Access Through
Health Care Provider Improvements
We must regularly review reimbursement so we can ensure the economic viability of diabetes service and supply chain. We need to continue support for telehealth services through broader policies and ensuring coverage.
Faster Care Decisions
We must encourage faster care decisions by minimizing roadblocks like step therapy and benefits appeals, which increase the odds of having prescribed medication and services denied.
Quality Through
Value-based diabetes coverage
Shift health care spending for diabetes away from fee-for-service to a value based model that focuses on the quality of care instead of the quantity of care. Ensure a comprehensive approach to diabetes care by reducing the burden of living with diabetes through prevention and treatment of the whole patient.
Stop non-medical switching
Non-medical switching is a strategy that health insurers use to control their costs and maximize profits by forcing stable patients to switch from their current, effective medications to drugs that may not be as effective, for reasons unrelated to health.
Resources
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Our Champion
Edward Hawthorne
Meet DLC’s Board Vice Chair Ed Hawthorne – a long-time champion for people living with diabetes, Ed has been involved in advocacy and research fundraising efforts for over 2 decades. Beginning with a volunteer opportunity through his previous employer, Bank of America, Ed has remained impassioned about the issues facing the diabetes community.
In addition to sitting on our board, Ed currently sits on the Emeritus Council for the American Diabetes Association and previously served as the Chairman of the National Board of Directors for the American Diabetes Association.
Tune in to hear why he remains a champion after all these years!