Summary: With ever rising cost of living thanks to inflation, 37 million Americans living with diabetes face nearly insurmountable healthcare costs. 3.7 million of them say they must choose between their daily living expenses or their medication. While the Inflation Reduction Act (IRA) provides some relief, more can be done to make healthcare more affordable for those living with diabetes. Below, the Diabetes Leadership Council outline policy solutions that best serve the growing diabetes community.
The impact of diabetes is staggering, Congress must act before the end of the year to support Americans facing serious financial challenges caused by the cost associated with their chronic conditions.
127 million Americans are impacted by diabetes or pre-diabetes. And diabetes is expensive, the chronic condition accounts for 1 in 4 healthcare dollars in the U.S. and adds $9,600 to an individual’s average annual healthcare costs. In addition to an untenable financial reality, 10% of people with diabetes say they must choose between their daily living expenses or lifesaving treatments.
Congress has put forth a myriad of policy solutions, many of which don’t address the systemic issues that drive up drug prices. That is why the Diabetes Leadership Council (DLC) and its sister organization the Diabetes Patient Advocacy Coalition (DPAC) partnered to educate Congress and push them to act.
DLC had the honor of sitting down with policymakers and their staffers, who are leading the charge to address the larger systemic issues impacting Americans with diabetes.
Insulin Preventive Coverage and Capped Cost Sharing
Congresswoman Angie Craig co-sponsored the Affordable Insulin Now Act. The bill would require public and private health plans in the U.S. to cover insulin without a deductible and cap patient costs at the lesser of $35 or 25 percent of the negotiated price.
After the Affordable Insulin Now Act passed the House, Diabetes Caucus Co-Chairs Congresswoman Diana DeGette, and Senators Jeanne Shaheen and Susan Collins, set to work on a broader bipartisan and bicameral framework to address insulin affordability. DeGette joined the program to share an update and timeline for those efforts, and other Diabetes Caucus priorities.
Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021
Congresswoman Craig and Congressman Buddy Carter of Georgia are co-sponsors of the Ensuring Access to Lower-Cost Medicines for Seniors Act of 2021 (H.R. 2846). The bill would ensure access to lower-cost prescriptions for seniors through Medicare by automatically covering lower-cost generics and biosimilars in Medicare Part D. Support of this bill would ensure lower price tags not only for patients at the pharmacy counter but for the healthcare system overall.
As one of two practicing pharmacists in Congress, Congressman Carter has seen firsthand how high drug prices harm his patients. He discussed how the current rebate-based system leaves patients paying higher prices instead of lower ones. As a member of the GOP Doctors Caucus, Carter has made it a mission to ensure members understand what is happening with drug pricing and what Congress can do about it.
Pharmacy benefit managers (PBMs) play an outsized role in driving up drug prices for patients. Their job is to secure lower drug prices by negotiating with manufacturers for rebates in exchange for inclusion on insurers’ formularies. Carter points out that PBMs own or are owned by insurance companies. Due to a lack of transparency, rebates are being pocketed by intermediaries rather than helping patients at the pharmacy counter. These rebates are substantial. A 2021 Senate Finance Committee report found insulin rebates can exceed 80 percent of the list price. Americans are paying $300 for a drug that costs their health plan $60!
Pharmacy Benefit Manager Transparency Act of 2022
Staffers from Senator Chuck Grassley’s office joined us to discuss their legislative solutions to the convoluted PBM system, including the Pharmacy Benefit Manager Transparency Act of 2022. The bill was recently introduced by Senator Grassley and Senator and Commerce Committee Chair Maria Cantwell of Washington. The PBM Transparency Act calls on the Federal Trade Commission to address PBM practices impacting patients and payers and inject much-needed transparency into the drug pricing system.
Cures 2.0
Passed in 2016, the 21st Century Cures Act has been a game-changer for many patients. By accelerating medical product development and approvals, new innovations are reaching patients faster than ever before. Congresswoman DeGette and her colleague, Congressman Fred Upton, discussed their proposed follow-on Cures 2.0.
DeGette and Upton underscored the importance of Cures 2.0 provisions to accelerate patient access to innovative treatments by fully funding federal research and providing regulators with the resources needed to review safety and efficacy. Innovation has transformed the landscape for diabetes management, which DeGette has experienced in her own family, after her daughter was diagnosed with type 1 diabetes. She shared how rapid and equitable coverage of innovative treatments in federal programs is critical for Americans with diabetes and to reduce costs for the U.S. healthcare system.
Treat and Reduce Obesity Act of 2021
Diabetes prevention is just as important as the research and addressing affordability issues. Obesity can play a critical role in the development of type 2 diabetes; obesity occurs in 90 percent of US adults aged 18 years or older who are diagnosed with diabetes. As a doctor Congressman Brad Wenstrup understands the health implications of obesity and the stigma that prevents patients from getting the treatments they need. He has worked to get the Treat and Reduce Obesity Act of 2021 passed so FDA-approved medications for chronic weight management and obesity treatment from nutritionists, clinical psychologists and dietitians are covered by Medicare.
Congressman Donald Payne of New Jersey shared some of his personal experience living with type 2 diabetes and its complications. He is co-sponsoring TROA and other legislation to help people with or at risk for the disease and address diabetes disparities in communities of color and other disproportionately impacted populations.
See the full segment below here: https://diabetesleadership.org/virtual-policy-rsvp
DLC is a 501(c)(3) patient advocacy organization is comprised of individuals who combine their passion for advocacy with decades of diabetes experience and leadership to advance patients-first policies at the local, state and national levels. Our members – all former leaders of national diabetes organizations – engage policymakers, and public and private sector influencers to call attention to the diabetes epidemic and provide a voice for 37 million Americans living with the disease
