Health Plan Design Solutions

FIRST-DOLLAR COVERAGE

Diabetes is a chronic disease that is a significant cost driver for most health plans. Investments in diabetes management through affordable access to drugs, devices and educational services should be considered preventive care by health plans. The good news is that the Internal Revenue Service (IRS) ruled in 2019 that care for chronic conditions can be provided under a high-deductible health plan (HDHP) without cost-sharing before the participant meets their deductible.

First dollar coverage of critical diabetes management therapies is an important step to reducing plan risk of the cost of the devastating complications of the disease such as heart attack, stroke, end stage renal failure, amputations and blindness. The costs of these complications far exceed the costs required to effectively manage a patient’s blood sugar, yet many plans are penny-wise and pound-foolish by limiting access to essential management tools such as:

  • Medications – insulin, SGLT2 and DPP1
  • Technologies – continuous glucose monitors and insulin pumps
  • Education – diabetes management and nutrition

It’s critical to note that patients without first-dollar coverage often put off visits and ration their medications and devices because they have to pay unaffordable out-of-pocket costs. This can have the unintended effect of exacerbating their health issues, leading to longer, and more expensive, procedures.

Please consider exempting diabetes management from the deductibles in your plan.