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Diabetes care is preventive and all health plans should cover it accordingly. Preventive care benefits morethan just the person with diabetes; it has substantially positive economic outcomes for our country,ensuring that as Americans with diabetes age, their health outcomes are better and require less supportfrom Medicare and other federal programs.
Waiving deductibles and cost-sharing for insulin and other diabetes management essentials is the mosteffective and equitable health benefit plan structure for Americans with diabetes or prediabetes. Whenwaived cost-sharing is not possible, patient costs should be kept low and predictable throughout the year.
The Diabetes Leadership Council (DLC) supports insulin caps at the lesser of $35 or a low percent of netcost so plan members directly benefit from any insulin rebates and discounts negotiated on their behalf,just as they benefit from negotiated plan rates for office visits, lab tests, and other care. Low, capped costsharing helps keep insulin costs level throughout the plan year, making it easier for families to budget anduse insulin as prescribed rather than risking significant complications or even death by rationing insulin.
Twenty-five states1 have already passed insulin cost-sharing cap legislation. It is time to protect allAmericans by putting in place a national standard across all government and commercial plans, includingAffordable Care Act (ACA) and Employee Retirement Income Security Act (ERISA) plans.
Further, Congress should improve insulin affordability by capping cost-sharing at the lesser of $35 or 25percent of the negotiated price for all FDA-approved insulins covered by a patient’s health plan, whichincludes all insulin prescriptions in the quantity prescribed. With retail prices now as low as $100 or even$50 for authorized generic and interchangeable biologic insulins, patient costs will be even less than $35if health plans cover these lower list price alternatives rather than their high list price reference productsthat carry rebates of 80 percent or more.
While a national insulin cost-sharing cap does not solve systemic problems driving up prescription drugprices, it does ease the current financial harm to people with diabetes and their families untilpolicymakers are willing and able to comprehensively address perverse financial incentives in the currentrebate-based system that inflate prices for insulin and other prescription drugs.
About the Diabetes Leadership Council: DLC is a 501(c)(3) patient advocacy organization committedto reducing barriers to effective, accessible and equitable care by informing policymakers about thepriorities and lived experiences of the diabetes community. Our members – all former leaders of nationaldiabetes organizations – share a singular focus on patient-centered policy advocacy to improve the lives ofall people impacted by diabetes.
Erin Callahan, Chief Operating Officer, ecallahan@diabetespac.org
April Gutmann, Sr. Manager Government Affairs & Policy, agutmann@diabetespac.org
1 https://diabetes.org/tools-resources/affordable-insulin/state-insulin-copay-caps
