On May 23, 2021, Joanna Buscemi, PhD shared her perspective on diabetes mortality inequality and policy recommendations to address it. As part of MedPage today‘s review of the top events of the past year, Buscemi and Allyson Hughes, PhD, are following the cutting edge of the Biden government’s Build Back Better Act (BBBA), which includes many policy changes related to diabetes.
The Biden government’s Build Back Better Act (BBBA) contains several provisions that are likely to benefit the health of Americans living with diabetes, as well as providing health benefits that go beyond just caring for diabetes. First, the law caps the price of insulin copay for insured Americans at $ 35. Second, the BBBA includes provisions for a major expansion of health coverage that is expected to cover an additional 4 million Americans. Finally, the BBBA expands nutrition programs to combat food insecurity and invests in parks and public transportation that promote safe and convenient opportunities for physical activity. While the future of the BBBA hangs in the balance now that Senator Joe Manchin (D.-W.Va.) announced he would not support it, any revised version of the bill or revised social spending laws should maintain these important health regulations and others Address important issues that are not addressed for people with diabetes, especially those belonging to minority groups.
It is important to start with an understanding of the limits of the insulin copay cap. While this copay cap can be helpful for many insured Americans, it doesn’t limit the cost of the insulin itself. This means that without insurance, insulin prices will stay the same – and will continue to rise exponentially over time. As a result, the costs remain difficult to manage for those not eligible for Medicaid or Medicare and with competing financial priorities. Additionally, those with insurance will still be responsible for the full cost of insulin if they run out of insulin but find themselves in an insurance gap. These guideline restrictions can result in insulin rationing, which can be fatal. It may also leave many people with diabetes with no choice but to seek insulin on social media sites from donors or vendors.
True justice for people with diabetes would mean that drug companies limit the cost of insulin themselves so that it is affordable for Americans with or without health insurance. Big Pharma continues to benefit from the backs of people with diabetes and Congress must put an end to that once and for all. Limiting the cost of this expensive, life-saving drug can also set a precedent and ultimately benefit people with other diseases that, due to price gouging, require costly medical treatment – such as people who need an EpiPen, have rheumatoid arthritis, cancer, etc. / or other conditions.
While the expansion of Medicaid and Medicare in the current version of the BBBA is likely to benefit those who were previously uninsured, the limitations of health coverage for those with diabetes remain in place. The first caveat, recently outlined in a joint position statement from the Society of Behavioral Medicine and the Society for Health Psychology of the American Psychological Association, is that there are significant barriers to obtaining essential diabetes products – such as Continuous Glucose Monitors (CGMs) and Insulin pumps – insured. To be approved for insulin pumps, diabetics must complete quarterly in-person visits to their provider, which increases the burden on patients and providers alike and decreases access to CGMs. This requirement has been temporarily lifted due to the pandemic, but needs to be lifted permanently in order to improve access to diabetes care in the long term. The second problem with health insurance is that it often deprives them of freedom of choice in terms of devices and types of insulin. Take Walmart Insulin, for example: Walmart has inexpensive insulin in its retail stores, but the insulin hit the market 25 years ago and it works more slowly than other insulins available. This may seem like a subtle problem to people without diabetes. But people with diabetes know that the speed of insulin makes a huge difference and that you need to be trained in using each type of insulin, which makes it very difficult to simply switch to something new. When people do not have freedom of choice due to the restrictions of insurance companies, it forces some to pay out of pocket for the best insulin for their needs. These restrictions are largely governed by the states, which suggests that statewide policies for insurance coverage for treatments and devices related to diabetes should include a variety of products.
Despite certain limitations in the BBBA, several health-focused initiatives with great potential are being launched to improve equity among diabetes mortality by reducing insulin supplements, expanding health care, and improving access to healthy food and safe exercise spaces. Future versions of the law must retain these changes. In addition, Congress must continue to focus on improving other social determinants of health – education, safe housing, safe drinking water, and affordable childcare. These are important structural changes that are likely to have positive effects on minority Americans in a broader sense. But until drug companies are held accountable, every American will be guaranteed health care, and insurance companies will cover and give patients choices about drugs and devices, inequalities and barriers will persist. There are three laws proposed by the Congressional Caucus on Diabetes that should be reconsidered to alleviate these remaining issues: Protecting Access to Diabetes Supplies Act (HR 771), Preventing Diabetes in Medicare Act (HR 1686), and Medicare CGM Access Act (HR1427).
Moving forward, researchers need to quantify the real impact of key laws on diabetes mortality inequality and other diabetes-related outcomes, as well as their impact on other systemic suppression-related diseases – heart disease, cancer, and obesity. , among other. In the meantime, it is important that in the New Year legislation focus on completely removing barriers to care in order to improve the health and quality of life for people with diabetes. The experts in removing political barriers to adequate care are the people who experience them. Therefore, patient councils should have a voice at the table when making political decisions to ensure that large investments are well-intentioned but not missed.
Joanna Buscemi, PhD, is a clinical psychologist, assistant professor in the Department of Psychology at DePaul University, and chair of the Health Policy Council of the Society of Behavioral Medicine. She specializes in health inequalities and health policy advocacy. Allyson Hughes, PhD, is a health psychologist and assistant professor at Ohio University’s Heritage College of Osteopathic Medicine. She specializes in the psychosocial challenges of diabetes management, including health equity in relation to severe hypoglycemia, diabetes ailments, diabetes complications and disabilities. She has lived with diabetes for 26 years.