Californians with Diabetes are in Crisis: Inspiring Creativity

Without injected insulin, an individual living with diabetes will die within days or even hours. Not get sick, not possibly die – they will die.

More than 13 million Californians depend on insulin to manage their diabetes. Every day, thousands of lives are devastated by the staggering cost of this lifesaving medication. These are women, men, and children who often require one or more daily insulin shots. Increasingly, many of these patients are forced to ration doses, risking kidney failure, blindness, loss of limbs, stroke, and even death. The result: another public health crisis being ignored.

While the average person spends about $1,025 per year on medications, many people with diabetes who require insulin often spend five times that amount on a treatment they cannot live without. The cost of insulin has skyrocketed more than 1,200 percent since the 1990s. Even if these patients are lucky enough to be insured, they often experience insufficient prescription drug coverage by their insurance carriers or the inability to afford their required copay or deductible. This untenable situation is leading to a monumental health crisis in our state that must be addressed immediately.

These solutions involve partnering with pharmaceutical manufacturers but make no mention of insurance providers. We must wake up to the fact that it’s health insurers who set the copay prices. It’s health insurers who are benefitting from pharmaceutical rebates that should go to patient care. Health insurers, both non-profit and for-profit, are getting rich while Californians with chronic diseases like diabetes suffer.

Lack of access to affordable insulin comes with very real humanitarian and fiscal costs. Far too often, the story is this: The patient has health insurance but cannot afford their insulin copay. The patient tries to stretch their medication by rationing it, not realizing they’re doing even more damage to their body. Or, the patient discovers expired insulin and tries to use it. Sometimes the patient stops eating, hoping that starving themselves will mean they will need less insulin. Patients who lack proper access to insulin are sicker, unable to work and care for their families, and end up seeking care in costly hospital emergency room settings.

Like HIV or AIDS medications, insulin is crucial for keeping an individual alive and generally independent. However, unlike HIV or AIDS medications, there are no state or federal programs to help insulin-dependent patients in need. This must change. It is time for a plan of action, now!

I am recommending the creation of the California Diabetes Solution (CDS).

The California Diabetes Solution requires all insurers and pharmacy benefits managers (PBMs) operating or selling products in California to offer all diabetic medications or any combination free including test strips.  This could be all generic diabetic medications, brand, or a combination.  That would be left to the insurer or PBM.

CVS Caremark, a national PBM will be offering such a program (without test strips) to its customers.  Why can’t California require every insurer/PBM to do the same?  New York-based Oscar Health insurer announced its individual insurance plan members will now pay $3 for a month’s supply of 100 commonly used diabetic medications including insulin.

While the CVS Caremark program requires the use of all generics, every PBM should design its best-in-class program.  Pharmaceutical manufacturers should be encouraged to work with PBMs do accomplish the same goal.  Competition is at the heart of America, and pitting brand vs, generic manufacturers is a great way to tackle the diabetes public health crisis.

In the public sector, hospitals and other 340B Covered Entities should be required to reallocate some portion of their 340B revenue to ensure that all of their patients never pay more than $20 a month for any or all diabetic medications and test strips.  This one change should help stop Emergency Rooms from being filled with people who cannot afford needed medications.

The California Diabetes Solution (CDS) program be required for two years allowing the State of California to utilize the expertise of researchers at UCSF Innovation Center to evaluate the impact of the program on insurers, PBMs, and patients.

Let’s allow California to be the testing ground for new and great healthcare ideas and challenge the private sector healthcare companies to demonstrate their expertise and commitment to affordable patient care.  Diabetes is a public health crisis.  Let’s not talk about it; let’s implement this solution today!

Jeffrey Lewis is president and chief executive officer of Legacy Health Endowment in Turlock, California. The views expressed are his own.