Advocacy

Diabetes coverage should bypass the deductible and be treated as preventive care in all commercial and public health plans. First dollar coverage reduces barriers to diabetes management, helping people with diabetes afford the health care they need to stay healthy and productive. This includes insulin and other medicines, medical devices, software, supplies, services, medical nutrition therapy and diabetes self-management education and support. 

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• First dollar insulin coverage in high deductible health plans with health savings accounts
• First dollar chronic disease management and prevention coverage in high deductible health plans

Until diabetes care is considered preventive care, DPAC will continue to champion measures that offer low, predictable cost sharing for people with diabetes. Advocacy topics include annual cost sharing caps, monthly caps and preserving patient access to assistance programs, copay cards or any mechanisms to reduce out-of-pocket costs. 

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• Medicare Part D annual cost sharing cap and monthly leveling
• State and federal cost sharing caps for insulin and diabetes supplies
• State legislation to eliminate copay accumulator adjustment and maximizer programs

Congress needs to fix the broken rebate system that drives up prescription drug costs for consumers. Americans who pay a premium to an insurance company should get the benefit of rebates and discounts negotiated on their behalf. Prescription drugs should not be treated differently than other covered health care products and services where patient cost sharing reflects net cost rather than inflated list prices. 

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• State and federal legislation requiring rebate and discount pass through at point of sale, or limiting safe harbor from federal anti-kickback laws
• Required coverage for lower cost generic and biosimilar medicines on formularies

Check out our rebate reform explainer video!

Utilization management for prescribed diabetes products or services are based on financial incentives rather than evidence-based clinical practice guidelines. They should be eliminated or strictly limited to avoid delays in care and ease administrative burdens on patients and providers.

• Medicare and Medicaid coverage for continuous glucose monitors and other diabetes technologies
• State and federal limits on step-therapy or ‘fail first’ policies that require patients to fail on treatments that are financially advantaged for the insurer, rather than preferred by a person with diabetes and their health care team
• State and federal limits on non-medical switching, or medication and device changes prompted by insurance formularies rather than medical necessity or clinical efficacy.