This map offers state-level summary statistics on diabetes impact and what, if any, legislative action has been taken to address the problem (information as of 6/1/23). We specifically highlight:
Rebate Pass-Through
Comprehensive Medicaid Coverage for CGM
Insulin Copay Cap
Diabetes Supply Copay Cap
Copay Accumulator Ban
First Dollar Coverage for Diabetes Care
Emergency Access to Insulin
Diabetes Action Plan
Diabetes Caucus
Requires pharmacy benefit managers (PBMs) to pass through a portion of drug rebates to patients at the point of sale, lowering to lower the cost of prescription drugs.
Ensures that beneficiaries with diabetes have access to Continuous Glucose Monitors (CGM) and related supplies as part of their healthcare benefits.
Limits the amount individuals with diabetes have to pay out-of-pocket for insulin by imposing a maximum limit on patient cost-sharing.
Set a maximum limit on out-of-pocket costs for various diabetes supplies, such as glucose test strips, lancets, insulin pumps, and continuous glucose monitors (CGMs).
Prohibit health insurers and PBMs from applying copay accumulator programs which prevent third-party copay assistance from counting toward a patient's deductible or out-of-pocket maximum.
Patient cost-sharing benefits begin without requiring the insured individual to pay a deductible or other out-of-pocket expenses first, ensuring that essential diabetes-related services, treatments, and medications are covered immediately, minimizing financial barriers for patients.
Permits pharmacists to dispense a 30-day supply of insulin in emergency situations where the prescriber isn’t available.
Strategic frameworks developed by state entities that include specific goals, strategies, and initiatives aimed at prevention, early detection, better management, and improved healthcare services for individuals living with and at risk for diabetes.
Legislative caucuses focused on diabetes are groups of lawmakers who come together to address issues related to diabetes, such as raising awareness, advancing diabetes-related legislation, and promoting policies that improve diabetes care and management.
The Kentucky Prescription Assistance Program (KPAP) enables and expands community-based efforts to enroll eligible individuals in reduced cost prescription programs presently offered by manufacturers, retailers and other sponsors.
Run by just a few full-time employees and contractors to keep the program lean and mean, KPAP connects Kentuckians with resources to reduce prescription costs, offering more direct access to the treatment they need to live. By partnering with individuals and organizations already active in underserved communities – including county health departments, hospitals, food pantries and faith-based organizations — KPAP can expand its capacity to all 120 counties without duplicating efforts. Today, KPAP is helping more than 4,800 Kentuckians access $47 million in free and reduced-cost medications in a single year. KPAP's efficient deployment of its annual $600K appropriation may make it the only state program across the nation to deliver a 78-times return on investment.
Arkansas has passed legislation requiring its Medicaid program to include diabetes technology to ensure low-income residents have comprehensive coverage.
Continuous glucose monitors (CGM)offer people with diabetes an essential tool to keep their blood glucose levels within a recommended range. By helping patients make prompt adjustments to manage their condition, these devices also mitigate avoidable complications that could cost Medicaid thousands. One study shows that patient adoption of CGMs for just nine months results in healthcare costs savings of $4,000 compared to a patient without a CGM.
While federal laws and regulations set standards for coverage under Medicaid, individual states may determine the finer points of what is and is not covered, and how programs are administered. By including tools like CGMs under Medicaid, a state may safeguard its most vulnerable residents while effectively managing its financial resource
Addressing the obesity epidemic requires a multifaceted policy approach that shifts the focus from short-term interventions to long-term, sustainable solutions, beginning with coverage of all obesity treatments, both behavioral and pharmacological. Specifically, states may:
– Offer coverage of Medicaid programs like the Diabetes Prevention Program (DPP) and clinical lifestyle approaches such as intensive behavioral therapy (IBT) and medical nutritional therapy (MNT)
– Expand treatment offerings to include anti-obesity medications
– Address the unwelcome impact of obesity stigma
Presently, there exists no legislative model which comprehensively addresses the need for enhanced access and awareness to treat and prevent obesity - we look forward to continued engagement from lawmakers on this subject and the creation of such a policy.
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