In the midst of National Diabetes Month as Congress decides what’s on their end of year agenda, now is the time for lawmakers to hear from us! Following our Hill Day, we're sending two petitions asking Congress to take action to prioritize patients and families in our community.
Specifically, we're advocating for $35 insulin copays across the board (not just in Medicare - although we applaud this move!) and access to obesity care. Sign on to support the INSULIN Act and Treat & Reduce Obesity Act below!
Approximately 102 years after the first patient with diabetes was treated with insulin, we, the undersigned, are asking for your help in setting a national standard across all government and commercial plans for low, capped copayments on this lifeline for our community.
Diabetes is a pervasive chronic condition affecting over 37 million individuals across the United States. Insulin is a life-saving medication for so many, allowing us to manage blood sugar levels and lead healthy, productive lives. However, the rising cost of insulin has created an untenable financial burden for individuals and families, jeopardizing access to this essential medication.
Two bipartisan bills – one introduced by Senators Susan Collins and Jeanne Shaheen, and a second by Senators Raphael Warnock and John Kennedy – address this unresolved issue. S. 1269 would cap monthly insulin copays at $35 and also digs deep into the drug pricing system, taking aim at pharmacy benefit managers’ harmful rebate negotiation and utilization management practices such as prior authorization. S. 954 would assure the same monthly insulin copay cap for the commercially insured, and also establish a program through HHS to ensure the same $35 copay cap through qualified entities for uninsured patients.
Current research on prescription abandonment suggests $35 is a reasonable national cost-sharing cap, making life sustaining insulin more affordable to millions of people and relieving many of the difficult choice between paying thousands of dollars for a medication they need to survive and paying for groceries or a place to live. This consistency across U.S. health plans will help improve insulin access throughout a person’s life, leading to a healthier Medicare population in future years.
This is not a new proposal, and there is a demonstrated track record of bipartisan support on the state level. In fact, 25 states – controlled by Republican and Democratic legislatures alike – and the District of Columbia have enacted copay caps. It is time for Congress to follow the example of these states and act now.
We understand the complexities involved in addressing healthcare issues and recognize the need for thoughtful consideration. However, the urgency of the insulin affordability crisis demands swift and decisive action. Without a collective effort, many Americans will continue to suffer and could face dire health consequences as a result of a treatable disease.
We, the undersigned, thank you for your attention to this critical matter. We trust that you will consider our voices as representatives of collective concern and urge your support if and when insulin copay cap legislation comes under consideration.
This National Diabetes Awareness Month, access to and affordability of care are top of mind for the diabetes community and we, the undersigned, are writing to urge your action on a critical issue for patients living with and at risk for diabetes: the lack of Medicare coverage for obesity treatment and therapies.
Obesity is a chronic disease which evidence suggests contributes to insulin resistance and hundreds of other complications in both type 1 and type 2 diabetes, including hypertension, cardiovascular disease, and certain forms of cancer. Combined, diabetes, obesity and other serious comorbidities contribute to health care costs totaling $170 billion in excess expenditures per year in the U.S. For maximum cost savings and quality of life, Medicare beneficiaries need access to a complete continuum of care.
The Treat and Reduce Obesity Act (TROA) of 2023 would expand the scope of providers that can bill Medicare for delivery of Intensive Behavior Therapy (IBT) to include clinical psychologists, registered dietitians and other nutrition professionals if the patient is referred by a physician. This legislation would also allow FDA approved weight management medications to be covered under Medicare Part D.
Access to this combination of safe, effective pharmacotherapy and lifestyle modification programming could thwart the onset of type 2 diabetes and other downstream conditions and also minimize the impact of diabetes for those already diagnosed.
Presently, Medicare only covers and pays for one of these innovative treatments – IBT – as a preventive service, and only when it is provided by a primary care provider in the primary care setting. Qualified providers as well as community-based organizations providing evidence-based health interventions are presently unable to receive Medicare reimbursement for delivering this important and effective intensive lifestyle intervention to the growing number of beneficiaries living with obesity.
Additionally, when Medicare Part D was created twenty years ago, obesity was not recognized as a treatable chronic condition, and Congress prohibited coverage of weight management medications, most of which were unregulated and dangerous. Today, there are a number of FDA-approved weight loss drugs available for patients living with obesity; this outdated ban on coverage of obesity medications creates an unreasonable barrier for patient access to these important therapies.
The lack of Medicare coverage also makes the program an outlier, as every other federally funded health plan (VA, TRICARE) will offer coverage of these medications beginning next year. Further, because Medicare is frequently used as a reference by other insurers, the lack of Medicare coverage also influences people who get their health insurance through their employer, making them less likely to have access to these important treatments.
Fundamentally, current statute has not kept pace with safe, approved scientific breakthroughs, nor with evolving medical guidelines for the treatment of obesity, maintaining outdated barriers to important obesity treatment options, including pharmaceutical therapies.
As a diabetes community, our request is simple: have obesity management encompass the best standards of treatments and coordination of care for Medicare beneficiaries. Ensuring coverage of these prevention and treatment options will better enable patients to avoid costly chronic illnesses and premature death.
Outdated language in Medicare – an oversight that lingers despite widespread support in the medical and patient communities – is costing people time and money, their health and their livelihoods. For the wellbeing of patients in your community, we ask that you please work to support this change in the 118th Congress.
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