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Reduced Cost of Insulin is Positive Step to Increased Patient Affordability

InsideSources

By: Joan Werblun, R.N., Advisory Committee Member, Chronic Care Policy Alliance

June 12, 2020

Health policy has become a dominant and divisive topic in American politics, and for good reason. It matters.

It is literally an issue of life and death for every citizen of this country. Therefore, it is important to recognize and applaud policies that ease the burdens of individuals seeking access to critical care in this country and create a pathway to health.

Recently, the Centers for Medicare & Medicaid Services Innovation Center (CMMI) moved forward with a new Medicare Part D demonstration that will cap patient copays for insulin at $35. Lowering patient cost sharing is a critical and monumental step toward ensuring that patients — especially those with chronic conditions like diabetes — can afford the medications that enable them to manage their disease and lead a healthier life.

As a retired diabetes nurse educator, I know that affordable access to medications makes a critical difference in not only the health of these individuals, but in their lives as well. That is why Medicare Part D has been such a transformative program, and why reforms to improve efficiency and affordability can make a momentous difference in the lives of seniors living with chronic disease.

This new demonstration model will have a far-reaching positive impact.

CMS reports that more than 3.3 million Medicare beneficiaries use one or more of the common forms of insulin and that one in three beneficiaries has diabetes. This model will provide significant savings to this broad population of beneficiaries.

The cost savings for these individuals could be the difference to make ends meet at the end of the month or to afford an additional medication they need.

Additionally, we have seen time and again that increased medication adherence in Medicare can reduce complications, decrease the need for hospitalizations and emergency care, and ultimately reduce healthcare costs for both patients and the government.

Improved health makes a critical difference in the life of the patient, but the benefits also extend to their families, the health system, and taxpayers.

For these reasons, we applaud this model and CMMI’s logical approach to increasing adherence and access to insulin among Medicare patients with diabetes, and we look forward to seeing the positive results of this model.

Furthermore, we encourage CMS to explore additional measures to reduce costs for patients including further decreasing patient cost-sharing, placing limits on patient out-of-pocket costs and ensuring negotiated rebates are passed along to patients, rather than pocketed by the already numerous and ever-increasing number of players in the healthcare system.

The Chronic Care Policy Alliance (CCPA) is dedicated to ensuring that patients with chronic conditions have reasonable access to the care and treatments needed to maintain their health. On behalf of the patients we represent, we commend CMMI for this momentous step towards Medicare reform solutions that focus on and ultimately benefit patients.

Despite progress, health reform is a long and arduous process; therefore, we urge policymakers at every level to evaluate future health models, proposals and solutions as if they will impact the individuals closest to your heart, because as this pandemic has made quite clear, ultimately, they will.