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Insurers drive up costs for people with diabetes

Written by Diane Archer

The Hill has an opinion piece on a new way that insurers are increasing their profits. Insurers drive up costs for people with diabetes, making it harder for them to get needed care. Instead of applying drug copay coupons toward people’s deductibles, insurers make them pay their deductibles out of pocket.

Insurers would rather steer clear of patients with diabetes, because they use a significant amount of health care. So, insurers are imposing an additional financial obstacle for them to get care. They are taking advantage of the fact pharmaceutical companies offer people with diabetes drug copay coupons; and, they are effectively appropriating the value of those coupons for themselves. Insurers now require patients to pay their deductibles in full out of pocket rather than allowing them to use their drug copay coupons toward their deductibles.

Insurers have a series of crazy names for this new policy: “Copay Accumulators,” “Out-of-Pocket Protection Programs” or “Coupon Adjustment: Benefit Plan Protection Programs.” Whatever insurers name the policy, it means that people with diabetes and other costly conditions who benefit from drug company coupons that help with their cost-sharing have to pay their full deductible out of pocket before their care is covered.

In a more just health care system, people with diabetes would not have to worry about the cost of their insulin or about meeting a deductible. And pharmaceutical companies would be required to charge fair prices for their insulin. They would not be able to hand out discount coupons that end up benefiting themselves and insurance companies more than patients.

There are now 30.3 million adults in the US with diabetes. And, they are increasingly struggling to get needed care. Over the last 15 years, costs for insulin have more than tripled. Moreover, pharmacy benefit managers (PBMs) are no longer covering many medications and supplies that people with diabetes need. (Another 84.1 million adults have pre-diabetes, a condition which, if left untreated, tends to lead to type 2 diabetes within five years.)

There are insulins, including NPH, which are far less expensive than the newer insulins. NPH is available without a prescription for less than $30 a vial at some pharmacies. NPH works, but it is harder to manage blood sugar with NPH than it is with more expensive insulins—Humalog or Lantus.

Here’s more from Just Care:


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