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Tag: Diabetes

  • Are weight-loss drugs cost effective?

    Are weight-loss drugs cost effective?

    Millions of Americans now take weight-loss drugs, some as a treatment for diabetes but, increasingly, simply to lose weight.  A new study funded by the Blue Cross Blue Shield Association suggests that these drugs might not be cost effective, reports Joshua Cohen for Forbes. Nearly six in ten people stop taking them before they lose significant weight.

    People who take weight-loss drugs—GLP1s—can improve their health, particularly if they eat well and exercise. The drugs can help reduce the risk of heart attacks. They can also help people with chronic kidney disease and non-alcoholic fatty liver disease.

    Some believe GLP1s also can benefit people with sleep apnea and people with joint issues. As of now, Medicare only covers these drugs for people with diabetes and a small group of overweight people at risk for serious heart events.

    To be effective, people must continue to take these drugs, if not for the rest of their lives, for a prolonged period. People who go off them before they have shown clinical benefit tend to regain the weight they lost.

    People with diabetes are less likely to stop taking these medicines, Still, 58 percent of people who start taking them stop before they’ve experienced any real benefit. And three in ten people don’t renew their prescriptions after taking them for just one month.

    Only 32 percent of people who start on a weight-loss drug appear to continue taking them after a year. About one in three working people do not have health insurance coverage for these drugs if they don’t have diabetes. These drugs cost so much that businesses who cover them will drive up insurance costs significantly.

    So, insurers don’t cover these drugs because of their cost, which is insanely high. Moreover, most people don’t continue on them long enough to benefit their health. And, their benefits for those who stay on them appear to be marginal.

    Even people who take weight-loss drugs on an ongoing basis appear to lower their risk of heart failure by just 1.5 percent, according to one recent study. Put differently, one in 67 people on these drugs avoid a serious heart event and virtually none avoid death any more so than people who don’t take these drugs.

    Bottom line, it’s still too early to make a compelling case that insurers should cover weight-loss drugs for people who are not diabetics. At least for now, the data suggest that the costs might outweigh the benefits.

    Here’s more from Just Care:

  • Raising Medicare eligibility age could lead to thousands of additional deaths

    Raising Medicare eligibility age could lead to thousands of additional deaths

    A new study, published in the Proceedings of the National Academy of Sciences, by Alison Galvani et al. at Yale, finds that raising the Medicare eligibility to 67, as many Republicans are proposing, could lead to thousands of additional deaths each year.

    The House Republican Study Committee recommended raising the Medicare eligibility age to 67 as a way to reduce Medicare spending. But Galvani found that raising the age would significantly increase the number of older adults who are uninsured. People who are uninsured often skip necessary treatments and forgo filling prescription medicines. They can end up spending more on health care than they would have had they received the care they needed.

    When people don’t get the care they need, they often end up in the emergency room and some die needlessly. In addition, says Galvani, if they have a contagious disease, they can threaten the public health. It “can cause a condition to become both more serious and ultimately more costly. In the case of infectious diseases, forgoing health care can lead to transmission to other people that may have been prevented.”

    Galvani and her team looked at how the two-year increase in the age of Medicare eligibility would contribute to the number of older adults who are uninsured. They then considered how being uninsured increases people’s likelihood of dying. They concluded that around 10,000 people would die needlessly every year if Congress increased the Medicare eligibility age two years.

    To protect themselves politically, the Republicans would increase the Medicare eligibility age slowly–likely by two or three months each year until the age of 67. During that time, Galvani’s team projects that 17,244 older adults would die if Congress raised the eligibility age by two months a year, and 25,847 older adults would die if it raised the eligibility age by three months a year.

    Galvani’s team also looked at the effects of raising the Medicare eligibility age on people with diabetes. They found that more than 325,000 people with diabetes could be unable to get health care if the Medicare eligibility age were raised to 67. Many of them would also struggle to get insulin.

    State governments would also feel the effects of an increase in the Medicare eligibility age. Their spending would likely increase. More people would look to their states for health care coverage and other supports.

    There are far smarter ways to reduce Medicare spending. Galvani’s team has looked at the effects of a guaranteed universal health care model and found that it could save a lot more money than raising the Medicare eligibility age to 67, while also saving lives. In an earlier study, they projected a single-payer system would save $450 billion each year. Raising the Medicare eligibility age would save at most $25,5 billion over five years. A single-payer system would also prevent nearly 70,000 deaths each year.

    “If policymakers want to save lives and costs, our analyses have shown single-payer universal health care is the solution,” says Galvani.

    Here’s more from Just Care:

  • Diet soda: Bad for your health and your weight

    Diet soda: Bad for your health and your weight

    According to the experts, diet soda is bad for your health and your weight, Peri Ormont Blumberg reports for Time Magazine. Notwithstanding, many Americans live on diet sodas. By so doing, they often mistakenly think they are keeping their weight down and promoting good health.

    According to recent research, however, diet drinks lead to all kinds of diseases, including cancer, mood disorders, fatty liver development and diabetes. There’s only observational studies to support these findings, which means the researchers can’t link cause and effect for sure. But, there’s mountains of long-term studies showing a correlation between drinking diet soda and poor health outcomes.

    • Type 2 diabetes strongly linked to consumption of diet soda: Many researchers find this connection. Here’s a recent study of 106,000 people.
    • Diet soda strongly linked to obesity. This meta-analysis of 11 studies found a significant association between artificially sweetened soda consumption and obesity.
    • Diet soda linked to heart conditions: People who drink more than two quarts of diet soda a week have a 20 percent higher likelihood of poor heart health, including heart attacks, heart disease and stroke. Here’s a recent study.
    • Diet soda linked to cancer. Here’s a meta-analysis. Other research has found potential links from diet soda to cancers including colon, uterine, kidney, and pancreatic, though it’s not clear whether obesity or diet soda is causing the cancer.

    No one can pinpoint why the link between diet soda and poor heart health. It could be most pronounced in people who don’t exercise, smoke, drink alcohol, and otherwise don’t take care of themselves.

    Diet soda is linked to cancer: The World Health Organization believes that aspartame, a key ingredient in some diet sodas, could be  carcinogenic. Some research has shown links between diet soda and colon, pancreatic, and kidney cancer. But, the World Health Organization somehow also found that it’s safe for people who weigh around 150 pounds to drink eight cans of diet soda with aspartame a day!!!! You wonder whether it is being sincere or is worried about a lawsuit from the diet soda manufacturers.

    Diet soda is linked to weight gain: Some researchers suggest that, because diet soda tends to be sweeter than sugar, it could change the way people experience tastes. As a result, it could make people feel hungrier, causing them to consume more calories and to gain weight. People should not think that drinking diet soda helps with weight loss.

    Should you drink diet soda? No. It is far better to drink water than diet soda. And, if you need your soda to be sweet, drink soda water with a bit of honey or juice in it. That said, some researchers believe that if you must drink prepackaged soda, diet soda could be preferable to sugary soda and alcohol for your health and your teeth. We know how harmful sugar can be; but, for some reason, we are not as clear about the harms of artificial sweeteners.

    Tricks to limit your diet soda intake:

    • Take a sip and pour the rest down the drain.
    • Think of it like candy, not like an alternative to water when you sit down to a meal.
    • Drink seltzer water with some fruit juice or honey added.

    Here’s more from Just Care:

  • Next frontier: Eye exams using artificial intelligence

    Next frontier: Eye exams using artificial intelligence

    Photos from a retinal camera allow an artificial intelligence (AI) algorithm to perform eye exams and quickly diagnose diabetic retinopathy, a condition that could lead to blindness, reports Hannah Norman for California Health Line. Diagnoses are immediate, and no doctor is involved.

    Diabetic retinopathy is the principal cause of blindness for adults under 65 and a health condition that millions of Americans with diabetes are at risk of getting. Today, some 9.6 million Americans have diabetic retinopathy.

    People with type 2 diabetes typically spend a lot of time and money getting tested for retinopathy. They must see an eye doctor, have their eyes dilated and then can easily wait seven days for a diagnosis. And, it is recommended that they do so each year or, at least, every other year.

    To date, the FDA has approved lots of medical devices that work through AI.

    What is diabetic retinopathy? It stems from injury to blood vessels in the retina from high blood sugar. People with diabetes can stave off diabetic retinopathy when they manage their condition. And, doctors can treat diabetic retinopathy. But, screenings allow for early treatment.

    How easy is it to you an AI system to detect diabetic retinopathy? It takes only a few hours of training.

    What happens during the AI diagnosis? Patients look into a special camera so that a technician can photograph their eyes. Generally, there is no need to dilate the patients’ eyes.

    What are the risks of using AI to diagnose diabetic retinopathy? At the moment, using AI will only detect diabetic retinopathy. It will not detect other eye conditions that an eye doctor might detect. For example, it won’t detect choroidal melanoma.

    What are the benefits of using AI to diagnose diabetic retinopathy? Using AI to diagnose diabetic retinopathy is faster and less costly than going to the eye doctor. With AI, people are also far more likely to go for a follow-up visit after diagnosis than if they went to the eye doctor, according to one recent study. Researchers attribute the increased likelihood of follow-up to the fact that patients get a diagnosis right away.

    Does Medicare cover this AI test? Medicare covers this AI eye test, albeit at a very low rate–$45.36.  Corporate health insurers have an average negotiated rate of $127.81 for the test.

    The technology is still in its infancy. But, based on what we know right now, it is more than likely to take off big time before long. And, of course, researchers are looking to expand the reach of AI to detect glaucoma and other eye diseases.

    Here’s more from Just Care:

  • Billions in Medicare savings from Medicare drug price negotiation by 2031

    Billions in Medicare savings from Medicare drug price negotiation by 2031

    A new report from Nicole Rapfogel at the Center for American Progress (CAP) finds that the Inflation Reduction Act’s provision allowing Medicare to negotiate drug prices for its highest cost drugs will reduce drug spending by tens of thousands of dollars a year for millions of people with Medicare and save Medicare millions of dollars a year.

    On September 1, 2024, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, will announce the prices it has negotiated with pharmaceutical corporations on ten drugs that treat, among other things, diabetes, kidney disease, blood clots and heart failure. Beginning in January 2026, the cost of these drugs should drop considerably.

    The ten drugs cost Medicare significantly more than other drugs it covers either because they have very high prices or because they are widely used. A total of nine million people currently use their Part D drug benefit to fill prescriptions for these drugs. These ten drugs represent roughly 20 percent of Medicare’s annual drug spending under Part D.

    CAP projects that the price of one insulin product, NovoLog FlexPen will fall $30 a month and the price of one cancer drug, Imbruvica, will fall $6,548 a month. The price of Eliquis, which 3.5 million people with Medicare take, could drop by $123 a month.

    Currently, Americans pay many times more than people in other wealthy nations for several of these drugs. For example, a dose of Stelara, another drug whose price Medicare is negotiating, which treats people with autoimmune conditions, costs $2,900 in the United Kingdom and $16,600 in the US. Moreover, Americans paid $6.5 billion in taxpayer dollars for the development of Stelara.

    While Medicare is only negotiating the price of 10 drugs this year, by 2030 it will have negotiated the price of 80 drugs. CAP estimates that Medicare will save $25 billion as a result of drug price negotiation in the six years between 2026 and 2031.

    Of course, the pharmaceutical corporations are trying to block these price negotiations in the courts, claiming that the government should not be interfering with the prices private corporations set. What they fail to say is that they developed these drugs with $11.7 billion in taxpayer dollars, The Lever reports. And, the pharmaceutical corporations made $70 billion on these drugs in 2022.

    Here’s more from Just Care:

  • Weight-loss drugs are a hot commodity and hard to get

    Weight-loss drugs are a hot commodity and hard to get

    Weight loss drugs are a hot commodity. They can be hard to come by. Getting them can try your patience and your pocketbook. Reed Abelson and Rebecca Robbins offer six reasons why it is so hard for people to get weight-loss drugs in the New York Times.

    1. A lot of people want these drugs. Already nearly four million people are taking weight-loss drugs. Between TikTok and advertisements, more and more people are wanting to take weight-loss drugs.

    2. Production of these drugs is slow. Few factories can manufacture the latest weight-loss drugs. And, they come in five or more strengths. Eli Lilly also needs to make enough of its pens used to inject Zepbound.

    3. Insurance often won’t cover these drugs, making them unaffordable to most. Medicare will only cover these drugs for people with diabetes. It does not cover weight-loss drugs for obesity. However, Medicare covers nutrition and weight-loss counseling.

    Medicaid does not either. The insurers consider them “lifestyle” drugs, rather than medically necessary drugs. As. result about 40 percent of employers also do not offer this coverage to their workers.

    These are injectable drugs that can cost as much as $16,000 a year. With discounts or coupons from Eli Lilly, people can get Zepbound, one of the weight-loss drugs, for $550 a month, if they have insurance. They can get a coupon from Novo Nordisk for Wegovy, another weight-loss drug, and pay $1,000 a month instead of $1,500 a month.

    4. People can’t find these drugs at their pharmacies. While these drugs are often not in stock at pharmacies, they will order them when requested. The drugs cost too much money, literally tens of thousands of dollars for a pharmacy to stock.

    5. Pharmacies sometimes claim that these drugs provide them no profit. In fact, some say that they lose money on weight-loss drugs because the insurers do not reimburse them adequately for the drugs. The insurers’ pharmacy benefit managers or PBMs reimburse the pharmacies below cost in some cases. This seems like a way for the insurers to avoid covering weight-loss drugs.

    6. Most insurers create hurdles in order to cover weight-loss drugs. People need their doctors to verify they qualify for coverage. In some cases, before the insurer will cover these drugs, enrollees must take a six-month nutrition and exercise program. Some insurers require people to try other less expensive drugs before they will cover these drugs.

    Here’s more from Just Care:

  • Some Medicare prescription drug plans dropping insulin coverage

    Some Medicare prescription drug plans dropping insulin coverage

    One of the many design and structural defects of the Medicare Part D prescription drug benefit is that the health insurers offering coverage have enormous latitude to determine the drugs they will cover. Not only does that mean the insurers might not cover some basic generic drugs, it means that they might cover some drugs today and different drugs tomorrow. With a recent legal requirement that limits out-of-pocket costs for people with Medicare using insulin, Medora Lee reports for USA Today that some Part D prescription drug plans are dropping coverage of insulin.

    Because insurers cannot charge people with diabetes more than $35 a month for each insulin product they take, Part D insurers might be able to keep down premiums and attract healthier members by dropping insulin coverage. The insurers also might project greater profits if they do not cover certain insulin products. So, anyone with Medicare in need of insulin better beware.

    You should check to ensure that your Part D prescription drug coverage will pay for the insulin you take in 2024. If not, you should switch to a different Part D plan if you can. Keep in mind that your Part D plan can change the drugs it covers at any time. However, if it does, you generally have a right to coverage of your medically necessary drug throughout the rest of the year if you have no alternative.

    It’s a travesty that Part D  insurers can game the Medicare system to the detriment of people with diabetes. It’s equally problematic that they can game the system to hurt people with all different sorts of prescription drug needs. For example, CVS was found not to have generic versions of some drugs on its Part D formulary; it profited more from only having the brand-name drugs, for which it received rebates and otherwise benefited financially.

    It’s also deeply concerning that Part D insurers can charge higher copays for some drugs than Costco charges for the full cost of the same drugs. One Just Care reader reported that to keep his costs down, he had to get his drugs from different sources.  Costco had lower prices for some drugs and his Part D plan had lower costs for others.

    In 2025, people with Part D will not pay more than $2,000 out of pocket for drugs their insurer covers. That’s the good news. I’m willing to bet that the Part D insurers find a way to take advantage of this new consumer protection, while making it harder for their members to get the drugs they need.

    Congress should come to its senses and establish one prescription drug benefit that meets everyone’s needs. It should not allow Part D plans to meet only some prescription drug needs. Right now, the Medicare Part D benefit is designed to line the pockets of insurance companies and pharmacy benefit managers not to bring down drug costs as much as possible for people with Medicare or to ensure that their Part D coverage meets their current and future prescription needs.

    Here’s more from Just Care:

  • Insulin manufacturers pressured to bring down prices

    Insulin manufacturers pressured to bring down prices

    Eli Lilly, Novo Nordisk and Sanofi have all said they will bring down the price of insulin significantly. Since nine in 10 Americans in need of insulin rely on these companies for their insulin, this appears to be a huge win. Everyone on insulin should benefit, but Americans cannot rely on pharmaceutical companies to sell their drugs at fair prices.

    Eli Lilly led the way to lower insulin prices when it announced it would cut the price of its insulin by as much as 75 percent. Novo Nordisk is lowering insulin prices 75 percent, beginning in 2024, bringing down the cost of its lowest-priced insulin to $48.20. Sanofi says it is cutting its insulin prices as much as 78 percent beginning in 2024.

    Some say the companies offering these lower insulin prices will profit more, not less, from the lower prices. They will save money on Medicaid rebates. Beginning in 2024, a federal law mandates much higher drug rebates in Medicaid.

    To be clear, even a price reduction of 75 percent leaves the cost of insulin higher than it should be. Kaiser Health News reports California has just cut a deal with Civica Rx to manufacture insulin for its residents at a cost of $30 a vial or $55 for five injectable pens. Novo Nordisk’s price is projected to come down to $48 and Sanofi’s to $64 a vial, 60 percent and more than 100 percent higher than Civica’s price, respectively. Eli Lilly’s reduced price, however, will be $25 a month.

    The Inflation Reduction Act capped the out-of-pocket cost of insulin for people with Medicare at $35 a month, for each insulin product people use. It also imposed penalties on pharmaceutical companies that raised their drug prices faster than inflation. But, it did nothing to lower the price of insulin for the uninsured or working people.

    The insulin crisis in the US: Nearly 40 million Americans need insulin to treat their diabetes. One million of them say they ration their insulin because the cost is too high.

    What pressured pharmaceutical companies to lower their prices further? The companies suggest that they were already offering their drugs at lower prices to pharmaceutical benefits managers, as well as through drug discount programs. Consequently, they might not be losing money by officially lowering insulin prices.

    But, the biggest push for lowering the price of insulin is likely a change in the way Medicaid rebates are calculated beginning in 2024. These rebates had been capped. But, the cap will be lifted in 2024. Axios reports that by lowering the price of insulin,  “Eli Lily is avoiding paying around $430 million per year in new Medicaid rebates and Novo Nordisk would save $350 million.” So, it appears these companies no longer have a financial incentive to keep the price of their insulin high.

    Who will benefit from these prices cuts? Both insured Americans and the uninsured should benefit from these price cuts. But, insured Americans already have their insulin copays set for this year, so they are not likely to see lower out-of-pocket costs until next year. The price cuts should not affect people with Medicare directly as their out-of-pocket insulin costs are already capped. But, lower prices for insulin should mean lower Part D prescription drug premiums.

    How long will Americans see lower insulin prices? Who knows. The pharmaceutical companies have the right to raise prices as much as they’d like whenever they’d like.

    Here’s more from Just Care:

  • One in seven diabetics struggle to pay for insulin

    One in seven diabetics struggle to pay for insulin

    About nine percent of Americans–30 million people in the US–have diabetes. A new Yale study finds that 14 percent of insulin users—-almost one in seven of them–struggle to pay for insulin. Democrats in Congress tried to include a provision in the Inflation Reduction Act that would have limited the cost of insulin to $35 a month for everyone, but only the limit on insulin costs for people with Medicare survived.

    Seven million Americans use insulin every day. Its price has doubled in the last ten years. After covering costs for food and housing, 14 percent of diabetics must spend at least 40 percent of their remaining income on insulin.

    The Yale researchers found that 1.2 million diabetics reached “catastrophic spending” on insulin in a single year. Of those, 800,000 were people with Medicare.

    Insulin is not the only health care cost for people with diabetes. Among other things, they need glucose monitors and insulin pumps. These costs are too often prohibitive.

    Notably, the researchers found that people with Medicaid, who have more comprehensive coverage than people with Medicare, were less than half as likely to reach catastrophic spending on insulin.

    Prices for insulin have soared since Eli Lilly launched Humalog, an insulin brand. Back in 1996, a vial cost $21. Today, that same vial costs more than $210. The Yale study’s lead author believes that insulin prices are likely to keep rising.

    The researchers also found that people with Medicare felt the burden of high insulin costs more than any other cohort of people with diabetes because their average annual income is lower. Provisions in the Inflation Reduction Act are intended to keep insulin prices from rising more than the rate of inflation for people with Medicare as well as to cap out-of- pocket insulin costs at $35 a month. Already, at least one Medicare Part D prescription drug plan in every state covers insulin at $35 a month. But, $35 a month for insulin alone is prohibitively expensive for a lot of people with Medicare.

    The researchers argue that any government savings from not making insulin affordable to people with Medicare in the short-term will mean much higher health care spending in the long-term. We can expect to see greater disabilities among people with diabetes who can’t afford their insulin, more hospital admissions, and more emergency room visits stemming from complications.

    Here’s more from Just Care:

  • If you have prediabetes, Medicare can help

    If you have prediabetes, Medicare can help

    If you are over 65, the odds are near 50 percent that you have prediabetes, meaning that your blood sugar levels are above normal, but it’s nothing to worry much about. Prediabetes does not mean that you are likely to get diabetes. But, if you have prediabetes, you should consider taking advantage of Medicare’s Diabetes Prevention Program or rethink your diet and daily activities.

    Why are older adults more inclined to have prediabetes? A lot of older adults have somewhat higher blood-sugar levels than normal because they tend to produce less insulin than younger adults. They also process insulin less efficiently. Learning how to stay healthy with less insulin can be great for your health.

    What to do if you have prediabetes? Prediabetes is associated with a greater risk of heart disease. So, you should focus on being active, keeping a healthy weight and eating healthy foods, particularly more protein, reports Judith Graham for Kaiser Health News. Medicare’s Diabetes Prevention Program is designed to help you do just that.

    Medicare’s Diabetes Prevention Program: Four years ago, Medicare began covering a Diabetes Prevention Program for people with prediabetes. The program offers classes in the community that teach people with Medicare how to eat healthy, lose weight and exercise more. Unfortunately, people do not know about the program or, if they do, most do not enroll.

    The risk of diabetes if you are found to have prediabetes: Some experts believe that you should be screened for prediabetes at 45 and again every three years. An April study by the Centers for Disease Control found that, in one year, just 2,500 out of 50,000 older adults with prediabetes ended up with diabetes. That amounts to a five percent risk of getting diabetes.

    A 2021 study in JAMA Internal Medicine found that fewer than one in eight people with prediabetes ended up with diabetes after six and a half years. That’s less than 12.5 percent of people with prediabetes. Many more of them got their blood-sugar levels under control.

    Risk factors for diabetes: You’re more likely to have diabetes if you are overweight or have a family history of diabetes. Black older adults and people with low incomes are also more at risk of getting diabetes. And, men are more likely than women to have diabetes.

    Should you take metformin? Don’t take metformin, says one endocrinologist, if you have prediabetes. Only take it if you have diabetes and are prescribed it.

    Here’s more from Just Care: