NO, this is not a political forum … but news about and for diabetics in medicine, Medicare, and a quick 2016 Voters’ Guide for Diabetics!
Bernie Sanders is Going After Insulin Makers over Price Hikes, Tuesday, November 1, 2016! YEAH, Bernie! He posted several tweets, specifying insulin makers: Eli Lilly and Novo Nordisk particularly, for their “greed” and “outrageous profits.”
Roughly 1.25 million people in the US who have Type 1 diabetes need to inject insulin to live, as do some people with Type 2 diabetes. The price of Humalog, a fast-acting insulin made by Lilly, has skyrocketed about 280% since 2006! Novolog, made by Novo Nordisk, has gone up the same amount.
Lilly’s stock fell about 1.5% after he began sending the tweets. What do Lilly and Novo Nordisk say?
Although the list prices have been increasing, the net price for Humalog is lower than it was in 2009, Lilly noted in a statement emailed to Business Insider. The company also pointed to pharmacy benefit managers as part of the problem. The companies — which manage relationships between drugmakers, insurers and pharmacies — have been taking an increasing cut of drug prices.
“A permanent solution that gives everyone who uses insulin reasonable access will require leadership and cooperation across many stakeholders, including manufacturers, PBMs, payers, and policymakers,” the company said.
- Bernie Sanders is going after insulin makers over price hikes
- Sanders, Cummings Ask Justice Department to Investigate Insulin Prices
Medicare Told to Cover CGMs in Ruling, according to an article in Insulin Nation, May 10, 2016.
Medicare doesn’t typically provide coverage for continuous glucose monitors (CGMs), as insurors who oversee Medicare coverage have long argued that CGMs are a “precautionary” device rather than a “medically necessary” one. Now, that argument’s premise is facing serious questions in federal court and in the Medicare appeals process.
In a case of a T1 in Wisconsin who was denied coverage under UnitedHealthcare SecureHorizons Medicare plan. She appealed through several levels, over the next 2 years. The case has now been sent back to the Medicare Appeals Council by a federal judge.
Debra Parrish, a Former DHHS staff attorney successfully pushed back against UnitedHealthcare’s outdated understanding of what a CGM does. She also was able to show that a CGM represents a more efficient and less error-prone method of keeping tabs on one’s glucose count, and that the device was more capable of warning the user or a caregiver of the onset of a dangerous high or low, than a traditional meter. Therefore, she argued, it shouldn’t be seen as a mere convenience or precautionary device. In an interview with Insulin Nation, Parrish said the appeal has the potential to be a landmark case that could change Medicare’s CGM policy.
In this case, the judge had reviewed all of Medicare’s requirements for coverage and determined that CGMs in fact meet the coverage requirements, said Parrish. In a practical sense, then, wider acceptance of CGMs by practitioners, patients, and private insurors is forcing the Medicare program and Medicare insurors to revisit their justifications for denying the benefit, she said. Approximately 95 percent of commercial insurors cover CGMs, according to an article appearing in American Journal of Managed Care.
The order was supposed to take effect by May 30th unless the Department of Health and Human Services challenges it. Because this ruling applies to a Medicare-insuring contractor who does business in several states, it could have a nationwide effect.
Stay tuned for updates!
Diabetes Voter’s Guide for Election 2016, compliments of Mike Hoskins of DiabetesMine.
This is a GREAT guide to help you make informed decisions and cast educated votes.
Regarding the presidential vote, Clinton and Trump have fundamental differences in their approach to healthcare in the US. Here’s the best, independent non-partisan comparisons from the Kaiser Family Foundation.
- Your Diabetes Voter’s Guide for Election 2016
- Snapshot of Where Hillary Clinton and Donald Trump Stand on Seven Health Care Issues
I certainly hope that a way can be found for CGM coverage for medicare recipients. It has been a long fight to get it covered and I suspect we will have a few more days until we get it worked out. But yeas it is coming. Sooner than later I hope.
This item has been referred to the TUDiabetes Blog page for the week of October 31, 2016
Thanks so much, Rick. I took my appeal up to the 4th level where the ALJ said I had proven medical necessity and cost effectiveness … and still said no because CGM is “precautionary.” I wonder if I can file another appeal based on the new rulings. But I haven’t heard anything about what’s happened since the end of May 2016.