It’s time to ‘build back the best’ for Americans with diabetes

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On May 23, 2021, Joanna Buscemi, PhD, shared her perspective on diabetes-related mortality inequalities and policy recommendations to address it. Within the framework of MedPage todayexamining the main events of the past year, Buscemi and Allyson Hughes, PhD, follow up with latest Biden administration-based Reconstructing Better Acting (BBBA), which includes many policy changes related to diabetes.

The Biden administration Reconstructing Better Acting (BBBA) includes several provisions that may benefit the health of Americans living with diabetes, providing health benefits beyond just diabetes care. First, the law caps the price insulin co-payment to $ 35 for insured Americans. Second, the BBBA includes provisions for a wide expansion of health care coverage which should provide health insurance for an additional amount. 4 million Americans. Finally, the BBBA expands nutrition assistance programs to fight against food insecurity and invests in parks and transit initiatives that promote safe and convenient ways to be physically active. While the future of the BBBA is now at stake since Senator Joe Manchin (D.-W.Va.) announcement he will not support it, any amended version of the bill or new social spending legislation should preserve these key health provisions and address other important concerns that go unresolved for people with diabetes, especially those of minority groups.

It is important to start by understanding the insulin quota limit limitations. While this participation cap can be useful for many American policyholders, it does not cap the cost of the insulin itself. This means that without insurance, insulin prices stay the same and will continue to increase exponentially over time. As a result, the cost remains difficult to manage for those who are not eligible for Medicaid or Medicare and who have competing financial priorities. Additionally, those covered will still be responsible for the full cost of insulin if they run out of insulin but are within a coverage gap. These political limitations can lead to insulin rationing, which can be fatal. It can also leave many people with diabetes with no choice but to look for insulin on social media sites of donors or sellers.

Real fairness for people with diabetes would involve asking drug companies to cap the cost of insulin itself so that it is affordable for Americans with or without medical coverage. Big Pharma continues to take advantage of the backs of people with diabetes and Congress must end it once and for all. Capping the cost of this expensive, life-saving drug may also set a precedent and potentially benefit people with other conditions that require expensive medical treatment due to the rising prices – such as those who need to. an EpiPen, have rheumatoid arthritis, Cancer, and / or other conditions.

Although the extension of Medicaid and Medicare in the current version of the BBBA will likely benefit those who were previously uninsured, the limitations of health insurance coverage remain for diabetic patients. The first limitation, recently detailed in a position statement of the Society of Behavioral Medicine and the Society for Health Psychology of the American Psychological Association, is that there are significant barriers to obtaining essential diabetes supplies, such as continuous glucose monitors (CGMs) and insulin pumps, covered by insurance. To be approved for insulin pumps, people with diabetes must quarterly face-to-face visits with their provider, which increases the burden on patients and providers and reduces access to CGMs. This requirement has been temporarily lifted due to the pandemic, but must be lifted permanently to increase access to long-term diabetes supplies. The second problem with health coverage is that it often takes away the freedom of choice about devices and types of insulin. Take the Walmart Insulin for example: Walmart has low-cost insulin in its retail stores, but insulin hit the market 25 years ago and works slower than other insulins available. This may seem like a subtle problem for people without diabetes. But people with diabetes know that the speed of insulin makes a significant difference, and you need to be trained in how to use each type of insulin, making it very difficult to just switch to something new. Likewise, if people do not have the freedom of choice due to restrictions imposed by insurance companies, it forces some to pay out of pocket for the best insulin for their needs. These limitations are widely regulated by states, suggesting that national policies regarding insurance coverage for diabetes treatment and devices should include a wide variety of products.

Despite some limitations of the BBBA, it raises several health-focused initiatives with great potential to advance equity in diabetes mortality by lowering insulin co-pay, expanding healthcare, and increasing access to healthy foods and safe spaces to exercise. Future versions of the legislation should retain these changes. In addition, Congress must maintain a focus on improving other social determinants of health – education, safe housing, safe drinking water, and affordable child care. These are important structural changes that are likely to have positive impacts on minority Americans in general. But until drug companies are held accountable, every American enjoys guaranteed health care, and insurance companies cover and offer patients choice about drugs and devices, inequalities and barriers will remain. There are three laws proposed by the Congressional Caucus on Diabetes that should be reconsidered in an effort to alleviate these remaining issues: Protecting Access to Diabetes Supplies Act (HR 771), Law on the prevention of diabetes in health insurance (HR 1686) and Medicare CGM Access Act (HR 1427).

Later, researchers will need to quantify the actual impact of key pieces of legislation on inequalities in diabetes-related mortality and other diabetes-related outcomes, as well as their impact on other diseases related to systemic oppression – heart disease. , cancer and obesity. , among others. In the meantime, it is important that the new year’s legislation focuses on completely removing barriers to care in order to improve the health and quality of life of people with diabetes. The experts in removing political barriers to adequate care are the people who experience it. Therefore, patient advisory committees should have a say in strategic decision-making to ensure that large investments, while well-intentioned, do not miss their mark.

Joanna Buscemi, PhD, is a Clinical Psychologist, Assistant Professor in the Department of Psychology at DePaul University and Chair of the Health Policy Council of the Society of Behavioral Medicine. She specializes in health inequalities and health policy advocacy. Allyson Hughes, PhD, is a health psychologist and Assistant Professor in the Heritage College of Osteopathic Medicine at Ohio University. She specializes in the psychosocial challenges of diabetes management, including health equity regarding severe hypoglycemia, diabetes-related distress, diabetes complications and disability. She has lived with diabetes for 26 years.

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