Improving Insulin Access: ADA Public Policy Recommendations

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The ADA’s recommendations include increasing transparency across the entire insulin supply chain and streamlining the approval process for biosimilar insulins.
The ADA’s recommendations include increasing transparency across the entire insulin supply chain and streamlining the approval process for biosimilar insulins.

The American Diabetes Association (ADA) has issued a public policy statement that outlines long- and short-term recommendations for improving insulin affordability.

The ADA's recommendations include increasing transparency across the entire insulin supply chain; streamlining the approval process for biosimilar insulins; lowering or removing patient cost-sharing for insulin; and increasing access to healthcare coverage for all patients with diabetes.

According to the ADA, the cost of insulin has nearly tripled between 2002 and 2013, which has caused many patients with diabetes to choose between purchasing insulin and paying for other necessities.

“The ADA is steadfast in our commitment to ensure every individual who needs insulin has affordable access to this critical, life-sustaining medication,” stated William T. Cefalu, MD, chief scientific medical and mission officer for the ADA. “We've incorporated our previous work with the conclusions and recommendations from our expert Working Group to present a full slate of public policy options.”

The ADA recommends increased transparency throughout the full insulin supply chain, including manufacturers, wholesalers, pharmacy benefit managers, health plans, and pharmacies, and notes that potential consequences may arise in releasing this information to the public. Therefore, the ADA advises that the information be provided to an independent third party or parties, such as Congress, state legislatures, state agencies, or federal agencies, which can compile and analyze the data to identify changes that will lead to long-term improvement in insulin affordability.

Increasing available options for insulin and other expensive medications could lead to lower costs for patients. The ADA recommends that the US Food & Drug Administration (FDA) continue its efforts to encourage additional competition within the insulin landscape, including fostering biosimilar competition.

In addition, the ADA recommends that health plans and government programs make changes to their prescription drug benefit designs to ease the financial burden for patients with diabetes by covering insulins without cost-sharing. Many health plans are moving toward a value-based insurance design, lowering or removing cost-sharing for high-value clinical services and medications. Providing diabetes medications with low or no cost-sharing has been shown to increase medication adherence and results in better long-term health outcomes.

The ADA also recommends that health plans and government programs be required to limit out-of-pocket spending for medications. For commercial health plans, this could be implemented as a monthly cost-sharing limit for medications; by applying the actuarial value standards to all covered benefits independently, including covered prescription drugs; and/or implementing an annual prescription drug out-of-pocket spending limit.

“The ADA has been advocating for improved access to affordable and quality health care for years,” said LaShawn McIver, MD, MPH, Senior Vice President of Government Affairs, Advocacy & Community Integrated Health at the ADA. “We look forward to continuing to work with policy makers to help us achieve the necessary changes that will reduce the financial burden, improve health outcomes, and protect our nation's most vulnerable populations from dangerously high insulin costs. It's a matter of life and death.”

References

  1. Maier K, Riley M; American Diabetes Association. Improving insulin access and affordability: public policy statement. Accessible at: http://www.diabetes.org/assets/pdfs/advocacy/improving-insulin-access-and.pdf
  2. American Diabetes Association. American Diabetes Association releases long- and short-term public policy recommendations for improving insulin affordability [news release]. May 24, 2018. Accessible at: http://www.diabetes.org/newsroom/press-releases/2018/public-policy-recommendations-improving-insulin-affordability.html
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