Now we continue our continuing coverage of this Insulin Affordability and Access Crisis at the U.S. using an intriguing interview by our correspondent Dan Fleshler at New York, who’s been following the role of Pharmacy Benefit Managers (PBMs) and what can be done to address the huge issue of drug prices.
Q&A with Diabetes Advocate Rick Phillips, by Dan Fleshler
The Diabetes Community desperately needs good ideas to cover the dangerous crisis of high insulin expenses, at a time when some Americans are literally made to choose between food and insulin. Searching for new alternatives, I talked with Rick Phillips, who’s uniquely qualified to explore the infuriatingly complex insulin supply chain.
Rick has both type 1 diabetes and Rheumatoid Arthritis and can be an energetic advocate for people with both diseases, composing the RA Diabetes blog. For 30 decades, he’s helped to administer medical insurance programs for college systems in Indiana. He retired in 2008 but keeps in close touch with former colleagues at the medical insurance trenches, along with his work there gives him very useful insights into our busted drug pricing system.
Here is my current back-and-forth with Rick:
DF) When speaking about large sugar costs, the focus has mainly been on insulin manufacturers and pharmacy benefit managers (PBMs). We don’t hear much about the companies that hire the PBMs and put up and host medical insurance programs for employees. Are they contributing to the catastrophe?
RP) Yes, I don’t believe insulin was given the importance it deserves in health program design. It’s frequently treated as a product and gets little recognition as a life-sustaining drug. We haven’t done enough to assist health plan administrators understand that insulin is vital for T1Ds to reside.
That’s astonishing. You mean the people responsible for health programs really don’t understand that without insulin, some of their employees or their relatives will die?
At the back of their heads, they might understand it at a certain level, but when they look and negotiate health programs, they don’t attach the importance to insulin that it deserves… In one of their last [health insurance] committees I worked on, I had been pressing to move several medications from one formulary category to another. Insulin was among these. An executive stated, “This is precisely the exact same place on the formulary that insulin has always had. It’s been there forever”
I don’t believe enough health program administrators understand that insulin needs to be treated as life-sustaining!
What do we do about this?
Only about 10-15 employers in this country actually have the ability to influence formularies — including GM, Ford, IBM, UPS, PepsiCo, Coca-Cola, FedEx, Verizon and many others who have elevated numbers of employees covered by personal insurance. These are the companies which have the most leverage with the PBMs, thus we need to focus on these and tell them our story, including the fact that insulin is not an optional medicine, and we need them to force the reclassification of formularies. I like the notion of an effort aimed at HR professionals at these companies to educate them about insulin.
We also need to put strain on each the other parts of the pricing system, right?
Obviously. We must educate employers, to speak on PBM’s and keep the strain on [insulin] manufacturers to reduce costs. No one single group can solve this matter independently.
What about people with diabetes that are uncomfortable approaching the HR folks in their companies and calling attention to their health state?
In my estimation, we must get over that. Not too long ago people were afraid to test their blood in people. Yet today we have begun to say it is OK to do so. We have a choice: are we ready to accept the status quo or are we ready to make our purpose? I don’t think there’s another way. However, the cost of insulin ought to be increased with employers in a civil fashion, not a confrontational one.
What if we need from PBMs, besides transparent pricing?
What is a “Formulary” Again?
A Formulary is a list of selected drugs and medical equipment covered with a given health insurance program. Formularies are divided into “tiers” — typically using the “preferred” medications with lowest co-payments at Tier 1, the majority of those being generic. The higher the tier, the more cash the individual will need to pay out-of-pocket.
PBMs can help reduce the Expense of insulin in a Number of ways:
- Place insulin at the lowest formulary tiers. Employing a new classification which puts insulin in precisely the exact same category as generic medications is your quickest way to solve the problem. I have felt it ought to be in that category for ages.
- Take the rebates now provided by manufacturers into PBMs and make certain consumers benefit from those discounts at the retail level, at the point-of-sale.
Do you honestly believe the PBMs, Big Insulin and other companies which have our own lives in their hands can be persuaded to change their strategy?
Yes. Allow me to give you an example of what is possible: most healthcare plans cover 100% of their costs of vaccinating children. Thirty decades ago, this wasn’t true in any way, and it only altered when, as a society, we came to know that vaccines are a necessity to public health. We need to work to elevate insulin to that degree of importance.
For your RA community, some medicines are life-saving. One of those will be Methotrexate. Now it is in the generic drug category. It did not utilized to be, but we fought for it. It’s time for us to help insulin work its way into the lower tiers like Methotrexate.
That might help. But those are all just baby steps, actually… What do you think of this notion of a single-payer system, which many believe finally is the only sensible path for American healthcare?
I didn’t utilized to feel that, but I do. By the time I started working in the system until today, it’s become more and more inefficient… A single-payer system like Medicare-for-all would be cumbersome and there could be problems. Nevertheless, the current situation is so outlandish that I don’t know what else to do, if we are talking about reforming the entire system.
Rolling Up Our Sleeves
Before my talk with Rick, I would have laughed if you had told me I would be invigorated, rather than put to sleep, with a talk about wellness insurance administration and formulary design. However, I found his perspective to be both fascinating and helpful. He’s written about his ideas for battling insulin price inflation on hisblog, and it is worth the read.
Even though that price hike is dreadful, it doesn’t imply the ideas discussed there ought to be discounted.
The Diabetes Community should continue rolling up its sleeves and keep on doing the tough work of pressing, pushing and prodding to make these reforms a reality (and, IMHO, join with people that are advocating for more systemic changes — notably a single-payer system).
Thank you, as always, for the hard work on this subject of #InsulinPrices and #PBMsExposed, Dan! We value your insights and expect the D-Community can effectively work together to transfer the needle (so to speak).
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