More than 30.3 million Americans, nearly 10% of the population, suffer from diabetes, according to the Centers for Disease Control and Prevention. In 2010, diabetes was the seventh leading cause of death in the United States, and the costs and lost productivity associated with the disease top $200 billion annually.
As rates of diabetes increase, the health care costs likewise increase; in fact, health costs for those with diabetes can be twice as high as for those without diabetes. Many health plans, pharmacy benefit managers and large employers implement controls on access to therapies to keep these costs down.
• “Fail first” or step therapy requirements often impede or unnecessarily delay access.
• Prior authorization for treatments can dangerously delay a physician’s prescribed course of care.
• Non-medical switching – when a health plan switches a therapy to a less costly alternative for reasons unrelated to a patient’s health – looms among diabetes patients as biosimilar insulin treatments come to market.
These techniques affect patients’ access, adherence and treatment for a disease that demands careful, individualized care.
With these access issues facing the diabetes community, the Diabetes Policy Collaborative addresses public policy on the federal, state, regulatory and health plan levels. DPC seeks to maintain access for diabetes patients and to restore the sanctity of the physician-patient relationship in diabetes care.