This article is more than 5 years old. Information may no longer be current.
Increased diabetes care access begins with involved stakeholders
SAN FRANCISCO — A lack of patient access to basic diabetes prevention and education services is hindering management of a growing disease epidemic, and all stakeholders must step up to ensure that patients receive the comprehensive care they need, according to a speaker at the American Diabetes Association Scientific Sessions.
“For the person with diabetes, access is the foundation of optimal health, outcomes, quality of life and affordable medical costs,” Gretchen Youssef, MS, RDN, CDE, president of health care and education for the ADA, said during a plenary presentation here. “For the health care system and society, access will help to control the rising health impacts and cost burdens of diabetes.”
Youssef said all stakeholders, including health care providers, patients and their friends and family, can take proactive steps to help fight for increased access to comprehensive diabetes care, including preventive services, diabetes self-management education and lobbying for policy changes that remove barriers to essential medicines like insulin.
Prevention services
With an estimated one-third of U.S. adults with prediabetes, there is an ever-increasing need for access to diabetes prevention services, Youssef said. In 2010, the National Diabetes Prevention Program, or DPP, was launched, and, in 2018, CMS expanded coverage of the National DPP. Early National DPP results, Youssef said, are promising, but they also highlight the challenges of translating results from a randomized controlled trial into a real-world setting.
“We need to learn from successful participants and programs which best practices supported their success, and conversely, learn from those who did not meet the program goals what could be done differently to enable success, particularly in high-risk communities,” said Youssef, who is also program director for the Medstar Diabetes Institute in Washington, D.C. “Additionally, there needs to be increased reimbursement for the [National] DPP.”
Insulin affordability
Insulin access and affordability remain pressing issues in the U.S., Youssef said, as costs for insulin continue to rise. The complex reasons behind the cost increases, she said, remain unclear.
“In the most extreme cases, there have been deaths, particularly among young people due to rationing of insulin attributed to costs,” Youssef said. “Shockingly, the average price of insulin has more than tripled from 2002 to 2019, making some choose between purchasing insulin or other necessities, such as food, utilities and rent.”
Even for patients with health insurance, Youssef said, high-deductible plans that can reach as much as $10,000 put insulin nearly out of reach for some.
“Unfortunately for most people with diabetes, going outside of the country is not a realistic strategy to purchase affordable insulin,” Youssef said. “It is certainly not a long-term solution to the current high cost of insulin here in the U.S.”
The ADA, Youssef said, is continuing to work with Congress to enact long-term solutions for all people with diabetes. For patients who do not meet requirements for pharmaceutical coupons or insulin-assistance programs due to insurance status or income level, Youssef said human insulin sold at Wal-Mart for $25 could serve as a lower-cost alternative. But more must be done, she said.
“What can Congress do to make insulin more affordable, and what is your elevator speech for this high priority issue?” Youssef said.
ADA priorities include lobbying for increased pricing transparency throughout the insulin supply chain, lower or removed patient cost-sharing for insulin, a streamlined biosimilar insulin approval process and increased access to health care coverage for people with diabetes, she said.
“What can you do?” she said. “Get mad. We have been dealing with this situation for too long. Sign the ADA insulin access petition and ask your patients to do the same.”
Diabetes education programs
Numerous studies have shown the benefit of diabetes education; however, it remains grossly underutilized, Youssef said. Less than 5% of Medicare beneficiaries and 7% of those with commercial insurance receive diabetes education in the first year of diagnosis.
In 2012, only 1% of Medicare beneficiaries with diabetes had a Medicare claim for diabetes education,” Youssef said. “Access to diabetes education continues to be a major impediment to gaining the skills and knowledge needed to effectively manage this complicated, chronic medical condition.”
Access, cost and reimbursement issues for patients and providers hinder the delivery of diabetes self-management education, or DSME, Youssef said. In 2019, the ADA introduced a bill to the house and senate: the Expanding Access to Diabetes Self-management Training Act. The act aims to remove barriers for Medicare beneficiaries by allowing providers, such as hospitalists, to refer patients with diabetes to DSME, increasing education hours, removing co-pays and deductibles and allowing services to be provided in community-based locations.
“When these barriers are removed, there is another important issue to consider,” Youssef said. “Will there be enough programs and educators to accommodate all people with diabetes?”
‘Policy drives access’
Access to medication and care by diabetes providers, including diabetes educators, will provide a person with diabetes with the tools to help them meet their targeted health goals, Youssef said.
“Policy drives access,” Youssef said. “I encourage you to get or stay involved, be the voice of diabetes and support the ADA and those you care for living with or at risk for diabetes. Sign up, become an advocate at diabetes.org. The health care environment is rapidly changing and all diabetes stakeholders must remain agile and flexible to ensure our success as a community for change on behalf of the person with diabetes in the evolving landscape of care.” – by Regina Schaffer
Reference:
Youssef G. President, health care and education address — it’s all about access. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, San Francisco.
Disclosures: Youssef reports no relevant financial disclosures.