The adoption of the Affordable Care Act (ACA) and rules imposed by insurers for scheduling and receiving care can be especially disconcerting for patients with diabetes. “With the ACA, patients are often left wondering about their access to care and to medications with higher price tags,” explains Jason C. Baker, MD. “The ACA has not matured to the point where it addresses coverage of newer diabetes drugs. This means some patients may be relegated to sticking with older medications that may be less effective or have more side effects rather than using newer treatments that are potentially more effective.”
Dr. Baker says that diabetes treatment should be personalized based on the unique needs of patients. “Older and less expensive medications may work well for one patient but result in side effects for another,” he says. “It’s important to consider all options when selecting diabetes medications, including newer and more expensive drugs. This allows for personalization of care and can increase our chances for success.”
How Can Doctors Help?
Dr. Baker says that doctors should strive to be proactive in the ever-changing healthcare environment. “One way to do that is to document how patients respond to new diabetes medications,” he says. “By logging this information routinely, we can organize our arguments for getting specific drugs covered by ACA and other insurance carriers. As we document the efficacy of newer drugs, we’re providing the foundation to informing insurance providers of the benefits of therapies, which in turn may increase accessibility to these drugs in the future.”
Clinicians should also serve as patient advocates when costs become an issue. “It’s important for physicians to be aware of coupons and rebate offers from drug manufacturers of newer medications,” Dr. Baker says. “We should also seek out drug assistance programs and be prepared to direct patients to these services.” He adds that patients should be encouraged to conduct research on their own about financial assistance. Patient engagement can further support the efforts of physicians to get diabetes medications covered by insurance.
Be Vocal, Get Engaged
“Physicians need to get involved with local and national healthcare reform chapters so that they can lend their voice to issues surrounding the high costs of diabetes care,” says Dr. Baker. “We also need to work with pharmaceutical representatives and give them feedback on insurance coverage issues when we’re advocating for newer drugs. Clinicians should be proactive participants rather than casual observers. There are forums available for physicians to express their opinions loud and clear. By being aggressive advocates, we can make a significant impact on enhancing care for patients with diabetes.”
Readings & Resources (click to view)
Gilmer TP, O’Connor PJ, Rush WA, et al. Predictors of health care costs in adults with diabetes. Diabetes Care. 2005;28:59-64.
American Obesity Association. Why health plans should cover treatments for obesity. Available at: http://www.obesity.org/treatment/health_plans_cover.shtml.
Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effect of improved glycemic control on health care costs and utilization. JAMA. 2001;285:182-189.
Costantino ME, Stacy JN, Song F, Xu Y, Bouchard JR. The burden of diabetes mellitus for Medicare beneficiaries. Popul Health Manag. 2014 May 27 [Epub ahead of print].