At our June 2nd Wednesday Speaker Series, Kevin Wren from the Washington Chapter of #insulin4all joined us to share how the insulin price crisis is forcing diabetics to resort to drastic measures just to stay alive, and he shared what has been done to address this crisis. 

This issue also includes a summary of the Universal Health Care Commission June meeting where we got to hear the commissioners speak!  

Let us know your opinion about  our change to focus on a single issue in our e-Bulletin. What do you think of the format? How can we improve the copy?   You can email me at [email protected] 

UHCC June Session Takeaways 
By Consuelo Echeverria 

In the  June session, we got to hear from the Commission members themselves as they discussed Washington’s readiness to implement key design elements of a universal health care system. 

1. What should WA state’s universal health care system key design elements be?

• Public health approach to a WA state universal health care system

  •  Jane Beyer, from the Office of the Insurance Commissioner,  stated there needs to be a universal entry point that includes everyone like a birth certificate 

• •  Nicole Gomez, with the Alliance for a Healthy Washington, suggested that we need to build simple, uncomplicated forms into the enrollment system.

  • Rep. Schmick asked if Medicare and Taft Hartley are out, who is in this plan? Are the bronze, silver, gold and platinum categories really necessary in a unified plan? 

• WA State's universal health care system must be trauma informed 

  • Dr. Johnson, Washington State Office of Equity, shared how the Veterans Administration (VA) was able to cater to the direct needs of veterans by designing a system that included input from families, specifically mothers and wives.  Go to women to get their input so the system is welcoming! The lessons learned in the VA can be transferred for UHCC.

2. Eligibility and enrollment 

• While eligibility and enrollment has a robust system for AppleCare and qualified health plans there is no centralized system. This fragmentation has severe consequences in understanding the true number of  WA state citizens who have insurance and how much it costs. 
• Joan Altman at the Washington Health Benefit Exchange (HBE), shared that HBE is exploring how the Health Plan Finder can integrate DHHS and  the 40 odd other federal  databases into their system, but the various technologies, some of which are 30 years old, make interoperability a challenge. 

3. Cost containment

Fee for service vs value-based payments (VBP)

• Jane Beyer, emphasized with the significant consolidation, both vertical and horizontal, a VBP model disproportionately impacts small practitioners who may not have the ability to take on financial risk. Therefore there should be some sort of protection. 
• Vicki Lowe, UHCC chair, shared the concerns from the American Indian Health Commission for Washington State that VBPs drive out rural practitioners leaving rural communities who are already struggling at further risk.
  
  “Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by 

  • a scarcity of services

  • a lack of trained physicians

  • insufficient public transport

  • No or poor internet”

  • Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015 Jun;129(6):611-20. doi: 10.1016/j.puhe.2015.04.001. Epub 2015 May 27. PMID: 26025176.

4. Infrastructure 

There seemed to be agreement that the commission should focus on what is working well now and then add to it. 

5. Governance  

Sequencing of elements was discussed with  Rep. Schmick very importantly noting that if the public perceives this Commission is operating behind closed doors, it will be harder to convince the public of our conclusions.  Jane  commented that the phased initiatives are outlined badly, we need to clearly articulate a path 

The meeting ended with a call to address the short term and help folks. Do what is easy first in order to help the most vulnerable while figuring out the more difficult questions with ERISA, Medicare  etc..

2ND Wednesday Speaker Series featuring Kevin Wren from “Insulin Access”

Takeaways on access, disparities and what we can do about it.  
By Consuelo Echeverria 

Background 

• Some 1.6 million Americans are living with type one (T1) diabetes.
• Insulin is the bare minimum: Without it, in ~3 days a diabetic would not be alive.
• Only three companies control 90%+ of global insulin production

Access

• Insulin has been around since the 1920s 
• The manufacturing costs for one vial of analog insulin is $3 to $6 per vial
• Yet Insulin prices have  increased by 1200% over the last 30 years 

Disparities 

• One in four people living ration their insulin 
• Most are under- or uninsured
• Technology improvements like continuous glucose monitors and insulin pumps are disproportionately unavailable to BIPOC communities.

  • Even though organizations such as the Juvenile Diabetes Research Foundation has raised millions 

Legislation in WA 

• Reauthorize the Total Cost of Insulin Work group 

  • Adding patient voices who are often left out

  • Identify long-term solutions and universal coverage 

• Concerning insulin affordability

  • Copay will be reduced to $35 for 30-day supply of insulin in 2023 

  • Copay was reduced to $100 for a 30-day supply in 2020. 

• Allows Washington to manufacture and distribute generic prescription drugs and biosimilar insulins 

  • State made insulin costs $200/yr vs $300/month the current cost to patients 

  • Introduces the potential for a multi-state compact with CA for production and distribution 

• The Prescription Drug Affordability Board (PDAB) 

  • Conduct affordability reviews on 24 drugs a year and establish upper payment limits on some

Federal Legislation 

• HB3 

  • Allowing the government to negotiate drug prices esp. insulin 

• Affordable Insulin Now Act  

  • Copay cap limit for those with insurance. 

  • Does not include uninsured 

Advocacy 

• Hand written letters work with clear messaging 

• Demonstrations to build public profile 

• Media and online advocacy to tell your story 

• Collaboration with partner organizations 

• Make time for self-care while you advocate 

You can see Kevin’s presentation with questions here

Bill of the month 

The doctor didn't show up, but the hospital ER still billed $1,012

Articles

Insulin: disparities and what we can do about it

Not So Sweet: Insulin Affordability over Time Insulin affordability

With costs rising rapidly, insulin is becoming more difficult to afford for many Americans, especially those with inadequate insurance coverage. Uninsured Americans with diabetes are much more likely to be using less costly (and less effective) formulations of insulin compared to peers with private insurance or Medicaid. Uninsured people are also much more likely to pay full list price for insulin (68%) than the privately insured (9%) or Medicaid beneficiaries (3%). The uninsured spend more out of pocket on all prescriptions ($2,456) than the privately insured ($1,274) and are more likely to report being unable to afford prescription medicines (38% versus 10%). However, among the privately insured, insulin accounts for a significant portion of total out-of-pocket expenses.

Racial Disparities in Diabetes Technology and Care

Technologies like CGM and insulin pumps have the potential to revolutionize a person’s diabetes care and management. Unfortunately, too many people with diabetes, particularly people of color and those who are low-income, do not have access to these devices.

National Panel to promote publicly-owned pharmaceutical enterprises, created by states to develop, manufacture, and distribute medication in the public interest  

Democracy Policy Network 

Organizations working to mitigate Insulin disparities: 

t1international

Washington #insulin4all