April 24, 2018

Drug Prices Should Piss People Off, Maybe Not For The Obvious Reason


Drugs are expensive. Like death and taxes, drug list price increases seem inevitable. There is lots of room for justifiable ire.

I think maybe that anger gets aimed at the wrong target. We all feel we understand prices. We go to the store, see an amount for a product on the shelf and choose to buy or not. If the price goes up, we pay more. Sometimes we fill out a form and get a rebate that limits that price increase. But rebates typically are a pain in the ass, and most folks don't factor them in.

But the list price of drugs on the shelf is misleading. In part because few see it. For most, we make a copay and don't know what the actual price our insurance policy paid for the meds.

HUGE rebates are happening, and nobody sees it. How huge? More than $150 billion. Yeah with a "B." So the drug prices keep going up but so do the rebates to the invisible parts of the drug payment system.

In some cases the rebates more than equal the price increases. What that means is that the drug company nets less income even while they raise the price. Where does the money go? Rebates.

Remember back when nobody bought a car without a rebate? It is like that - on steroids. Plans do not buy drugs without rebates.

Those rebates may get back to the insurance plan and in theory, reduce premiums. But that is not true in all cases, and there is no way to know.

So be pissed that $150 billion in drug rebates seems to sift through the cracks of insurance coverage and we the insured patients may or may not get the benefit of that sifting.

What can be done?

Maybe the first thing to do is to start to understand that rebates exist and be pissed that $150 billion is getting shuffled around with nothing approaching transparency. Our anger at drug prices should be focused on this rebate scheme.

What is a good policy solution? Applying rebates at the point of sale for all plan members, whether or not they have met their deductible.

For the uninsured require the average rebate that drug pays insurers to be applied to the uninsured too.

Want to learn more?
This post at Drug Channels.



July 7, 2017

Vote for FDA's AP Efforts as Excellent Public Service

FDA has given us, diabetes community, excellent efforts on artificial pancreas regulation. They have worked with innovators and patients to help the regulatory process work for people with diabetes. We should say thanks. Here is an easy way to do that.


Vote to recognize FDA's Artificial
(https://servicetoamericamedals.org/peoples-choice/index.php)

Scroll down and click next to
"Courtney Lias, Stayce Beck and the FDA Artificial Pancreas Team"

Here are the details:
The FDA's Artificial Pancreas team was selected as a finalist for the Samuel J. Heyman Service for America Medal in the Management Excellence category for our contribution to the first-in-the-world approval of the 670G hybrid closed loop system last fall. These Medals are awarded by the Partnership for Public Service, a non-profit organization whose mission is to "help government serve the needs of all Americans by strengthening the civil service and the systems that support it." In part the nomination says:

Before Lias and Beck got involved, both the industry and patient advocacy groups publicly voiced concerns that FDA’s review process caused unnecessary roadblocks and was standing in the way of developing this technology and delivering it to those in need. 
Lias and Beck changed this dynamic by treating all those involved—the device companies doing the research, the doctors, the hospitals and the advocacy groups—as partners, not adversaries, as they worked to improve and speed up the process. 
“They used to see the FDA as a barrier and now I believe they see us as an ally,” Lias said.
Read the full details of the nomination.

More information about the award program can be found here https://servicetoamericamedals.org

June 27, 2017

Meter Accuracy Study - DTS

Diabetes self-care is driven by data from glucose meters. The accuracy of meters matters because it is the cornerstone living successfully with diabetes. The Diabetes Technology Society just published a blinded study of meters. Have a look: https://www.diabetestechnology.org/surveillance.shtml

February 9, 2017

Pills better than insulin for t2?

Physicians Briefing reports a Swedish study that shows a lower risk of mortality (I vote that is a better outcome) with oral type 2 medications than with insulin. Good to see the study considered hypos. Given that diabetes is underestimated as a cause of death, it is good to see research looking at the big picture of all-cause mortality.

WEDNESDAY, Feb. 8, 2017 (HealthDay News) -- For patients with type 2 diabetes, novel oral glucose lowering drugs (GLDs) are associated with reduced risks of all-cause mortality, cardiovascular disease (CVD), and hypoglycemia, compared with insulin use, according to a study published online Jan. 24 in Diabetes, Obesity and Metabolism. 

Still - YDMV. The best course of treatment is the one the patient and physician agree meets the individual needs.

I think this "all-cause" approach should be taken when considering access to care beyond medications. One size doesn't fit all. Disrupting access to diabetes tool from strips, to the appropriate pump should be considered on a similar basis. 

February 2, 2017

Diabetes is Underestimated

Sometimes I think diabetes it is the Rodney Dangerfield of health. Unfortunately, it isn't a joke.

A recent study highlighted in this piece at Medscape says diabetes is underestimated as a cause of death in the US. The study puts diabetes, "the third leading cause of death in the United States in 2010, after diseases of the heart and malignant neoplasms and ahead of chronic lower respiratory diseases and cerebrovascular diseases." 

People with diabetes can thrive. By engaging early, we minimize complications, costs, and deaths. We need the appropriate tools and medications to be successful. 

Join me in calling on Congress to maintain the prohibition on pre-existing conditions, like diabetes, being grounds to exclude people from health care coverage. 

It is easy. 
  • The Diabetes Patient Advocacy Coalition has an easy to send letter to Congress. I'm sending it often. You can too.  
  • I'm sending Tweets from their Twitter Scorecard. Join me.
  • Getting through to our Senator's by phone has been iffy recently. So I 'm sending snail mail. 
Not only do we need to work with our doctors to care for diabetes. We need to work with our elected officials to maintain access to coverage. We need respect.




January 25, 2017

My Diabetes May Vary


Variations are inevitable and frustrating. 

Following treatment for cancer, I started medications as part of recovery including an emotional health medication. They seem to help. But the emotional health drug has a side effect - it bumps up my glucose levels. This feeds a feeling of fasting glucose frustration.

My go-to response is to try "to eat better." But when I don't see immediate results, the myth that I can control the rat bastard with diet, makes me feel a temptation to just eat less, to produce less glucose. The risk (and some days the reality) then becomes to eat less AND worse.

I aggravate everything doing that. It is a losing proposition.

So type 2 diabetes becomes more front of mind. I am checking glucose more. (Boy, I would love a sensor that filled in the gaps in my glucose profile. Come on Libre)

I think on balance the numbers are OK-ish. But they show that type 2 diabetes doesn't play well with others health issues, including emotional health.

As it changes, it demands additional adjustments. I know that is the deal. Knowing it doesn't make it less frustrating.


Type 2 is inevitably frustrating.


MDMV


January 16, 2017

CMS Ruling on CGM

The Centers for Medicare & Medicaid Services has concluded that Continuous Glucose Monitor Systems can be covered as durable medical equipment.* Specifically, those with an FDA label for the purpose of adjusting the treatment diabetes.

In practical terms currently, means the Dexcom G5. The CMS finding also established criteria for coverage that is an innovation target for other devices to achieve. Codes and coverage still need to be worked out. Still, this is great news. As one piece on the ruling observed. "Nearly 25% of patients with type I diabetes fall under Medicare."

A lot of effort, by many, contributed to this success. The industry has maintained a rapid pace of innovation. FDA has responded with timely reviews of CGM applications, most recently with a non-adjunctive label for the G5. A majority of both houses of Congress supported legislation in the last Congress supporting coverage. Courts ruled in individual cases for coverage. We, the people with diabetes, advocated in every avenue open to us to ask for coverage.

Positive diabetes health news is great. Savor this.


*You read the CMS Ruling at https://www.cms.gov/Regulations-and-Guidance/Guidance/Rulings/Downloads/CMS1682R.pdf

December 19, 2016

Last Minute Shopper Alert: Stuff the Vegas UnCon into Their Stocking.

Looking for one more brilliant gift?

Your Diabetes May Vary but the gift may not. What's better thanVegas UnConference?

Don't know about the UnConference? Learn here, it is perfect for People with Diabetes (PWDs) and the People who Love Us (PLUs). Find your people. Have fun in the process.

Winter is coming. With it the winter doldrums and the need for a Valentine's Day celebration. Give the Unconference now as a stocking and join the fun in Vegas.

Book the UnConferece here. Then with Amazon Prime you can have these socks to hang from the bed post in time for a visit from Naughty Santa's Helper.

Wink Wink, Nudge Nudge.

December 14, 2016

I had prostate cancer. It’s been a blessing.


I've been out of circulation.

Turns out I’m fortunate; I had prostate cancer. It’s been a blessing.

Fortunate first because, I’m using the past tense - HAD. OK, it is still early, but all the information so far points to success. Score. I’m saying had.

From the first concerns to the diagnosis, and surgery, I had a lot of fun riding hundreds of miles on my bike. They had me in better condition than I have been in for a decade or more. Being in better shape helped. Rides were my meditation and were the space where I could get emotionally ready for the surgery.

I’m lucky it was detected while it was localized. What matters is I had, and still have a stunning level of support from family, friends and health care team.

I wince when people say they are sorry for what I have been through. While I greatly appreciate that sentiment, sorry isn't the lens I see my experience through.
I’m not at all sorry for it.

I am thrilled that, if cancer was in my life’s path, it was slow growing, highly treatable type.

I greatly appreciate that my family doctor of 30+ years connected me with a second opinion. That second opinion proved to be the star of my team. I benefited from the personal relationship between these two professionals. It is such that a phone call from my primary was all it took to get me a personal phone call and appointment from a surgeon whose staff said his calendar was booked for months. That took less than a day.

I could not work with better people. Family first isn't what they say; it is how they live. It was never about picking up the slack; it was always about being proactively supportive.

My family is wonderful. They showed that even when I didn’t. They supported my both contradictory fierce independence charting a path through the process and rants at the myriad of SNAFUs that come from the spectacularly non-systematic health process, incorrectly called the healthcare system. I am sure my vacillating between being noncommutative or a ranting loon was not fun.

I’m not sorry. I’m blessed.

I much more clearly see the many blessings who are the people in my life.

Love Ya Mean It

September 8, 2016

Glycemic Index' May Be Too Unreliable to Manage Diabetes: 
Wide variability seen after eating same food at different times

The opening: Glycemic index values of the same foods can vary widely and may be an unreliable indicator of blood sugar response, according to a new study.

No kidding?!

YDMV