s the debate over the future of health care coverage moves in fits and starts, it may seem like any improvements in health care coverage are equally stalled. But they aren’t. Insurance companies can take action now to make immediate differences in people’s lives — especially those with type 1 diabetes.
Improving the coverage they offer can help these individuals more easily control their condition. Such changes could also benefit insurance companies — keeping people with diabetes healthier would ultimately boost their bottom lines.
Unlike type 2 diabetes, which is much more common, type 1 diabetes has nothing to do with diet or lifestyle and, at least for now, it can’t be prevented. It occurs when the body mysteriously mounts an immune system attack against certain cells in the pancreas, severely damaging their ability to make insulin. Without this hormone, sugar builds up in the bloodstream, damaging tissues and eventually causing death.
Controlling type 1 diabetes requires daily use of insulin and the medical supplies needed to administer it safely. These things are not “nice-to-haves” — they are essential to survival.
I’ve seen firsthand the challenges that people with type 1 diabetes face. My son, Turner, was diagnosed with the disease in 2004, when he was 10.
Since then, the scientific community has created better types of insulin, more effective insulin pumps, and monitors that continuously measure blood sugar. Just this year, an artificial pancreas system came to market. Artificial pancreas systems automate blood-sugar management by monitoring glucose levels around the clock and automatically providing the right amount of insulin at the right time.
All of these advancements reduce the burden of managing this life-changing disease, as well as the risks of experiencing potentially deadly blood sugar lows and highs. But they can only do that if people can access them. Increasingly, that’s not the case. For many Americans, type 1 diabetes is becoming harder — not easier — to manage.
Insulin costs are soaring, and for too many people the costs are unpredictable from month to month. Some insurers are taking steps to limit people’s coverage of insulin pumps and other lifesaving technologies. At JDRF, a global organization that funds type 1 diabetes research, we’ve heard countless stories of people choosing to go without an insulin pump, or stories of how they share insulin and other supplies to make ends meet. As Jessica Hoffer, a 28-year-old from Pennsylvania, told one newspaper: “To take away the choice of what is essentially an organ — a body part — it’s insane.”
Some individuals have called for the government to cap the costs of insulin and take other strong actions. Putting aside the wisdom or desirability of these efforts, waiting for Washington to act will likely take too long for people with type 1 diabetes. That’s why JDRF is encouraging insurance companies to take three practical steps to give people with diabetes the coverage they need to control their disease.
First, insurance companies should keep out-of-pocket costs for insulin and diabetes management tools such as pumps and meters predictable. They can do this by removing insulin and diabetes management tools from the deductible, as health plans do for preventive drugs. Doing so would make costs more consistent throughout the year. They can also move insulin and diabetes management tools to tier 1 or tier 2 benefit levels and provide cost-sharing for insulin and diabetes management tools as fixed-dollar copayments rather than as coinsurance, which is a percentage of the list price of the item or service.
Second, insurers should give people the freedom to choose the type of insulin and other supplies that are right for them. One major insurer entered into an exclusive agreement with a single insulin pump maker, effectively limiting its members’ choice to one brand. But insulin pumps aren’t one-size-fits-all devices — different ones work better for different people. The same is true of insulin — the choice of which one is right should be made by people with diabetes and their physicians, not by insurance companies.
Third, insurance companies should cover all lifesaving technologies, including artificial pancreas systems. These are on the road to becoming one of the most revolutionary advancements in diabetes care since the discovery of insulin.
Giving the 1.25 million Americans with type 1 diabetes the best available tools so they can achieve better blood sugar levels with significantly less effort and risk than they do today will greatly improve their health and quality of life. It would help them avoid costly emergency room visits, inpatient admissions, and complications like heart attack, stroke, blindness, kidney disease, and amputation that can result from type 1 diabetes. Covering these tools, including artificial pancreas systems, would be a smart investment in the health outcomes of any plan’s beneficiaries and also yield profound savings for insurance companies.
Even in the face of ongoing uncertainty over the future of health care, it’s time for insurance companies to help people take control of their health. When they do, the entire health care system — including the insurers themselves — stand to benefit.
Derek Rapp is president and chief operating officer of JDRF, the leading global organization funding type 1 diabetes research.