Thursday, Nov. 21, 2019 | 2 a.m.
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Almost 300,000 Nevadans — an eighth of residents — suffer from diabetes. And 10,000 additional Nevadans develop this chronic condition each year.
The disease exacts a fearsome toll on patients. Untreated diabetes can lead to blindness, kidney failure and tissue damage so severe it requires limb amputations. It also increases the risk of cardiovascular disease. Nevadans with diabetes suffer heart attacks four times as often as adults without diabetes.
Fortunately, patients can manage the disease and lead relatively healthy lives — as long as they can afford the latest treatments. It’s up to our political leaders to expand patients’ access to those drugs.
Diabetes threatens Nevadans’ physical as well as financial health. It’s now the eighth-leading cause of death statewide, accounting for 21.5 fatalities per 100,000 people in 2018. That’s a 44% increase since 1980. All told, the disease costs Nevada $2.4 billion each year in direct health care expenses and lost productivity.
Diabetes also boosts people’s risk of developing an even more deadly condition — heart disease, the No. 1 cause of death in Nevada. Eighty percent of Nevadans with diabetes suffer from at least one heart ailment. Nationwide, more than two-thirds of seniors with diabetes ultimately die of heart disease.
There are only two ways for political leaders to combat this scourge — prevent people from developing diabetes in the first place, and ensure that all current patients get the treatments they need to manage the disease.
Politicians could enact dozens of small reforms — such as mandating less sugar in school lunches, requiring restaurants to publish calorie counts on their menus and boosting funding for public parks — that would help people stay fit. That would prevent many people from contracting diabetes, which often results from obesity.
To help people who already have diabetes, politicians could expand access to insulin. Currently, a quarter of diabetes patients ration insulin due to cost concerns. When patients skip these medications, their health can quickly spiral out of control.
Lawmakers have identified this problem. And at the state level, local legislators have responded with efforts to bring greater transparency to drug pricing more generally. State Sen. Yvanna Cancela, for instance, has introduced two bills to force drug companies to disclose drug manufacturing and research costs to help patients understand how they price certain medications.
On the federal level, many House lawmakers want to impose price controls on insulin and other medicines.
These legislators have good intentions. But blunt-force price caps ultimately deter research investments. They trade short-term savings — most of which would go to government programs, not directly to patients — for longer-term medical breakthroughs.
These lawmakers could help patients — without stifling research — by targeting the outsized profits earned by middlemen in the drug supply chain. Consider the role of pharmacy benefit managers, or PBMs. These corporations neither invent drugs nor administer them to patients. They manage drug benefit plans for insurers and help decide which medicines are covered.
PBMs use their gatekeeper status to negotiate massive rebates from drug firms. Often, PBMs secure discounts that reduce the price of insulin by 70% or more. But PBMs don’t disclose these discounts — so people with diabetes have to pay copays and coinsurance based on the public, undiscounted sticker price of insulin.
Consider a patient whose insurance plan requires him to pay 25% of his drug’s cost out-of-pocket. If a particular brand of insulin nominally costs $300, the PBM might have negotiated the true price down to $90 — a 70% discount.
However, the patient would still pay $75 out-of-pocket — 25% of the undiscounted $300 sticker price. This is outrageous.
Some pharmaceutical companies have tried to cut out these middlemen. This spring, drug giant Eli Lilly released a generic version of Humalog, its popular insulin, at half-cost to patients who’d prefer to pay out-of-pocket. This arrangement ensures that patients, not middlemen, collect the discounts.
Politicians could further slash patients’ out-of-pocket costs by requiring PBMs and health plans to share discounts at the pharmacy. If 100% of insulin rebates were shared at the point of sale, patients’ out-of-pocket costs would plummet 40%. That could save Nevadans with diabetes nearly $800 per patient, according to a study from my organization, the Partnership to Fight Chronic Disease.
When diabetes patients face lower out-of-pocket costs, they’re more likely to adhere to their treatment regimens and avoid unnecessary hospital visits, which would save our nation more than $8 billion per year.
Diabetes will continue to ravage Nevada — unless politicians take action to keep people healthy and make insulin more affordable.
Kenneth Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease.
