It is estimated over 240,000 West Virginian’s are diagnosed with living with type 1 or type 2 diabetes and another 65,000 are not diagnosed.
Every West Virginian with type 1 diabetes and many with type 2 diabetes rely on daily doses of insulin to survive. The annual medical cost related to diabetes in our State is estimated at $2.5 billion annually, and persons diagnosed with diabetes will incur medical costs approximately 2.3 times higher than persons without diabetes.
The cost of insulin has increased astronomically, especially the cost of insurance copayments, which can exceed $600 per month. Similar increases in the cost of diabetic equipment and supplies, and insurance premium has resulted in out-of-pocket costs for many West Virginia diabetes in excess of $1,000 per month.
National reports indicate as many as one in four type 1 diabetes underuse, or ration, insulin due to these increased costs. Rationing insulin has resulted in nerve damage, diabetic comas, amputation, kidney damage, and even death.
It is important to enact policies to reduce the costs for West Virginians with diabetes to obtain lifesaving and life-sustaining insulin.
Legislation proposed by selected members of the House of Delegates calls for any drug containing insulin and used to control blood glucose level to treat diabetes shall provide coverage for prescription insulin beginning July 1, 2020.
Cost sharing for a 30-day supply of a prescription insulin drug shall not exceed $25 for a 30-day supply of a prescription insulin drug, regardless of the quantity or type of prescription insulin drug used to fill the covered person’s prescription needs.
A drug manufacturer, drug wholesaler, or pharmacy benefit manager may not pass through the costs of the prescription insulin drug to the pharmacist or pharmacy. The Insurance Commissioner may use any of its enforcement powers to obtain an insurer’s or pharmaceutical benefit manager’s compliance with this section.
An insurer subject to the provisions of this proposed law shall provide coverage for the following equipment and supplies for the treatment and/or management of diabetes for both insulin dependent and noninsulin dependent persons with diabetes and those with questational diabetes: Blood glucose monitors, monitor supplies, insulin, inject aids, syringes, insulin infusion devices, pharmacological agents for controlling blood sugar and orthotics.
Insurers subject to these provisions shall include coverage for diabetes self-management education to ensure that persons with diabetes are educated as to the proper self-management and treatment of their diabetes, including information on proper diets.
Coverage for self-management education and education relating to diet shall be limited to:
(1) Visits medically necessary upon the diagnosis of diabetes;
(2) Visits under circumstances where a health care practitioners identifies or diagnoses a significant change in the patient’s symptoms or conditions that necessitates changes in a patient’s self-management; and
(3) Where a new medication or therapeutic process relating to the person’s treatment and/or management of diabetes has been identified as medically necessary by a health care practitioner; Provided, That coverage for reeduction or refresher shall be limited to $100 annually.
The education may be provided by a health care practitioner as part of an office visit for diabetes diagnosis or treatment, or by a licensed pharmacist for instructing and monitoring a patient regarding the proper use of covered equipment, supplies and medications, or by a certified diabetes educator, or registered dietitian.