diabetespac.org

This law allows pharmacists to dispense the appropriate amount of prescription medications to patients who are experiencing an emergency situation and unable to get a prescription from their healthcare practitioner. But every person with diabetes has different needs, and that preset amount won’t be enough for everyone. Now, pharmacists are allowed to dispense the appropriate amount of insulin (and some other life-sustaining prescription medications) that a patient needs to get through an emergency situation. This is a great win for our community, and one more way we can ensure people who rely on insulin stay safe!

As prescription drug prices become unattainable for many, patient assistance programs (PAPs) are becoming increasingly important. As advocates for patients with diabetes, we wanted to learn more about how patients were using these resources. According to the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS), “pharmaceutical manufacturers may sponsor patient assistance programs (PAPs) that provide financial assistance […] to low income individuals to augment any existing prescription drug coverage.”1 PAPs have varying qualifications and requirements for admission that differ based on the PAP administrators’ preferences, the type of drug or supply needed, and the patient’s income level or household size, but all PAPs have one ultimate goal: to provide patients with the medications they need. PAPs serve an incredibly important purpose in our healthcare environment, and improvement in their operation will mean improved outcomes for the patient community.

This amendment would remove safe harbor protection for rebates involving prescription pharmaceuticals and creation of new safe harbor protection for certain point-of-sale reductions in price on prescription pharmaceuticals and certain pharmacy benefit manager (PBM) service fees. Per the Health and Human Services department, the purpose of this proposed rule is to update the discount safe harbor to update the discount safe harbor to address the modern prescription drug distribution model and ensure safe harbor protections extend only to arrangements that present a low risk of harm to the Federal health care programs and beneficiaries. This switch may lead to higher health plan premiums (estimates range from a $4 to $10/month increase), but for millions of Americans who have diabetes, the increased cost is more than offset by savings patients will see in their cost-sharing burden. Health plans retain a majority of rebates collected during the deductible, coverage gap, and catastrophic phases of the Part D benefit, even though plans are only responsible for covering a small portion of drug costs during these phases.

Non-medical switching disrupts patient care, increases out-of-pocket costs, and often has negative consequences such as: new symptoms and side effects, increased frustration, and harmful medication reactions. For patients with diabetes, a change in medication can result in unmanageable fluctuations in insulin, increased out-of-pocket costs, and additional visits to their physician. For patients with chronic conditions, like diabetes, this means an abrupt change in their treatment plan can occur and disrupt their medical stability. Health plans can execute non-medical switching in a multitude of ways, including eliminating the drug from their formularies, or adding additional out-of-pocket costs to the patient via changing the drug’s coverage tier.