A Slice of Life with Diabetes

WHO ARE THE PLAYERS IN DRUG PRICING?

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As a type 1 diabetic, (T1D), I find the maze of price and restrictive rules which are raising the price of insulin are insidious. Denise Roland and Peter Loftus wrote in a Wall Street Journal article dated October 7, 2016, entitled; “Insulin Prices Soar While Drugmakers Share Stays Flat”. If the manufacturer of insulin is not profiting from the price rise of insulin than who is?

Peter Loftus next wrote in a Wall Street article dated October 28, 2016, entitled; “Backlash against Drug Prices Hits Manufactures and Middlemen”.

DiabeteMine Team from Healthline wrote in a January 24, 2017 release, entitled; “Who Are Pharmacy Benefit Managers (PBMs) and How Do They Influence Drug Pricing”.

There is still one organization that is a player and their impact has yet to be discussed. What is the role of the Centers for Medicaid and Medicare, (CMS)?  The opening page of the CMS website is clear. CMS covers 100 million people.

The case can be made that there are additional procedural paths that need to be identified for further review of the recent ongoing rise in the price for insulin in the USA.

  1. Who is responsible for the preparation of an annual formulary list?
  2. Do all organizations comply with a singular annual formulary list?  If not does the ability to review and exam an organization’s formulary list prior to a sign-up period for new calendar year of health care coverage exist?
  3. There is a need to examine the progressive changed in the formulary lists for the last eight years. My suggestion is calendar years 2009 through 2017.
  4. When. Where, Why and How was the change in insulin initiated on a formulary list to only include one choice of short term insulin. In particular, Humalog, Novolog and Apidra. The appeal process for an insulin choice not on the formulary list is time consuming process as well as addition cost increases to the patient.
  5. When, where and how does the bidding process of the government, which could be another governmental organization, enter into this annual decision?

It is interesting to note that in simple terms insulin is a manufacturer product. What is the best timely inexpensive processes to deliver the manufactured product, insulin, to Type 1 diabees and other diabetic patients on an insulin program?

The management of glucose levels with insulin for diabetics entails far more than just access to insulin. It demands an ongoing monitoring of the multi-factors that impact a person living with diabetes. The change in the choice of an insulin product should be focused on the doctor-patient relationship and not defined by an ever changing bureaucratic formulary list.

 

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