Category Archives: Healthcare

Underwhelmed.

It’s back in the news… insulin pricing.

Helped along by a few well-meaning tweets from Senator Bernie Sanders, and maybe a little by the Epipen debacle by Mylan, insulin makers are finally coming to patients and discussing cost in more detail. See the excellent reporting by Mike Hoskins at Diabetes Mine HERE and HERE. It’s good that they’re at least talking about the ever rising cost of this drug. I mean, it’s good, right?

Excuse me while I yawn.

There are countless reasons why insulin costs as much as it does in the United States. One thing is certain: no one wants to break down those reasons for you in any kind of concrete terms. In the case of “pharmacy benefit managers”, they won’t even come to the table to discuss it at all. And in the case of Novo Nordisk, Eli Lilly, and Sanofi, they’re going to talk, but they’re not going to help you understand how much of the cost of insulin goes to them and how much goes to everyone else in this game of legal graft.

This story has really been in the news for some time… I even wrote about it a year and a half ago, after NPR did a story on it. Yet we’ve continued to see the cost of insulin soar higher.

The amount of revenue generated through insulin pricing is in the tens of billions of dollars per year, most of it coming from here in the United States. It’s more than enough for everyone with skin in the game to be rewarded handsomely. Those are just the facts. Like it or not, insulin is a cash cow for drug makers and “pharmacy benefit managers”. Sure, it costs a lot to produce or acquire, but with Type 1 patients especially, they will always have a market for their product. It’s a drug of necessity, not a drug of convenience. I’m not sure there’s any motivation at all for producers or “pharmacy benefit managers” to take action on price.

I hope the discussions that are taking place between the drug manufacturers and patient advocates result in positive steps that will reduce the overwhelming cost of insulin for patients who need it to survive. But I have to be honest: I’m feeling underwhelmed.

Look, discussion is good. It means we’re not forgotten, or worse, ignored. Discussion often leads to things, positive things. I do worry that, as an HIV/AIDS advocate once told a gathering of diabetes advocates, they’re just “checking our box”. Check the box, move on. I don’t think the attendees at the meeting in Washington in November are the type of advocates who will stand for just having their box checked. I hope not.

But for now, I’m in a wait and see mode. Respond to calls for response on insulin pricing issues offered by advocates. Contact my congressman and senators, maybe my state’s insurance commissioner. Spend too much for insulin. Rinse. Repeat.

Underwhelmed.

Yes… I actually did see the eye doctor.

That’s the message I can finally give my endocrinologist when she asks me in January. I needed to find a new ophthalmologist since I had reservations about the doctor I had been seeing before. No major complaints, but I felt that he just wasn’t thorough enough in examining my eyes. And when you’re talking about the eyes of someone who has lived 25 years with Type 1 diabetes, thorough is what you want.

So I moved on. I found a new ophthalmologist, in my neighborhood which is a plus, and I went to see him last week.

Verdict? I’m not so excited about the ophthalmologist, though he’s not bad. He doesn’t know the first thing about diabetes beyond asking “how are your numbers?”. Despite that, I think we started on good footing. I felt he was listening to me. And I really like his assistant, who seems to know a lot and has some grasp of diabetes too. She’s one of those assistants who seems to do all the work, then turns it over to the doctor to gild the lily, whatever that means.
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At the end, I wound up with a new prescription, which I hope will help me see stuff on the computer better. And most importantly, after a thorough exam, there were no signs of retinopathy, glaucoma, or cataracts. I’m good for another year.

It’s a good feeling. A good feeling to get good news from the eye doctor, and a good feeling to know that I’m finally taking care of some of that regular maintenance I’ve been putting off for a while. More to come…

I’m not saying this is a brand new me. I am saying that knowing what’s going on with my health beats worrying about what’s going on with my health anytime.

Regular Maintenance.

Baltimore County has been busy on my street in the past week.

The county is in the process of replacing water mains in our area, and they’ve been at work for about a week on our block.

Naturally, this made me think about my diabetes (because, why not?).

Occasionally, we need to step back from the everyday grind and consider what about our diabetes needs an upgrade. Or a change. Or a budget adjustment. I’ve got to admit… it’s time for me to do some diabetes maintenance.
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I’ve been putting off doctor visits. Not because I hate going to doctors, but because I’ve been busy, and the daily grind of my life these days has made it easy to forget about scheduling an appointment once I get to work or to the gym or out in the yard. Funny how, even at my age, I can still let everything else be an excuse for not getting to the things that I know I need to do for me.

I missed the last appointment with my endocrinologist because I was traveling. I haven’t been to an ophthalmologist in about a year and a half. Finding a good one locally is really tough. And I can’t tell you how long it’s been since I’ve seen a podiatrist. Same reason. To make matters worse, I need to get in to see a gastroenterologist because… well, you know. I’ve been putting that off for a few years.

I also have to consider replacing my wonderful Accu-Chek Nano meter that I’ve been using for something near four years. But I like it so much, and I have four of them, and I just don’t want to get another one. But what am I missing by not finding a newer model?

Last Friday, the county workers must have done some real damage underground, because at the stroke of midnight, I heard pounding outside. It was Baltimore Gas and Electric performing emergency repairs on the natural gas line that runs right where the county was digging. They were working all night and all day Saturday.

I don’t want to get to where my casual attitude toward regular maintenance of my health results in missing something important that I need to address. Besides, the appointments I need to make are piling up.

This isn’t about burnout or anything like that. I’ve just let things go for far too long. It’s time for me to ignore ignoring my well-being and focus on getting the regular maintenance of my health addressed.
 

Choice Is Necessary.

United Healthcare has decided that, as of July 1, adult patients with diabetes on certain UHC insurance plans who want insulin pump therapy should only be allowed to choose a Medtronic insulin pump. Hat tip to DiabetesMine for breaking the news.

There’s a lot more to it than just that one sentence, and obviously, people have a lot of questions.

Let me first say this: people who work for medical device makers and insurance companies are actual people, and they have families and concerns of their own, so I don’t think it’s fair to equate companies and their practices with the people who work hard for them every day.

That said, it’s really hard to find anything good in this discovery. Let’s be honest, okay? There is nothing good in this discovery. It is only benefitting those implementing the rule, and only harming those affected by the rule.

There was some explanation from United Healthcare about why they’re going down this road, and it’s a ridiculously weak argument. You can come to your own conclusions about it after you read what they have to say about it. But my take is that they’re not even trying to give a good explanation for this. Medtronic, for their part, has remained silent.

Did UHC get something for making Medtronic an exclusive provider? Or are they just being lazy, deciding they don’t want to keep up on all of the insulin pump manufacturers out there? Is Medtronic out there trying to cut similar deals with other insurance companies? Does this put pressure on other device makers to try and secure their own piece of the pie? Most of all: What if an actual artificial pancreas solution is approved by the U.S. Food and Drug Administration, and it’s not a Medtronic solution? Does that leave UHC patients out in the cold?

I’m not even going to try to answer those questions. They’re not important. They just don’t matter.

Because any way you slice it, this is bad news for People With Diabetes.

United Health Group, parent company of United Healthcare, has this as their mission statement:
 
 
“We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities.”

“We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price.”

“We support the physician/patient relationship and empower people with the information, guidance, and tools they need to make personal health choices and decisions.”
 
 
It appears that the latest about this exclusivity arrangement shows UHC’s mission statement to be rather disingenuous. In fact, it looks like they just took a giant shit all over it and its claims to “expand access to quality health care so people get the care they need at an affordable price”.

Reducing Eliminating choice for patients is wrong, it reduces innovation, and in no way does it “improve the overall health and well-being” of People With Diabetes, or even save them money.

I’m going to start saying something, and I’m going to repeat it any time someone asks me why something like this is a big deal.

Choice isn’t just important… choice is necessary.

Companies love to talk about how competition is good for the marketplace, good for consumers. Apparently, it’s not good enough for United Healthcare, because they just turned a fire hose on the idea of competition. You know, there are studies that show People With Diabetes do better when they have more information, more tools, and yes, better tools to help them manage their condition. I can’t find a single shred of evidence anywhere that says removing choices for patients with a chronic condition helps them live better lives.

You are wrong, United Healthcare. You’ve made a decision that only benefits you, and does not ensure even one better outcome for any of your patients. You are wrong, and I will keep telling your rotten story to as many people as I can. Including my elected officials, and news agencies.

For my part, I wish I would have had access to this information when I visited Medtronic a couple of weeks ago. The upper echelons of Medtronic Diabetes management was there that day, and someone must have known that this decision was imminent. But they didn’t share it with any of the advocates in the room. I would have liked to have asked questions and share my view directly with Medtronic brass that day.

Just as there are actual people working for these two organizations, there are actual People With Diabetes insured by UHC. And those people deserve and are entitled to choices when it comes to how they manage their diabetes. Patient trumps proprietary. And it always will.
 

PPACA Survives intact.

Healthcare advocates throughout my country were thrilled yesterday when the U.S. Supreme Court upheld the part of the Patient Protection and Affordable Care Act (“Obamacare”) that allowed for subsidies to help patients pay for healthcare insurance obtained through insurance exchanges nationwide.

Had the justices overturned that part of the legislation, something akin to chaos in the insurance marketplace could have ensued, owing to the fact that many who can barely afford coverage with the subsidy probably would have dropped their coverage and risked prosecution for not being covered at all. It might have meant that many who are relatively healthy but still couldn’t afford the coverage without a subsidy would drop their coverage, which would have put insurers in a tough spot, with too many chronic and acute issues to pay for, and not enough money coming in from healthy patients to make up the difference.

The vote of the nine-justice panel was 6 to 3. Chief Justice John Roberts wrote the majority opinion, once again surprising many who thought he was the perfect neo-conservative to lead the highest court in the land when President Bush appointed him to the post a decade ago. His remarks included this little nugget:

”Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”
 
 
Imagine that… he goes against nearly every republican in America, using one of their biggest rallying cries to do it: Free Market Capitalism!

The dissenting opinion, given from the bench by Justice Antonin Scalia, smacked of sour grapes, though I guess every dissenting opinion does to some degree. At one point, he got laughter from the courtroom for saying “We really should start calling this law SCOTUS-care”. He also referred to the majority opinion as “interpretive jiggery-pokery”.

Well, I’m just a high school graduate, so I never learned from books that contained such eloquent terms as “jiggery-pokery”, but I really hope that Justice Scalia, or Justice Alito, or Justice Thomas, who also sided with the minority, never have to experience moments where they have to choose between paying for healthcare for themselves or a loved one, and paying the rent. Republican members of the U.S. Congress, for their part, are still vowing to repeal this important legislation. They’ve already tried repealing all or parts of it 67 times.

I will also point out that a day later, our fair republic still stands, and still stands for the right to healthcare for everyone.

If we’re not for that, what are we saying? Really… if you’re against my right to affordable healthcare, are you saying that, although my diagnosis of Type 1 Diabetes is not my fault, I don’t deserve to be able to afford to pay for care, drugs, and devices? Are you saying I should “work harder”, “get another job”, “do whatever it takes”, or adhere to some other catchphrase out of the conservative handbook?

Well, let me quote from another one of your favorite books, the holy bible.
Matthew, chapter 25, verses 44 through 46:

“Then they themselves also will answer, ‘Lord, when did we see You hungry, or thirsty, or a stranger, or naked, or sick, or in prison, and did not take care of You?’ “Then He will answer them, ‘Truly I say to you, to the extent that you did not do it to one of the least of these, you did not do it to Me.’
These will go away into eternal punishment, but the righteous into eternal life.”

 
 
Again, I am thrilled at the result of yesterday’s ruling. I do recognize that the law isn’t perfect, but had the challenge to the law been upheld, it would have been even less so.

Now, as I mentioned on Facebook yesterday, we can… continue to defend this law against all manner of attacks. Hopefully, yesterday’s decision makes defending it easier.

In other news: The Supreme Court just handed down another ruling, legalizing gay marriage nationwide. It’s been a busy week, Justices. Take the rest of the summer off.
 
 
 

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