Tag Archives: Medicare

Take action Now (it’s soooo easy)

Courtesy of Diabetes Patient Advocacy Coalition, I wanted you to know about a proposed change to Medicare Part D coverage (that’s drug coverage) that could be a big win for older people in America. And you can help add your voice to the growing chorus in support of this change!

Today, there are a lot of middlemen in the insulin pricing process. Those middlemen spend a lot of time negotiating discounts from drugmakers for insulin, and then putting those discounted savings right into their own pockets.

Under this system, the middlemen negotiate the $300.00 retail price of a vial of insulin down to about $85.00. Then they keep the difference for themselves. Medicare recipients don’t see that discount at the pharmacy!

But… under a proposed rule, those middlemen would have to pass the discount on to Medicare recipients, significantly lowering their cost of staying alive. Who couldn’t be for a change like that?

So here’s what I’m asking you to do: Go to the DPAC website, check out the slick informational graphic at the top of the page, and then add your name to the DPAC Rebate Reform Petition in support of this proposal.

I promise you it will only take a minute. And you’ll be one of many who have added their name to the list in support of something that will help to make diabetes patients, and everyone living with a chronic condition, a lot more likely to be able to afford the drugs they need to live their best in their senior years.

CLICK HERE to add your name to DPAC’s Rebate Reform Petition

Your one minute of advocacy can change lives. As someone with parents on Medicare, and as someone who will be eligible for Medicare in about eight years… Thank You.

Advocacy Works.

I suppose we’ve all become jaded a bit over the years. When you ask for intelligent changes to policy or rules, you get used to having your concerns ignored, sometimes validated, and mostly not acted upon.

But a recent announcement flies in the face of that argument, and before any more time goes by, I think it’s important to talk about it.

The news, which you may have heard: the U.S. Centers of Medicare and Medicaid Services (CMS) has agreed to allow seniors on Medicare to view CGM data on their smartphones.

As Diabetes Patient Advocacy Coalition noted, this is pretty big news, and it’s thanks to advocacy of this organization and others, as well as individual advocates across the country, that this injustice has been righted.

There are a couple of reasons why I wanted to talk about this.

To begin with, this is how advocacy is supposed to work. In this instance, people saw that seniors on Medicare were being denied the right to use their smartphones as a medical device. Those advocates banded together and took their message to CMS, who were empowered to consider the advocacy message and act on it. And they did.

Second, I wanted to talk about this win because it’s a win. So often, we advocate for causes, and our causes remain causes for years until some movement happens on them (and that’s the most times I’ve written “causes” in one sentence in my life). Once our cause is helped along by a decision or a product launch or something else, we move on to the next cause so quickly that we almost forget the fact that real progress was actually made.

I don’t want that to happen here. Let’s stop and smell the lithium ion of our cell phone batteries and recognize that something pretty great happened here. And you and I had a hand in making it happen.

Let’s take a moment and remember that advocacy works. And let’s remember to thank all those responsible for making it work.

One for the patients, and interoperability.

There’s an announcement that went out a week or so ago from the USA’s Center for Medicare and Medicaid Services. Not much has been written about it. I thought the wording of the statement was interesting enough to spend a few minutes talking about it here.

Essentially, CMS has a regulatory requirement in place that states that providers have to maintain patient health records electronically. They’re using a phased approach toward getting everyone there, and that requirement hasn’t been met by many, mostly because of difficulty in implementing systems to handle this. As a result, they pushed back the date for provider compliance with this rule to January 1, 2018. That’s the bad news.

The good news? Well, patient health records for those on Medicaid (receiving federal or state healthcare assistance) and Medicare (federal healthcare program for U.S. residents 65 and older) will all be electronic by 2018. Also, there is a significant push by CMS to make the systems housing patient information available and accessible to patients. As in, no more wondering what is in your folder, but actually knowing what’s there.

According to the fact sheet distributed by CMS (click HERE for the full text):

”We want actionable electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange information.”

There’s incentive in this too. Eligible physicians, clinics, and hospitals who move to electronic health records receive incentive payments from the government for doing so ahead of schedule. They get their payments cut if they fail to comply by the CMS deadline.

But there were additional items that really struck me in this announcement, and I’m just going to quote them here one at a time.

”For example, the regulations will:
Shift the paradigm so health IT becomes a tool for care improvement, not an end in itself.”

CMS is focusing on using technology to improve patient outcomes, but not in a “set it and forget it” kind of way. They want health records to be useful in a patient’s care plan.

”Address health information blocking and interoperability between providers and with patients. Commenters recommended we emphasize measures that focus on interoperability instead of those that focus on data entry. We modified the measures so that more than 60 percent of measures rely upon exchange of health information, compared to 33 percent previously.”

Anyone who’s been to one doctor for one test, then another doctor who has wanted to perform the same test can tell you that being able to exchange data between providers (in a safe, secure manner, of course) will save a lot of time and money for providers, for patients, for insurance companies. Interoperability is also huge in a hospital setting, or when a patient may not be able to speak for themselves.

”We are Transitioning to a New and More Responsive Regulatory Framework”

Part of that is due to passage of the Medicare Access and CHIP Reauthorization Act of 2015, and part of that is due to the fact that, well, this is the 21st century, and we all need to use technology where it can help us. It’s a no-brainer, right?

Here’s something else to remember: If the federal government is moving toward a more patient outcome based, interoperable, responsive framework, it’s much more likely that individual providers of healthcare will do so too. Seeing how this all works out over the next five years or so will tell doctors, hospitals, and health systems what works and what doesn’t about operating with health IT as “a tool for care improvement, not an end in itself”. My hope is that they will improve upon that idea. They also have incentive in keeping us all alive longer.

So here we are… a little blip on the radar screen of our medical lives. But a significant blip, if the goals associated with these regulations actually come to pass. I’d be okay with that, and the sooner the better.

Interview: Kevin Sayer, Dexcom President and CEO.

I had a super conversation this week with Kevin Sayer, President and Chief Executive Officer of Dexcom, the most popular continuous glucose monitor on the planet.

This was intended to be a podcast interview, but due to technical issues on my part, we were not able to record our conversation. Too bad, because it really was a good one.

Since I’m not very good at writing down things word for word (one of the many reasons I started a podcast), I will instead give you a synopsis of the questions I asked (in bold), and the answers that were given. Just imagine us talking, and it will be almost like being there.
First, I asked Kevin about his twenty-plus years of experience in the medical technology and medical device field. What has that experience taught him about the importance of what he does, and how it affects patients living with diabetes?

He answered this by telling me about a Facebook post he read earlier in the day. It was from a parent of a child with diabetes, who was in the hospital. The child was wearing a Dexcom CGM, and had a glucose check performed by a nurse. The check came in in the 240 mg/dL range, and about an hour later, the nurse came back to perform a correction bolus based on that amount. Only the Dexcom the child was wearing had shown that his BGs were coming down, and were still trending that way. After some pleading, the parents were able to convince the nurse to check again before blousing. That check resulted in a reading in the 60s. In this instance, the Dexcom, and the parent’s trust in what they were reading, helped to avoid an emergency, and possibly saved a child’s life. Cases like that help underscore what Mr. Sayer, and Dexcom, are trying to accomplish.

Dexcom has been pretty innovative over the years. In the past year, we’ve seen the rollout of Dexcom Share, and FDA approval of the Dexcom G5. A little over a week ago, they received the CE mark of approval in Europe for the G5, so they’ll be rolling out that product to Europe in the coming weeks. Has Dexcom started shipping the G5 to users in the USA?

The answer is: Yes! Just this week, the G5 started going out to users here in the USA.

FYI: If you are currently on the G4 Platinum product, there are low cost, and in limited cases, no cost upgrades so people can more easily move to the latest and greatest Dexcom system. Go to the Dexcom website for more details.

In the news release on the G5 in Europe, I noticed language that states:

“…the new Dexcom G5 Mobile CGM system does not require confirmatory finger sticks when making treatment decisions.”

Now, we know that’s a no-no here in the USA, and the G5 has not been approved for that here. But I also know there are clinical trials ongoing to help determine the efficacy, I guess, of People With Diabetes dosing insulin based on CGM numbers rather than fingersticks. Other than being the CGM involved in the studies, is Dexcom involved in those trials in any other way?

This elicited a passionate response I wasn’t expecting. Kevin Sayer is firmly behind the idea of using a properly-functioning, properly-calibrated CGM to inform insulin dosing decisions, independent of fingerstick confirmation. Dexcom has mounds of data, from multiple studies, and they are planning to go to FDA at some point to get the, I believe the term was, adjunctive exemption that would allow Dexcom to promote their CGM (either the G5 or a future generation product) in the same way that they are promoting it in Europe. He believes that trending data gathered over hours, rather than a one-time BG meter reading, is a more accurate way to determine insulin dosing decisions.

I’m really blown away by the amount of collaboration that Dexcom has been involved in over the years, and I’m talking several years, at least back to 2007. Most recently, we’ve seen Dexcom become part of the Animas Vibe system, and part of the T:Slim G5 system. In an industry that gets a lot of criticism for not playing well with others, what’s the secret to Dexcom’s success in making these partnerships happen time after time?

Mr. Sayer gave kind of a two part answer to this. In the beginning, Dexcom was very small, and collaborating with a bigger partner was a way to grow the business and forge relationships. Today, it’s about Dexcom being the CGM of choice, and making sure that if a Person With Diabetes wants to use a Dexcom as part of their overall diabetes management, they should be able to do that. And forming relationships years ago helped Dexcom have those conversations with other companies when the time came to branch out.

I also asked: Does he see Dexcom as a leader in collaboration as well as technology? The answer is yes. It happened the way it happened over the years, but yes, Dexcom sees collaboration as essential and good for Dexcom.

Finally, I asked about CGM coverage for Medicare patients here in the USA… rather than talk about what passage of such legislation would mean to his company, I wanted to ask: How does it make you feel knowing that patients on Medicare, some of whom were your customers a year or two ago, are unable to use CGM technology at all, without paying 100 percent out of pocket for it?

This, he admitted, is the biggest thorn in his side right now. It’s the biggest complaint that Dexcom gets on a regular basis. He mentioned that his most reliable customers, in addition to children using the G4 and G5, are those in their 40s, 50s, and 60s, who might be less hypo aware, and rely on the safety of CGM technology to help keep them out of the hospital. And have been steady CGM users for a long time. To take all that away just because you reach a certain age doesn’t make sense. Dexcom is working alongside others to try to convince lawmakers to add a category to Medicare coverage, allowing seniors in my country to continue using CGMs. The patient data and the dollar data backs it up. Dexcom will continue to fight for CGM coverage for patients on Medicare.
You know, the thing about Dexcom is, you can’t even blink hardly without seeing another announcement about a new product, upgraded technology, regulatory approvals, and continued partnerships. It has to have been an exciting almost nine months as CEO for Kevin Sayer. From my standpoint, I’m looking forward to what the next nine months and beyond will bring from Dexcom.

8 Things I think I think.

With an affectionate nod to Peter King at Sports Illustrated, who in his Monday Morning Quarterback blog has a feature called Ten Things I think I think, I’m doing the same thing minus two. Hey man, I don’t do this for a living. If you want two more, you’re gonna have to pay me.
1. If all insulin pump warranties are for four years, and Medicare is a little over 12 years away for me (2027), do I want to get a new pump now— so I don’t have to get one until 2030, late in my third year on Medicare (2014, 2018, 2022, 2026, 2030); or do I wait until after my next birthday, which means I would have to go to a new pump on my first year on Medicare (2015, 2019, 2023, 2027)?
2. I’m wondering why, when I already have my brainpower sapped by managing my diabetes every day, I’ll have to decide from a complicated system of 4(+) Medicare options to make sure I’m covered for whatever comes up. Who designed this and thought this was a way to reward seniors for contributing to society for 65-plus years?
3. I’m worried that as a result, once I become Medicare eligible, I’ll probably just choose the first plan that covers my pump and ignore everything else.
4. I really don’t have to worry about all of this, because if the “experts” are correct, diabetes will be cured by then and I won’t even need a pump in five years (or less).
5. If only.
6. I’m pretty sure that first thing is the longest sentence, like, ev-er.
7. That fifth thing is the shortest.
8. Damn, that’s a lot of pumps.

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