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Evidence-Based Diabetes Management September 2019
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For Young Adults With Type 1 Diabetes, Insulin Costs Can Mean Chasing Benefits, Not Dreams
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For Young Adults With Type 1 Diabetes, Insulin Costs Can Mean Chasing Benefits, Not Dreams

Jaime Rosenberg
Diabetes fully ripped my life and potential away. I always grew up thinking I would be a professional musician. I feel like I’m still mourning the loss of what my life would have been.”

--Sarah Tackett, age 26
When her internship ended in August 2010, Jackson moved in with her mom in Richmond Hill, Georgia. That October, she moved to Atlanta, Georgia, where she accepted a job without benefits with the hope that if she worked hard, she would be offered health coverage. Between October 2009 and May 2010, her pay increased from $800 to $1500 per month, her rent was $650 per month, and insulin cost $125 per bottle. After 9 months at the job, she was taken on full time and offered benefits.

During the year and a half that Jackson lived without insurance, she would ration her insulin. She also landed in the hospital 3 times, which added ED bills to her plate.

“Most people who knew me during the time would say I was just existing, that I was kind of a shell at that point,” said Jackson in an interview with EBDM. “I only survived because of all the people who understood what was happening,” she explained, reflecting on the time when her friends would pool their resources to try and help her, including her rent.

Fast forward to 2019, and the current mix of high prices, rebates, cost-sharing, and benefit design can mean that despite the ACA, today’s young adults with T1D face similar challenges.

Marotta told EBDM her days of seeking care when she needs it are coming to an end. “Now I have the freedom to go to urgent care whenever I think something is wrong and be proactive about it or go see my primary care,” she said. “When I’m uninsured, seeing a doctor is not an option, because it will be so expensive.”

References:
  1. Catch website. https://catch.co/. Accessed August 22, 2019.
  2. Hoskins M. Living “off label” with diabetes. Healthline website. healthline.com/diabetesmine/off-label-life-diabetes-cgm#1. Published June 14, 2018. Accessed August 20, 2019.
  3. Statistics about diabetes. American Diabetes Association website. diabetes.org/resources/statistics/statistics-about-diabetes. Accessed August 20, 2019.
  4. Hua X, Carvalho N, Tew M, Huan ES, Herman WH, Clarke P. Expenditures and prices of antihyperglycemic medications in the United States: 2002-2003. JAMA. 2016;315(13):1400-1402. doi: 10.1001/jama.2016.0126.
  5. Biniek J, Johnson W. Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices. Washington, DC: Health Care Cost Institute; 2019. healthcostinstitute.org/research/publications/entry/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices. Accessed August 20, 2019.
  6. Varney S. Watch: high cost of insulin sends Americans to Canada to stock up. Kaiser Health News website. khn.org/news/insulin-high-cost-americans-caravan-to-canada-for-cheaper-supply/. Published July 10, 2019. Accessed August 20, 2019.
  7. Inserro A. House subcommittee hears about impact of rising insulin prices. The American Journal of Managed Care® website. ajmc.com/newsroom/house-subcommittee-hears-about-impact-of-rising-insulin-prices. Published April 2, 2019. Accessed August 20, 2019.
  8. Caffrey M. Bipartisan Senate bill seeks to roll back a decade’s worth of insulin price hikes. The American Journal of Managed Care® website. ajmc.com/focus-of-the-week/bipartisan-senate-bill-seeks-to-roll-back-a-decades-worth-of-insulin-price-hikes. Published July 22, 2019. Accessed August 20, 2019.
  9. Olivo A. He lost his insurance and turned to a cheaper form of insulin. It was a fatal decision. The Washington Post. August 3, 201 washingtonpost.com/local/he-lost-his-insurance-and-turned-to-cheaper-form-of-insulin-it-was-a-fatal-decision/2019/08/02/106ee79a-b24d-11e9-8f6c-7828e68cb15f_story.html. Accessed August 20, 2019.
  10. Diabetes education online. Human insulin. University of California, San Francisco website. dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/types-of-insulin/human-insulin/. Accessed August 20, 2019.
  11. Grunberger G. Insulin analogs—are they worth it? Yes! Diabetes Care. 2014; 37(6): 1767-1770. doi: 10.2337/dc14-0031.
  12. Inserro A. Pre-existing conditions remain popular with voters ahead of midterms. The American Journal of Managed Care® website. ajmc.com/newsroom/preexisting-protections-remain-popular-with-voters-ahead-of-midterms. Published October 18, 2018. Accessed August 20, 2019.
  13. Kirzinger A, Sugarman E, Brodie M. Kaiser health tracking poll: November 2016. Kaiser Family Foundation website. kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-november-2016/. Published December 1, 2016. Accessed August 20, 2019.
  14. Bihari M. Dependent coverage for young adults: Affordable Care Act extends dependent coverage to age 26. Very Well Health. verywellhealth.com/dependent-coverage-for-young-adults-1738926. Published June 23, 2019. Accessed August 20, 2019.
  15. Cohen R, Martinez M, Zammitti E. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2018. Hyattsville, MD: National Center for Health Statistics; 2018. cdc.gov/nchs/data/nhis/earlyrelease/Insur201808.pdf. Accessed August 20, 2019.
  16. Wharam J, Zhang F, Eggleston E, Lu C, Soumerai B, Ross-Degan D. Effect of high-deductible insurance on high-acuity outcomes in diabetes: a natural experiment for translation in diabetes (NEXT-D) study. Diabetes Care. 2018;41(5): 940-948. doi: 10.2337/dc17-1183.
  17. Rosenberg J. New guidance allows HDHPs to expand preventive care benefits for chronic conditions. The American Journal of Managed Care® website. ajmc.com/focus-of-the-week/new-guidance-allows-hdhps-to-expand-preventive-care-benefits-for-chronic-conditions. Published July 18, 2019. Accessed August 20, 2019.
  18. Joszt L. DOJ reverses course, sides with judge striking down ACA. The American Journal of Managed Care® website. ajmc.com/focus-of-the-week/doj-reverses-course-sides-with-judge-striking-down-aca. Published March 26, 2019. Accessed August 20, 2019.
 
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