Dr Robert Gabbay Reflects on Insulin Cost Caps for Some Medicare Beneficiaries

The announcement of a $35 per month out-of-pocket cap for insulin for some individuals with Medicare is a real victory for the American Diabetes Association and for people with diabetes, said Robert Gabbay, MD, PhD, chief medical and scientific officer of the American Diabetes Association.

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How will Medicare's $35 per month out-of-pocket cap for insulin affect pricing policy for other people who rely on insulin?

For individuals that have the appropriate Medicare plans, it will significantly reduce the cost of insulin, and we're very excited about that. That's a real victory for the ADA and most importantly for people with diabetes. What we hope is that commercial payers and others will follow suit and be able to adopt similar programs. Some have. Again, this has been a wonderful, private-public partnership fostered by ADA's advocacy to reach this point. We hope to be able to extend this to all people that require insulin.

You are well known for implementing the patient-centered medical home and the medical neighborhood. How will you bring this experience to others in your new role at ADA?

Within the science and medicine portion of the ADA, where we really engage the wide breadth of professionals focused on diabetes, the plan will be, and the hope, of course, most people with diabetes are cared for by primary care providers. To be able to reach out to that constituency group, and engage them in ways to be able to improve care, will really have an opportunity to have a dramatic impact. One of the ways that ADA has been doing that, and we'll be launching a larger program that you'll hear about in the coming weeks, is around reducing therapeutic inertia that will leverage the patient-centered medical home and the neighborhood to improve the outcomes once again for people with diabetes.