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Legislature should pass diabetes cost caps

Douglas Anderson Douglas Anderson |

Jan 26, 2023

It’s time West Virginia’s legislative agenda focused on improving the health of all West Virginians.

What’s at stake? Unsustainable direct and indirect economic, emotional and quality-of-life affects individuals, employers and communities. Let’s start by improving the health of diabetic patients throughout West Virginia by passing House Bill 2430, which would reduce the copay cap on insulin and diabetic medical devices. The bill passed the House and Senate last year, yet failed to become law. It should be fast-tracked this year.

HB 2430 begins reversal of the effects of diabetes on affected people (and employers and communities) by creating reasonable out-of-pocket cost caps — insulin copay cap at $35 (now $100), supplies and equipment insurance copay cap at $100 and insulin pump copay cap at $250 for one pump every two years. New technology aside, test strips cost a typical patient over $3,200 a year.

Legislators and stakeholders must face the grim facts together. Patients, employers, health insurers and health care institutions face unsustainable health care costs. About 232,000 West Virginians, or 15% of the population, have been diagnosed with diabetes. An additional 45,000 West Virginians don’t know they have diabetes. Approximately 502,000, or 34.8% of the adult population, have prediabetes, with higher than normal blood sugar levels but not high enough to be diagnosed. Each year, 14,000 West Virginians are diagnosed with diabetes.

These facts reflect increased health risks and costs to individuals and increased burdens on families, employers and communities. Their medical expenses are 2.3 times higher than those without diabetes.

Uncontrolled diabetes results in consuming more resources, such as visits to emergency rooms. The direct costs related to diabetes include the condition itself, related complications, such as heart disease, stroke, blindness, kidney disease and lower-limb amputations.

West Virginia’s total direct annual medical costs are about $1.8 billion. Medical costs per patient are $9,595 for those with diabetes. Someone must pay the bill. Those costs are eventually passed onto employers and individuals with and without diabetes.

Employers and patients’ families are affected by the poor health of people with diabetes. The total indirect annual diabetes-attributable productivity losses — death, household productivity, inability to work, absenteeism — in the United States are estimated to be $640 billion. The estimated loss in West Virginia is $880 million.

Legislators must lead by example. West Virginia’s legislators can help residents struggling with diabetes with the affordability of prescription drugs, supplies and equipment with HB 2430.

The Legislature directed the development of the Diabetes Action Plan. It’s time to follow through.

The plan identifies three needs: education, programming and coverage. The top barrier to obtaining insulin medication was high out-of-pocket costs. The plan contains four long-term goals and five specific recommendations, including increasing insulin availability.

HB 2430 supports other legislative agendas on achieving economic prosperity. The efforts align with the Department of Health and Human Resources report on the reorganization and transformation of the DHHR.

Passage of HB 2430 demonstrates a step in the right direction in prioritizing the health and economic prosperity of all West Virginians. HB 2430 helps employers avoid the direct and indirect costs of diabetes in the workplace. HB 2430 gives West Virginians with diabetes a fighting chance to make the right choices to avoid expensive health complications and emergencies, and increase workplace productivity.

Do what’s right. Lead by example. Pass HB 2430 this week.

Douglas Anderson, of Martinsville, is a health care administrator. He chairs the Health Work Group, Eastern Panhandle Health and Human Services

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Legislature should pass diabetes cost caps
Legislature should pass diabetes cost caps