Metabolic

Lowering insulin prices isn’t the (only) answer to helping patients with diabetes

Every 23 seconds, another American is diagnosed with diabetes. This skyrocketing incidence became even more apparent amid the Covid-19 pandemic, as those with diabetes experienced high rates of severe illness and mortality, in ways scientists still don’t fully understand. In 2021, diabetes-related deaths jumped by 15% compared to pre-pandemic levels.

The financial consequences are equally staggering. One estimate calculates the total economic effect of diabetes and prediabetes at $400B+ annually.

And yet, there is no coordinated strategy to address this growing crisis.

The current insulin pricing discussion is proof of our piecemeal approach. Those with type 1 diabetes (~5% of the total diabetes population) need it to survive, while many with type 2 rely on insulin to manage their blood sugar. Tragically, one in four Americans with diabetes report rationing this life-saving drug because they cannot afford it.

Politicians on both sides of the aisle are rightfully eager to make insulin more affordable. The House of Representatives passed bipartisan legislation that would cap out-of-pocket insulin costs at $35 per month and take other steps to ensure affordable access. Senators Shaheen and Collins have just introduced a bipartisan companion, and we hope that Congress will find an agreement to send to the President in the coming months.

That said, the system is critically ill, and making insulin more affordable is a bit like putting a band-aid over a bullet wound. Policymakers should simultaneously support diabetes reversal treatments that help patients normalize blood sugar levels while reducing or eliminating the need for insulin.

This might seem antithetical to standard metabolic disease care. Typically, diabetes is treated as a chronic, progressive illness that requires increasing levels of medications to stave off complications.

But the status quo is shifting. There are new, evidence-based treatments proven to reverse the progression of diabetes and prediabetes, empowering patients to achieve remission and ditch their insulin and other diabetes medications. Just last year, an international consensus report from medical and scientific experts defined diabetes remission criteria and acknowledged diabetes reversal—the process of restoring blood sugar to normal levels without medication—for the first time.

So, how can the American healthcare system support patients who wish to put their condition in remission? We recommend these steps:

  • Modernize quality indicators for patients with type 2 diabetes. Incentives to measure and recognize quality care for patients with diabetes should be updated to encourage normalization of blood sugar levels alongside appropriate deprescription of diabetes-related medications. We recognize that not everyone is ready to seek remission, but the system should reward clinicians and payers who support these efforts.
  • Use policy levers to emphasize both prevention AND more effective treatment. The Medicare Diabetes Prevention Program created a new opportunity to expand benefits under the Innovation Center. However, the effort should be broadened to include secondary prevention (eg, more effective treatment regimens) and other models, including virtual care, that provide evidence of comparable or better outcomes.
  • Improve drug price transparency. The opacity of the current system makes it nearly impossible to have true market-based competition. Improved price transparency at each step in the process between manufacturers and patients will shed sunlight on problems and help reveal potential solutions. This may require reducing barriers to entry for competitive insulin manufacturers.
  • Modernize nutrition policies and recommendations. One-size-fits-all models of nutrition are outdated. The growing epidemics of diabetes, obesity, and fatty liver disease offer proof we have yet to get it right. It is time for a comprehensive nutrition policy overhaul to address the root causes of metabolic disease. This includes the use of targeted evidence-based guidelines and a comprehensive re-evaluation of subsidies and incentives—some of which may have contributed to our current metabolic crises—that drive food policy and access.

Critically, improving population-level diabetes treatment and prevention offers an enormous opportunity to address the disproportionate burden of diabetes on underserved and minority populations. With health equity taking center stage, implementing a strategic plan to combat diabetes would create concrete measures for success.

In closing, capping patient insulin prices will not affect the unsustainable trajectory of the type 2 diabetes epidemic in America. Ironically, it may even result in a cost shift, where gross prices and premiums change to recover the lost revenue.

Until resources are dedicated to broadening access to treatments that help reverse diabetes, we will continue to fight a losing battle. It is time to shift the conversation, incentives, and policy solutions to help people improve their health and get off of medications—not just make them cheaper.

Photo: Maksim Luzgin, Getty Images

Related Articles