A couple years of ago the Centers for Disease Control released a report detailing that 30.3 million Americans — 9.4% of the population — have diabetes. If that number holds in Idaho, over 160,000 Idahoans have diabetes. And, the numbers are growing . . .
With such a large population impacted, policymakers are focused on reducing the rapidly growing cost of medications and expanding access to treatments that make a difference.
The Trump administration rolled out last year an IRS guideline that allows high deductible healthcare insurance plans to pay for insulin and blood testing strips before a deductible is met. The president pushes the idea of importing drugs like insulin from Canada.
Last year Colorado capped payments for insured patients at $100 a month for insulin. Washington, Connecticut and Kentucky are looking at similar measures. A bill has been introduced in the U.S. House and Senate to roll back insulin prices to 2006 levels.
Many drug manufacturers have made available discount programs that are very helpful for those who must pay cash for insulin or have insurance that covers their needed form of insulin.
Should Idaho do anything in this area? Before I share my thoughts, a bit of factual context.
First, diabetes is really two diseases. By far the most common is Type 2 diabetes in which the recipients generally produce insulin but have trouble utilizing it. Insulin allows sugars in the bloodstream to move into the cells. Weight is often a significant factor for those who suffer this version and it is more and more prevalent as people get older. But, as our population gets heavier and heavier many younger people are being diagnosed with Type 2 diabetes.
Type 1 diabetes is a different disease and is far less common (only about 4% of the diabetic population). Basically, the immune system targets the cells in the pancreas that produce insulin so that little, if any, is produced. Most commonly it hits before graduation from high school, often at a young age. I was diagnosed when I was a high school senior.
Diabetics who have blood sugars that are too high can suffer strokes and heart attacks, loss of eyesight, gangrene and loss of feeling in their hands and feet. It is the seventh leading killer in the United States.
Type 2 diabetics usually take medication and are pushed to exercise more and lose weight. Eventually, insulin may be required. Because they do produce insulin naturally, swings are somewhat moderated.
Type 1 diabetics must take insulin several times a day — or they will die rather quickly. Blood sugars often swing high after consuming carbohydrates and drops dangerously low as insulin kicks in.
The financial burdens can be significant. I personally require each month three bottles of insulin in two different varieties. The cost is just shy of $1,000 a month. In addition, I wear a continuous glucose monitor (a small device inserted in the skin with a Bluetooth transmitter that sends a reading of my blood sugar to my phone every five minutes). It is critical to managing the highs and lows and runs in excess of $400 a month.
I have health insurance, but my out-of-pocket amount is roughly $7,000 personally before any insurance coverage kicks in. I have not been able to get life insurance for years though my overall health picture is solid (great blood pressure, low cholesterol, etc.). I’m heavier than I should be but work out somewhat strenuously six days a week (I am now much thinner than my picture — with more to go).
The cost of insulin has been covered intensively in the media. Modern insulin (called “analog” insulin) is expensive, roughly $300 or so a bottle. The reason it is used is that it acts much faster to control blood sugars and is more predictable. Walmart sells older versions of insulin that run $25 a bottle but, if I took that, much of my day would be unproductive as the swings from high to low would be far higher and lower and much longer in extent.
What can Idaho policymakers do to assist Idahoans with diabetes?
One option is nothing. Just let any national initiatives or pharmaceutical programs play out.
Another approach would be to aggressive legislate insulin price caps like Colorado or impose regulatory restrictions on insurance carriers.
Personally, I would let the national/company initiatives play out and focus state efforts on prevention, particularly of Type 2 diabetes. We need a strong physical education focus in our public schools and in our state colleges and universities. The focus should be on getting people to embrace an active lifestyle. That would save many Idahoans from that version of the disease.