In March 2020, Wisconsin signed the Diabetes Care and Prevention Action Program Act, Wis. Stat. § 255.085. The goal of this act is to assess the impact and reach of diabetes in Wisconsin. In response to this act, the Wisconsin Department of Health Services created the Wisconsin Diabetes Action Plan 2021: Report to the State Legislature, P-03154. This report also lists a range of actionable recommendations for consideration by the legislature. It is important to note that there are many things that private insurance companies, private employers and plan sponsors, and other partners can do to make these recommendations a reality. The goal of these recommendations is to reduce the number of new cases of diabetes, improve diabetes care, and manage issues with diabetes.
Recommendations to address diabetes
Below is an overview of the recommendations to address diabetes for consideration by the legislature. These recommendations focus on how changing systems, policies, and funding under legislative control can positively influence diabetes prevention and management.
Cost sharing refers to the patient's portion of costs (paid out of pocket) for health care services covered by their health insurance plan. Common types of cost sharing include copayment, deductibles, and coinsurance.
For people with diabetes, this includes the recurring costs of:
Cost of diabetes management medication is a large barrier for patients. The average list price of insulin tripled between 2002 and 2013 and doubled again from 2012 to 2016. According to a report by the CDC (Centers for Disease Control and Prevention), nearly a quarter of people with diabetes report asking their doctor for a cheaper medication, and one in 10 said they didn’t take insulin as prescribed because of cost. By clearly laying out costs and pricing for diabetes management medications, we can work to decrease the cost of these medications.
Source: American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-928. doi:10.2337/dci18-0007
There are a couple of ways to expand access to CGM:
- By expanding CGM coverage across private and public marketplaces, and
- By expanding ForwardHealth’s CGM device and accessory coverage by replacing the prior authorization requirement with revised qualifying criteria.
Expansion should include people under 25 years of age, members with type 2 diabetes, and anyone out of ideal blood glucose control ranges.
Under certain insurance systems, DSMES is only reimbursed by insurance providers if the program is delivered by an approved provider. Many times, nurses, pharmacists, certified care and education specialists (CDCES) are excluded from the list of approved reimbursable providers and therefore, services that these providers deliver to community members are not covered under Wisconsin health care insurance companies, including Medicaid. By allowing for reimbursement of DSMES when delivered by all professionals, access to education services can increase. This reimbursement structure also ensures the sustainability of the programs.
The expansion of telehealth in both rural and urban areas has increased overall access to health care. Including DSMES in the reimbursable services covered by telehealth in both rural and urban areas can increase the services' reach. As described above, including pharmacists, nurses, and CDCES as reimbursable providers by telehealth is important as well
Insulin is expensive, even for people with health insurance. Besides insulin, there are a wide range of medications that can help manage diabetes, but not all health care insurance companies will cover them. Policy change is needed to expand medications covered by health care insurance plans to ensure people can afford to treat their diabetes.
CHWs can reach a wide variety of communities and provide a number of health care services. CHWs work with community, local, and state agencies to build trusting relationships with community members for individual care coordination and community education and outreach. However, Wisconsin CHWs are not currently a reimbursable provider type and therefore, services that CHWs provide to community members are not covered under Wisconsin health care insurance companies, including Medicaid. In addition to including CHWs as a covered provider type, policy change is needed to recognize a CHW scope of practice and ensure professional development standards.
Under the Affordable Care Act all preventative services must be covered by health care insurance providers. By listing the National Diabetes Prevention Program and diabetes self-management education and support services as preventive services, these costs can be covered by insurance health care plans.
To gain community input on these recommendations, the Chronic Disease Prevention Program surveyed community members on the impact of diabetes. To learn more about the survey, visit the Wisconsin Diabetes Action Plan Survey.
If you have any questions, comments, or additional information to share, email the Chronic Disease Prevention Program.