Coverage2Control is the Breakthrough T1D effort to work with legislature, pharmaceutical companies and insurance companies to make coverage and treatments affordable for everyone, including fighting for coverage for pre-existing conditions. Breakthrough T1D Advocacy is a strong proponent and voice driving choice and coverage, particularly for devices, for all members of the T1D community – youth and adults.

Affordability

Making insulin more affordable requires action from drug companies, health plans, employers, and the federal government. Insurers and employers must provide affordable coverage that reflects insulin’s role as a life-saving drug. To do this they must:

• Remove insulin from the deductible so costs don’t fluctuate and are consistent throughout the year, as plans do for “preventive” drugs
• Provide insulin at low, fixed “co-payments” instead of “co-insurance”
• Eliminate rebates, which make up 70% percent of the list price of insulin. Breakthrough T1D supports the Administration’s anti-rebate rule change that would end rebates in federally-funded health programs and has urged Congress to end rebates in the commercial sector

In addition:

• Manufacturers must lower list prices and restrict increases to no more than the Consumer Price Index
• Companies should do more to provide free or low cost insulin to those who need it
• Public and private sectors need to do more to help the uninsured, and those in high-deductible plans, obtain the insulin they need to stay alive
• Resources to help with costs
• JDRF.org/insurance has information on programs that can help with costs
• Human insulin purchased at pharmacies without a prescription should be preserved as an option, but this is a band-aid, not a solution.

Choice

T1D is not a one-size-fits-all disease. You should choose the insulin therapy that is best for you – not your insurance company. United Healthcare is no longer covering all brands of insulin pumps. People withT1D & their doctors should decide which pump to use. Insurance restrictions like these are bad for people with T1D and bad for our healthcare system. Breakthrough T1D strongly opposes this new policy and is actively working to change this policy and the proliferation of more restrictions.

Coverage

We work to ensure coverage of all life-saving technology, including the artificial pancreas. All 25 of the nation’s largest health plans cover artificial pancreas systems, including Anthem, which reversed its policy after hearing from Breakthrough T1D and the T1D community. Breakthrough T1D and a coalition of patient, clinician groups defeated legislation in 2017 which would have abandoned these pre-existing conditions protections. While there is litigation currently in federal court that could jeopardize them, Breakthrough T1D is calling for Congress to re-establish protections if needed.

What you can do

If you haven’t already, please sign up to become a Breakthrough T1D Advocate
If you’re already an Advocate, please respond to all alerts
Share any connections with Congress, federal officials, health plans and large employers with our team. Who you know matters!

We hope you enjoyed this Mission Update Series!