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Innovation amp Inclusion Essential Tools to Improve Diabetes Care and Cost ManagementHRcomAugust 17 2021
INTRODUCTIONS
GEORGE HUNTLEYCEO Diabetes Leadership Council
AARON TURNER-PHIFERDirector Health Policy JDRF
2
OBJECTIVES
UNDERSTAND how diabetes impacts health plan risk and costs and disproportionate impact in communities of color
HEAR about innovative and individualized approaches to diabetes management and prevention
LEARN from employee benefit experts who aligned incentives for their employees insurance companies and pharmacy benefit managers
TAKE AWAY key health plan design features and concrete steps your organization can take
3
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO MANAGE DIABETES-RELATED RISK amp COSTS
QampA
4
THE STATE OF DIABETES CARE amp COVERAGE
1 IN 8 ADULTS
34 million Americans
HAVE DIABETES1
SPENDING
HEALTH DOLLARS2
TOP 4
LARGE EMPLOYERS3
Health plan cost driver
IN 2020
1IN 4
IN 2017
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf2 American Diabetes Association httpsdoiorg102337dci18-00073 Society for Human Resource Management Managing Health Care Costs toolkit 2020
5
DIABETES IS CHRONIC amp PROGRESSIVE
Kidney Failure
There is no cure but individualized diabetes management plans can helpPREVENT OR DELAYserious complications
Approximately 1 in 3 aged 40 years or older1
Diabetic Retinopathy
2 to 4 times more likely to die2
Heart Disease
44 of new cases1
60 of non-traumatic amputations1
Lower-limb amputation
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdata2014-report-estimates-of-diabetes-and-its-burden-in-the-united-statespdf2 American Heart Association httpwwwheartorgHEARTORGConditionsMoreDiabetesWhyDiabetesMattersCardiovascular-Disease-
Diabetes_UCM_313865_ArticlejspW1un89JKhPa
6
DIABETES amp COVID GLOBAL PANDEMICS
75
117
125
126
149
Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White
5-10 TYPE 1Autoimmune
Canrsquot produce insulin
90-95 TYPE 2AutoimmuneMetabolic
Insulin deficient or resistant
DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2
PERCENTAGE OF DIAGNOSED DIABETES
IN US ADULTS BY RACEETHNICITY
People with diabetes are at higher risk for severe complications from COVID-191
1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260
2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
7
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
INTRODUCTIONS
GEORGE HUNTLEYCEO Diabetes Leadership Council
AARON TURNER-PHIFERDirector Health Policy JDRF
2
OBJECTIVES
UNDERSTAND how diabetes impacts health plan risk and costs and disproportionate impact in communities of color
HEAR about innovative and individualized approaches to diabetes management and prevention
LEARN from employee benefit experts who aligned incentives for their employees insurance companies and pharmacy benefit managers
TAKE AWAY key health plan design features and concrete steps your organization can take
3
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO MANAGE DIABETES-RELATED RISK amp COSTS
QampA
4
THE STATE OF DIABETES CARE amp COVERAGE
1 IN 8 ADULTS
34 million Americans
HAVE DIABETES1
SPENDING
HEALTH DOLLARS2
TOP 4
LARGE EMPLOYERS3
Health plan cost driver
IN 2020
1IN 4
IN 2017
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf2 American Diabetes Association httpsdoiorg102337dci18-00073 Society for Human Resource Management Managing Health Care Costs toolkit 2020
5
DIABETES IS CHRONIC amp PROGRESSIVE
Kidney Failure
There is no cure but individualized diabetes management plans can helpPREVENT OR DELAYserious complications
Approximately 1 in 3 aged 40 years or older1
Diabetic Retinopathy
2 to 4 times more likely to die2
Heart Disease
44 of new cases1
60 of non-traumatic amputations1
Lower-limb amputation
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdata2014-report-estimates-of-diabetes-and-its-burden-in-the-united-statespdf2 American Heart Association httpwwwheartorgHEARTORGConditionsMoreDiabetesWhyDiabetesMattersCardiovascular-Disease-
Diabetes_UCM_313865_ArticlejspW1un89JKhPa
6
DIABETES amp COVID GLOBAL PANDEMICS
75
117
125
126
149
Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White
5-10 TYPE 1Autoimmune
Canrsquot produce insulin
90-95 TYPE 2AutoimmuneMetabolic
Insulin deficient or resistant
DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2
PERCENTAGE OF DIAGNOSED DIABETES
IN US ADULTS BY RACEETHNICITY
People with diabetes are at higher risk for severe complications from COVID-191
1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260
2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
7
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
OBJECTIVES
UNDERSTAND how diabetes impacts health plan risk and costs and disproportionate impact in communities of color
HEAR about innovative and individualized approaches to diabetes management and prevention
LEARN from employee benefit experts who aligned incentives for their employees insurance companies and pharmacy benefit managers
TAKE AWAY key health plan design features and concrete steps your organization can take
3
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO MANAGE DIABETES-RELATED RISK amp COSTS
QampA
4
THE STATE OF DIABETES CARE amp COVERAGE
1 IN 8 ADULTS
34 million Americans
HAVE DIABETES1
SPENDING
HEALTH DOLLARS2
TOP 4
LARGE EMPLOYERS3
Health plan cost driver
IN 2020
1IN 4
IN 2017
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf2 American Diabetes Association httpsdoiorg102337dci18-00073 Society for Human Resource Management Managing Health Care Costs toolkit 2020
5
DIABETES IS CHRONIC amp PROGRESSIVE
Kidney Failure
There is no cure but individualized diabetes management plans can helpPREVENT OR DELAYserious complications
Approximately 1 in 3 aged 40 years or older1
Diabetic Retinopathy
2 to 4 times more likely to die2
Heart Disease
44 of new cases1
60 of non-traumatic amputations1
Lower-limb amputation
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdata2014-report-estimates-of-diabetes-and-its-burden-in-the-united-statespdf2 American Heart Association httpwwwheartorgHEARTORGConditionsMoreDiabetesWhyDiabetesMattersCardiovascular-Disease-
Diabetes_UCM_313865_ArticlejspW1un89JKhPa
6
DIABETES amp COVID GLOBAL PANDEMICS
75
117
125
126
149
Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White
5-10 TYPE 1Autoimmune
Canrsquot produce insulin
90-95 TYPE 2AutoimmuneMetabolic
Insulin deficient or resistant
DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2
PERCENTAGE OF DIAGNOSED DIABETES
IN US ADULTS BY RACEETHNICITY
People with diabetes are at higher risk for severe complications from COVID-191
1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260
2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
7
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO MANAGE DIABETES-RELATED RISK amp COSTS
QampA
4
THE STATE OF DIABETES CARE amp COVERAGE
1 IN 8 ADULTS
34 million Americans
HAVE DIABETES1
SPENDING
HEALTH DOLLARS2
TOP 4
LARGE EMPLOYERS3
Health plan cost driver
IN 2020
1IN 4
IN 2017
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf2 American Diabetes Association httpsdoiorg102337dci18-00073 Society for Human Resource Management Managing Health Care Costs toolkit 2020
5
DIABETES IS CHRONIC amp PROGRESSIVE
Kidney Failure
There is no cure but individualized diabetes management plans can helpPREVENT OR DELAYserious complications
Approximately 1 in 3 aged 40 years or older1
Diabetic Retinopathy
2 to 4 times more likely to die2
Heart Disease
44 of new cases1
60 of non-traumatic amputations1
Lower-limb amputation
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdata2014-report-estimates-of-diabetes-and-its-burden-in-the-united-statespdf2 American Heart Association httpwwwheartorgHEARTORGConditionsMoreDiabetesWhyDiabetesMattersCardiovascular-Disease-
Diabetes_UCM_313865_ArticlejspW1un89JKhPa
6
DIABETES amp COVID GLOBAL PANDEMICS
75
117
125
126
149
Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White
5-10 TYPE 1Autoimmune
Canrsquot produce insulin
90-95 TYPE 2AutoimmuneMetabolic
Insulin deficient or resistant
DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2
PERCENTAGE OF DIAGNOSED DIABETES
IN US ADULTS BY RACEETHNICITY
People with diabetes are at higher risk for severe complications from COVID-191
1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260
2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
7
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
THE STATE OF DIABETES CARE amp COVERAGE
1 IN 8 ADULTS
34 million Americans
HAVE DIABETES1
SPENDING
HEALTH DOLLARS2
TOP 4
LARGE EMPLOYERS3
Health plan cost driver
IN 2020
1IN 4
IN 2017
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf2 American Diabetes Association httpsdoiorg102337dci18-00073 Society for Human Resource Management Managing Health Care Costs toolkit 2020
5
DIABETES IS CHRONIC amp PROGRESSIVE
Kidney Failure
There is no cure but individualized diabetes management plans can helpPREVENT OR DELAYserious complications
Approximately 1 in 3 aged 40 years or older1
Diabetic Retinopathy
2 to 4 times more likely to die2
Heart Disease
44 of new cases1
60 of non-traumatic amputations1
Lower-limb amputation
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdata2014-report-estimates-of-diabetes-and-its-burden-in-the-united-statespdf2 American Heart Association httpwwwheartorgHEARTORGConditionsMoreDiabetesWhyDiabetesMattersCardiovascular-Disease-
Diabetes_UCM_313865_ArticlejspW1un89JKhPa
6
DIABETES amp COVID GLOBAL PANDEMICS
75
117
125
126
149
Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White
5-10 TYPE 1Autoimmune
Canrsquot produce insulin
90-95 TYPE 2AutoimmuneMetabolic
Insulin deficient or resistant
DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2
PERCENTAGE OF DIAGNOSED DIABETES
IN US ADULTS BY RACEETHNICITY
People with diabetes are at higher risk for severe complications from COVID-191
1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260
2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
7
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
DIABETES IS CHRONIC amp PROGRESSIVE
Kidney Failure
There is no cure but individualized diabetes management plans can helpPREVENT OR DELAYserious complications
Approximately 1 in 3 aged 40 years or older1
Diabetic Retinopathy
2 to 4 times more likely to die2
Heart Disease
44 of new cases1
60 of non-traumatic amputations1
Lower-limb amputation
1 Centers for Disease Control and Prevention httpswwwcdcgovdiabetespdfsdata2014-report-estimates-of-diabetes-and-its-burden-in-the-united-statespdf2 American Heart Association httpwwwheartorgHEARTORGConditionsMoreDiabetesWhyDiabetesMattersCardiovascular-Disease-
Diabetes_UCM_313865_ArticlejspW1un89JKhPa
6
DIABETES amp COVID GLOBAL PANDEMICS
75
117
125
126
149
Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White
5-10 TYPE 1Autoimmune
Canrsquot produce insulin
90-95 TYPE 2AutoimmuneMetabolic
Insulin deficient or resistant
DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2
PERCENTAGE OF DIAGNOSED DIABETES
IN US ADULTS BY RACEETHNICITY
People with diabetes are at higher risk for severe complications from COVID-191
1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260
2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
7
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
DIABETES amp COVID GLOBAL PANDEMICS
75
117
125
126
149
Native AmericanAlaskan NativeAsian IndianHispanicNon-Hispanic BlackNon-Hispanic White
5-10 TYPE 1Autoimmune
Canrsquot produce insulin
90-95 TYPE 2AutoimmuneMetabolic
Insulin deficient or resistant
DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR2
PERCENTAGE OF DIAGNOSED DIABETES
IN US ADULTS BY RACEETHNICITY
People with diabetes are at higher risk for severe complications from COVID-191
1 Gregory JM Slaughter JC Duffus SH et al COVID-19 severity is tripled in the diabetes community a prospective analysis of the pandemicrsquos impact in type 1 and type 2 diabetes Diabetes Care 2021 Feb 44(2) 526-532 httpsdoiorg102337dc20-2260
2 Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
7
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
ROOM FOR IMPROVEMENT
Centers for Disease Control and Prevention National Diabetes Statistics Report 2020 httpswwwcdcgovdiabetespdfsdatastatisticsnational-diabetes-statistics-reportpdf
8
16 MILLION ER visits per year
78 MILLION inpatient hospital stays
per year
~50reached A1C goal
19met A1C blood
pressure cholesterol and non-smoking goals
89overweight or obese
CDC 2020 National Diabetes Statistics Report
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
THE STATE OF DIABETES CARE amp COVERAGE
JOHN E ANDERSON MDFrist Clinic Nashville TN
DLC Medical Advisor
DONNA B RYAN RN RD MPH CDE FAADE
Ascension Health Pensacola FLDLC Board Member
9
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
DIABETES IS NOTONE-SIZE-FITS ALL
24 7 365SELF-MANAGEMENT
++
42 FACTORS affect blood glucose
The 42 Factors graphic is used with permission from The diaTribe Foundation To learn more go to diaTribeorg42FactorsExplained
10
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
TECHNOLOGY IS PERSONAL
GLUCOSE MONITORING INSULIN ADMINISTRATION
11
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
90
96
82
8790
7880
88
73
79
83
7470
75
80
85
90
95
100
lt13 13-lt26 ge26
Mea
n H
bA1c
AGE
Injection only Pump only Injection + CGM Pump + CGM
IMPROVE GLYCEMIC MANAGEMENT
Foster NC Beck RW Miller KM et al State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018 Diabetes Technol Ther 201921(2)66-72 doi 101089dia20180384
Continuous glucose monitoring technology improves glycemic levels regardless of the insulin
delivery method
12
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
bull Net cost $424monthbull Net cost $53monthbull Net savings $53monthbull Net savings $424month
POLL QUESTION13
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
bull In a recent study of 571 people with type 2 diabetes what was the financial impact of using a Continuous Glucose Monitor
POLL QUESTION - ANSWER14
$424month net savingsCost reductions were driven
by reduced inpatient hospital costs
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
INFORMED DIABETES DECISIONS
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
16
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
INSULIN IN THE NEWS
NET prices
Competitionbull Brandsbull Biosimilarsbull Authorized generics
LIST prices
$85NET
$334LIST
1 IN 4Patients report
cost-related rationing
17
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
FOLLOW THE REBATES
$-
$50
$100
$150
$200
$250
$300
$350
$400
2012 2013 2014 2015 2016 2017 2018 2019 2020
LIST PRICE NET PRICE +141
-53
1 US Senate Finance Committee on Finance Insulin examining the factors driving the rising cost of a century old drug January 14 2021 httpswwwfinancesenategovimomediadocGrassley-Wyden20Insulin20Report20(FINAL201)pdf
2 Kakani P Chernew M Chandra A Rebates in the pharmaceutical industry evidence from medicines sold in retail pharmacies in the US March 2020 NBER Working Paper 26846 httpswwwnberorgpapersw26846
3 Sanofi 2021 Pricing Principles Report March 3 wwwsanofiusenpricing-principles-report Sanofi is a member of the DLC Industry Advisory Board 2021 https
People with diabetes are overcharged for lifesaving
insulin when exposed to list price instead of net or a flat copay
INSULIN REBATES CAN EXCEED 701 VS 48 FOR ALL BRANDS2
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
BENEFIT STRUCTURE DETERMINES ACCESSHIGH COST BURDEN FOR CHRONIC DISEASE MANAGEMENT
RAISES RISK TO EMPLOYEES AND PLANS$0 MONTH
First dollar preventive coverage consistent with IRS guidance on HDHP-
HSAs
Low predictable
copays
Net cost bull Coinsurance
based on netbull Full rebate
pass-through
Full ldquoretailrdquobull No preventive
coveragebull Coinsurance
based on list pricebull No rebate pass-
through
$25MONTH
$360MONTH
$1200MONTH
19
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
bull Does your organization offer at least 1 plan with full rebate pass through to plan members
bull Yesbull Nobull Not sure
POLL QUESTION20
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
MANAGE PBMs LIKE A VENDOR
Most
27Some
32
Very Little
18Dont Know
23
How much do large employers receivefrom PBM-negotiated rebates1
Many employers donrsquot know who benefits from rebates discounts and fees related to their plan
THIS LEADS TObullUncertain cash flowbullPoor understanding of cost controls
bullPerverse incentivesbullLower trust in the plan
1 The Kaiser Family Foundation Employer Health Benefits 2019 Annual Survey httpfileskfforgattachmentReport-Employer-Health-Benefits-Annual-Survey-2019
21
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
22
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
bull Does your organization offer at least 1 plan with first dollar coverage (pre-deductible) for chronic disease management
bull Yesbull Nobull Not sure
POLL QUESTION23
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
RATIONINGbull 34 of families with employer-provided insurance ration
medical care (compared to 33 of uninsured)1
bull 1 in 4 people with diabetes report cost-related insulin rationing2
COMPLICATIONSbull gt60 of diabetes-related medical expenditures treat
complications vs management3
bull 2x spending on prescriptions to treat diabetes complications vs management3
STIGMAbull Obesity treatment coverage is largely limited to bariatric surgery
versus less expensive and less invasive options4
bull 80-98 of dieters regain their lost weight5
PENNY WISE amp POUND FOOLISH PLAN DESIGN
1 Foster S Survey As coronavirus spreads nearly 1 in 3 Americans admit to not seeking medical care due to cost httpswwwbankratecomsurveyshealth-care-costs 2 Herkert D Vijayakumar P Luo J et al Cost-related insulin underuse among patients with diabetes JAMA Intern Med 2019179(1)112-114 doi101001jamainternmed20185008 3 American Diabetes Association Economic costs of diabetes in the US in 2017 Diabetes Care 201841(5)917-928 doi102337dci18-00074 Partnership to Advance Cardiovascular Health
httpsstatic1squarespacecomstatic56e6efdb5559866c54beb696t60ccb8b8838f3b6afccd1d4a1624029373909PACH_Obesity_WhitePaper_June2021pdf5 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 200582(suppl)222Sndash5S doi101093ajcn821222S
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
PLAN DESIGN TO MANAGE DIABETES RISK amp COSTS
KAREN BRUSTBusiness Administrators amp Consultants Columbus OH
Vice President
LORI SWEENEYInsperity
Senior HR Specialist
25
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
PRE-DEDUCTIBLE COVERAGEDiabetes management is preventive
LOW PREDICTABLE EMPLOYEE COST SHARINGSpread cost throughout the plan year
REBATE PASS THROUGHEliminate list price exposure and reverse insurance
TREATMENT CHOICESuited to patient needs and clinical complexity
KEY PLAN DESIGN FEATURES
1234
26
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
Continuity of care rather than annual
medication changes
Rapid adjudication for diabetes-related
claims
Diabetes care and education as needed rather than capped
Avoid copay accumulators and
maximizers for products with no
generic alternative
Eliminate or minimize spread on generics
Insurance literacy and plan selection
guidance for employees
BONUS FEATURES27
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
Examine your current plans
bull Does your organization offer at least 1 plan that offers 3+ key featuresbull Do you know where your rebate dollars go
Analyze data for diabetes direct
plan costs
bull Prescription drugs ndash how much $ what types metrics on persistenceadherencetimely refillsabandonment
bull Devices and supplies (glucose monitoring pumps etc)bull Hospitalization or other major claimsbull Maintenance services ndash office visits labs etc
Examine any available data on
indirect costs
bull Absenteeismbull Presenteeismbull Reduced productivity ndash eg prior authorization and appeal phone calls
obtaining supplies office visits vs telehealth
Model plan design options
bull Preventive coverage ndash for insulin for all prescriptions all productsservicesbull Zero copaybull Nominal flat copaybull Rebate pass throughbull Work arounds (eg timing employer HSA contributions case management)
TAKE AWAY STEPS28
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
AGENDA
THE STATE OF DIABETES CARE amp COVERAGE
MARKETPLACE DYNAMICS INFLUENCING DIABETES CARE amp COSTS
HR PERSPECTIVES PLAN DESIGNS TO REIN IN DIABETES COSTS
QampA
29
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
THANK YOUDownload this slide deck at HRcom
Download a summary of key plan design options atbull httpsdiabetesleadershiporgwhat-we-doemployerinitiative
Please share your thoughts with usbull Take our 2-minute survey at tinyurlcomDLC-Webcast-Survey
Questions bull Contact us at - employersdiabetesleadershiporg
