How about solving the problem

How about solving the problem

When it comes to diabetes management it should be all about outcomes, getting the patient to manage their diabetes effectively. Given the most recent research on this subject we are beginning to understand that effective management, i.e. outcomes, are not the same for every patient. That in some cases a patient is better off with an HbA1c of greater than 7. That diabetes should not be managed as a one size fits all disease. This is the goal of all this new whiz bang way cool data driven cloud enabled devices, personalized diabetes management.

We mention this as there is virtually no hard data on whether the rising out of pocket of insulin is impacting outcomes. While everyone is busy villainizing the insulin companies, no one seems to be looking out for the people that matter most; patients with diabetes. While everyone is looking to place blame or point fingers the harsh reality is we don’t know the extent of the problem or even if there is a problem. Perhaps a better way to look at this issue is to define exactly what the problem is and isn’t.

Let’s say that the conspiracy theories are correct, that the insulin companies conspired to raise insulin prices. Let’s further assume that this factor alone led to the patient paying more out of pocket. What was the impact? Is the impact merely an economic impact or is it also an outcomes impact? Just as important under either option just how many patients are impacted? Are we looking at a minority of patients or is the rising out of pocket of insulin impacting millions of patients?

The most daunting and never asked question is; if we were to solve this problem tomorrow would anything change other than patients saving money? Would a lower out of pocket cost of insulin led to better patient outcomes? Without any hard evidence, any of those pesky facts, people just assume that this higher out of pocket for insulin is directly linked to poor patient outcomes. That the patients, however many there are, are choosing to forgo using insulin as prescribed due to the high out of pocket cost.

Listen we are all for patients saving money, nothing wrong with that. And if that’s the goal here we applaud everyone and anyone who is working towards this end. What we don’t applaud is the tactics being used to get here as pointing fingers and trying to villainize insulin companies accomplishes nothing.

Let’s say that after all the shouting, opinion pieces and investigations that the insulin companies are proven guilty of price collusion. Let’s say that after all the pressure these companies agree to pay a fine. A fine which by the way does not help patients in any way but does help the government pay its bills. Let’s further assume that as part of a settlement these companies agree to limit or halt any further price increases; what then? We ask again will this help patients in any way?

Take a patient who is one of the many that has a high deductible health insurance plan, would such a settlement lower this deductible? Or what about a patient who has no coverage will they benefit? Would such a settlement do anything towards improving patient outcomes?

We’ll say it again what exactly are we looking for here lower out of pocket costs or better patient outcomes? Correspondingly would lower out of pocket costs led to better outcomes? If the answer to the second question is no, then what’s all the fuss about. We are not trying to be cold hearted here but if the out of pocket cost did decrease and outcomes stayed the same what other than saving the patient a few bucks was accomplished. As we noted before we are all for saving patients saving money but we are more concerned about whether after saving this money outcomes improve. After all poor outcomes led to even higher out of pocket costs due to the many complications that occur from poorly controlled outcomes.

What’s happening here is that this lynch mob that is calling for this witch hunt want to exact their pound of flesh. They want their fifteen minutes of fame. They want to show off their credentials as patient advocates. Many of them are the same people who applauded competitive bidding for test strips only then to do an about face and say hey maybe this wasn’t such a good idea after all. These are the same people who ripped Medtronic (NYSE: MDT) a new one after the company made a deal with United HealthCare only to do another about face when the 670G was approved.

These people are now clamoring for lower insulin prices and at the same better insulin’s. Why would any insulin company spend millions in such a pursuit if they can’t make any money selling these new and better insulin’s? Yes, we know this just drives this group crazy but the insulin companies don’t answer to anyone but their stakeholders. Their goal isn’t to please Congress or patient advocates, their goal is to please their stakeholders. Stakeholders who invested in these companies to make money and who quite frankly don’t care how that happens.

The funny thing is none of these companies get any credit at all when they do try and help patients. Each insulin company has special programs for patients who are either under-insured or have no insurance at all. Programs that help these patients afford insulin.

Listening to the lynch mob they seem to think that the insulin companies are some sort of community trust or not-for-profit organizations who should give insulin away for free. As pie in the sky as this is the reality is this wouldn’t help patient outcomes either. We hate to be redundant but where is the evidence, where is the study data that proves a correlation between out of pocket costs and outcomes.

These are the same people who believed lower test strip costs would increase testing frequency, something that did not happen. These are the same people who believed that Medtronic’s deal would limit patient choice and reduce innovation, that didn’t happen either. Now they have set their sights on insulin companies and when this is all said and done they will be wrong here too.

What gets under our skin most is that these people who claim to be patient advocates haven’t a clue as to how things work in the real world. They are either too lazy or just don’t want to know the facts. They talk out of both sides of their mouths taking whichever side is the most convenient. Rarely if ever do they offer anything in the way of possible solutions but they sure as heck love to complain. They see insulin companies as the enemy and rather than engage in a constructive dialogue and work towards a solution, it’s off with their heads and let’s put these bastards in jail.

Momma Kliff a woman not known for shyness or being PC used to say; “IF you are really a patient advocate, IF you really want the out of pocket cost to decrease then work towards that end. Stop all the f-ing complaining, finger pointing and placement of blame. Solve the f-ing problem or shut the F up.”