Now we’ll see

This morning CVS announced a plan to eliminate the out of pocket cost for branded diabetes medications. Per a company issued press release;

“CVS Health (NYSE: CVS) today announced a new solution eliminating member out-of-pocket costs associated with all diabetes prescription medications, including insulin.”

CVS noted that patients on average spend $467.24 per year out of pocket with 12% of their patient population spending over $1,000 per year. CVS is just the latest company to offer a program making diabetes medications more affordable. Lilly and Novo Nordisk have also launched programs to lower the cost of insulin.

While we applaud these efforts and we know we’re going to take a ton of flak for what we are about to say – now we’ll see if making drugs more affordable does anything in terms of improving patient outcomes. Each time a company launches one of these programs we get a statement like this that came from CVS;

“Eliminating out-of-pocket costs for diabetes medications ensures long-term affordability, improves adherence, and most importantly, puts patients on the path to better health,” said Troyen A. Brennen, MD, Chief Medical Officer, CVS Health. “A person living with diabetes is required to take many tasks to manage their condition annually. Unfortunately, that can include making difficult decisions about whether they can afford their medications and fill their prescriptions.”

Let’s be very clear here we are all for making diabetes drugs more affordable. However we have yet to see one study that proves the cost of diabetes drugs impacts patient outcomes. Everyone says that lower costs will improve adherence but there is no hard evidence to support this view. We hope it does but until there is some hard evidence we really don’t know.

Not to be snarky but look at the data CVS provided patients on average spend $467.24 per year which is just under $39 per month. Is $39 a month really that much of a burden? Is $39 month truly preventing these patients from being adherent with their therapy regimen? Even the 12% that are spending over $1,000 per year that’s about $85 per month.

Yes, there is a no question for a certain segment of the patient population cost is a major factor. If we’ve said it once we’ve said it a thousand times no patient should ever have to choose between getting their meds or paying their rent. However this is not the case for the majority of patients, the fact is most patients can afford $39 per month.

Now if we wanted to be truly snarky, we would say that CVS has run the numbers, they know they aren’t going to lose much in terms of revenue, could pick up new business for their PBM and get a ton of free favorable publicity as well. CVS is in a battle with Walgreens and diabetes patients are the most profitable. Patients with diabetes visit the pharmacy more often and generate higher per visit sales than patients without diabetes. Both companies are expanding beyond their traditional roles becoming patient coaches using their in-store clinics to support this move.

To us this isn’t about improving adherence this is all about what it’s always about MONEY. Who spends it, who saves it and who makes it. We sure as hell hope it improves patient outcomes, but something tells us that 10 years from now we will not look back at this moment as a turning point. That we will not say that because CVS eliminated $39 per month from the family budget there was an improvement in patient outcomes. No we suspect in 10 years we will unfortunately be in the same place we are today, the same place we have been with nearly two thirds of all patients not under good control.

One final point as long as we are on the subject of patient out of pocket cost. Let’s give credit where credit is due and this includes the West Coast Mafia who along with other patient advocates have pushed for making diabetes drugs more affordable, insulin in particular. Besides the programs offered by Lilly and Novo several states have recently enacted laws capping the out of pocket cost of insulin. Hopefully we will never again hear of a patient dying because they could not afford the drug that keeps them alive.

As much as we applaud their efforts, we still can’t help but wonder if anything will really change. We never considered the out of pocket cost of insulin a big issue and quite frankly many of the stories that went viral on social media played fast and very loose with the facts. What got lost in all this outrage was one huge pesky fact namely was cost preventing patients from achieving better outcomes. Our contention was and still is you could give away insulin for FREE, but this would not produce improvements where we think it matters most, patient outcomes.

Better patient outcomes eliminates a greater cost from the healthcare system. Better patient outcomes prevent many of the costly complications associated with poorly controlled diabetes. Better patient outcomes improves not just the life of the patient it saves the healthcare system billions. Yet there is not one sherd of hard evidence that shows a connection between the out of pocket cost of medications and better outcomes. That by lowering or eliminating these costs outcomes improve.

So here we are with cost being removed as a barrier. The question is other than saving families money will this move result in better outcomes? Time will tell but something other than 20 plus years covering this wacky world tells us nothing will change. As Momma Kliff used to say you can remove every barrier that stands between the person and success, yet success will never be achieved if that person doesn’t walk down that barrier free path.