Welcome to the club

Welcome to the club

According to a company issued press release; “Express Scripts (ESRX) today announced the launch of its Diabetes Care Value Program℠, the industry’s most comprehensive approach to improve pharmacy care while controlling plan costs for people with diabetes.

The new program – part of the Express Scripts SafeGuardRx℠ suite of pharmacy solutions – combines a novel quality-based pharmacy network, a holistic approach to diabetes patient care and cost management, and financial guarantees that will significantly reduce participating plans’ anticipated increase in diabetes-drug spend for 2017. “

“We plan to increase medication adherence, broaden insulin options for patients, and bend down the cost curve of what is currently the costliest class of traditional prescription drugs,” said Dr. Stettin. “As we have done with our other SafeGuardRx solutions, Express Scripts will assume financial risk for drug spending in excess of the caps to protect our clients from skyrocketing costs and budget uncertainty.”

Like so many others Express Scripts is using a combination of tactics to educate and motivate patients with diabetes. Like so many others the company is trying to increase medication adherence while driving the down the cost of diabetes management. Express Scripts is also driving another nail in the Sanofi (NYSE: SNY) coffin noting;

“In conjunction with the announcement of the Diabetes Care Value Program, Express Scripts is also announcing that its 2017 National Preferred Formulary will include multiple preferred basal insulins. Pending market entry later this year for the country’s first follow-on insulin, Basaglar® (insulin glargine), Express Scripts plans to add Basaglar as a preferred product for the National Preferred Formulary, alongside the originator product Lantus® (insulin glargine).”

Now we don’t want to cast any aspersions on what Express Scripts is trying to accomplish and ultimately hope they are successful. At the end of the day it’s hard to argue with any attempt to help patients better manage their diabetes. However, this is a well-traveled road that has yet to yield much success.  A road which is getting increasingly crowded as it seems everyone is attempting to increase medication adherence and drive down costs.

As everyone should know by now Diabetic Investor is huge proponent of patient education. That we see patient education as the path to better overall outcomes. That educated patients are the most adherent with their prescribed therapy regimen. For at the end of the day is this not the true goal of all of these programs.

We’ve said it before and we’ll say it again ask any physician who treats patients with diabetes what’s the biggest obstacle standing between patients and better outcomes. The answer isn’t that we don’t have enough drugs to treat diabetes. Nor is the answer that the drugs we do have don’t work, they work just fine. The problem isn’t lack of glucose monitoring or that diabetes devices are too complex. For insulin using patients it’s not the “pain” of insulin injections. For non-insulin using patients it has nothing to do with how many pills they are being asked to take.

The answer is getting patients to follow their therapy regimen, to take the damn drugs as prescribed. Medication compliance or adherence or whatever the current politically correct term is, is the single biggest obstacle standing between patients and better outcomes. A problem we have known about since Diabetic Investor began publishing over 20 years ago. A problem still looking for a solution.

The solution de jure is interconnected diabetes management (IDM) which in reality isn’t really a new solution it’s just what we used to call disease management with advanced technology. The goal of IDM is the same as the goal of old disease management programs; get these patients to take their damn medications as prescribed. For insulin patients not to skip doses, for patients taking oral meds to take their pills.

The problem we see with many of the current IDM programs are the same we saw with old fashioned disease management programs; they fail to grasp how the majority of patients feel about their diabetes management. They fail to understand that for the majority of patient’s diabetes management is one big pain in the rear. That these people want to live their lives with their diabetes and not for their diabetes. That they want diabetes management to be part of their lives but not to run their lives. That diabetes is not like other disease and a patient who is completely out of control does not necessarily feel bad when their diabetes is out of control. We have long contended that if a patient experienced physical pain due to poorly controlled diabetes they would do a much better job of managing their diabetes. Unfortunately, by the time poorly controlled diabetes reaches that stage its too late.

Another major failure is these programs think a patient actually cares what their A1c is and even worse is willing to do all the heavy lifting required to achieve a good A1c. Again we’ve said it before but diabetes management is 24 hours a day 7 days a week 365 days a year JOB. A job which does not yield results which can be seen or felt by a patient. A job which yields little if any positive reinforcement.

Good diabetes management is not like a diet, a patient does not walk into a room and have someone come up to them and say “Hey you’re A1c is great”. Anyone who has lost weight knows that great feeling when someone walks up and says; “You look great.”

This is one reason we have strongly believe that every program needs use the carrot and stick approach. A combination of incentives and lots of positive reinforcement. The fact is incentives alone won’t work, they may get the patient initially engaged but given all the work necessary to achieve better outcomes without positive reinforcement many patients simply give up. Simply put the incentive alone isn’t enough to keep them motivated, even when that incentive helps them save money.

While we applaud what Express Scripts is attempting and truly hope they are successful we can’t help but wonder whether they actually understand what a patient with diabetes goes through each and every day. How the daily grind of diabetes impacts their lives, not just the physical impact but the psychological impact. This is perhaps the most misunderstood aspect of diabetes management how it plays on the mind of the patient.

Practicing good diabetes management even with all its benefits is just another reminder to the patient that they have a chronic condition that they really don’t want to have in the first place. It would nice if the people who designed these programs recognized this fact. That instead of telling them what they should be doing, congratulate them for what they are doing. As Momma Kliff used to say; “Positive reinforcement is the fuel that motivates, a fuel which reinforces all the hard work a person has put in to achieve something.”