We've all been griping for who knows how long about insurance companies messing with our coverage, limiting access to needed medications and supplies and prioritizing profit over patient health.

Their complex procedures force us to spend maddening amounts of time chasing after answers and pleading our cases on why these prescriptions are necessary.

It's no surprise that our doctors and educators are facing the same hurdles, and rest assured that #DiabetesAccessMatters to them almost as much it does to us on the patient side.

That's why our Diabetes Community is working on a new initiative to bring the patient and provider community voices together to call for change. A group of diabetes advocates is working with some leading healthcare professionals to craft a template letter that patients and HCPs can use together to approach insurers.

This effort echoes the broader #PrescriberPrevails movement happening across the U.S., calling for medical professionals' judgment to be trusted instead of second-guessed by insurance companies. There are even specific policies materializing in places like New York, where a state law's been adopted re: doctors determining the best treatments for Medicaid patients.

#PrescriberPrevails and Access for All

The diabetes-specific letter being developed is a work in progress, that will be launched more formally later in the year. A reminder of the backstory here:

In May 2016, Medtronic announced a deal with UnitedHealthcare making their insulin pumps the "preferred brand" for everyone covered by that insurance. While many noted that this wasn’t the first preferred arrangement and wouldn’t be the last, it lit a fire under our D-Community advocacy efforts to take a stand for patient and provider choice.

Advocates raised our voices, launching the hashtag #DiabetesAccessMatters, and within a few months the Diabetes Patient Advocacy Coalition (DPAC) brought a number of us together by phone for a strategy session, that led to the realization and theme:

Our patient community can’t really affect change without our medical professionals, and they feel the same way. We need to combine forces for impact!

Thanks to DPAC, we PWDs (people with diabetes) now have a one-stop shop (the DPAC Action Center) to send form letters to various insurance execs. But the doctors and educators don’t have a similar resource...

Clearly, they're already scrambling to see patients and provide the best care possible while juggling the myriad requirements of clinical and insurance paperwork, so when their recommendations are turned down by insurers, they often don't have the energy, time or resources to fight back. And we all know that the insurance companies are banking on that: the fact that loads of denials do not get appealed, because it's simply too much work for the patient and HCP alike.

One idea that our DPAC-led group of advocates has to combat this problem is crafting a form letter that can be downloaded by all and universally used by any doctor or educator to protest, so to speak. The hope is that patients will also bring it in to their medical professionals to sign and submit to the insurance company in question.

So far, the group of D-advocates and HCPs has crafted a first draft of a form letter that reads along these lines, with blanks to fill in with the relevant names of the doctor, patient, and insurance company involved:

To: Medical Director
Re: {Patient Name}
Date
Insurance ID number

Dear  ________________:

I am writing to express my concern with how {INSURANCE NETWORK} is limiting my patient’s access and choice to the {DIABETES TREATMENT}. I have recommended, after careful consideration with my patient. Overruling this patient-physician decision without knowing the many specific factors that led to it, could lead to inferior diabetes management and potentially endangers my patient's well-being...

As a responsible {HCP}, I understand and appreciate your efforts to contain healthcare costs. However, cost alone cannot be the guiding force in coverage decision-making. We must ensure that these decisions are based largely upon the benefit to a patient’s health over his/her entire life span, as determined by the patient and his/her physician.

It should be understood that when {HCPs} submit prescriptions, we have already determined that treatment is medically necessary. We have already discussed the various treatment options with our patient and have mutually determined the medical necessity of a particular course of treatment. This approach is consistent with the peer-reviewed 2016 American Diabetes Association Standards of Care. The document states: “Treatment decisions should be timely and based on evidence-based guidelines that are tailored to individual patient preferences, prognoses, and comorbidities.” (Diabetes Care 2016;39 (Suppl. 1):S6–S12 | DOI: 10.2337/dc16-S004).

The letter will end with a statement in this vein:

I would like to see your company take a reasonable “Prescriber Prevails” view when considering any coverage requests for diabetes medications, supplies, and equipment.  

Remember, this isn't just about insulin pumps or CGM, but rather everything -- from being limited to "preferred brands" of test strips, meters, to insulins themselves and oral medications. It involves everyone with diabetes no matter the type, and it goes beyond diabetes and applies to millions out there struggling to get the treatment that works best for their own conditions, as decided by the patient and their care team, who knows them best.

Already, we have vocal support and buy-in from multiple diabetes organizations and top doctors and educators, and we are working on getting this online ASAP with a mechanism to track how many times it’s shared. From there, we’ll prepare for a full media blitz.

 

Why Write Letters?

In the age of social media, why focus on a traditional letter-writing campaign? Frankly, the hope is to bombard insurance company execs with a stream of similar sentiments coming in from medical professionals around the country -- the very experts they claim to base their decisions on.

As noted, the broader #PrescriberPrevails campaign is pushing for legislation, whereas the D-Community isn't addressing that for now. Rather, these letters are about taking the first important step of getting HCPs to send a loud, coordinated message to insurers that they are not happy with being overridden -- that putting profits over patient health is simply WRONG. We hope to create an onslaught of dissenting correspondence, a la Harry Potter's Hogwart's letter that wouldn't go away.

We are also working to get this letter initiative visible at the big diabetes conferences this year -- the American Association of Clinical Educators (AACE) annual meeting in May, the American Diabetes Association (ADA) Scientific Sessions in June, and the American Association of Diabetes Educators (AADE) annual meeting in August. Hopefully, we can get this in front of thousands of doctors and educators so they can be part of the effort.

 

March for Health (!)

No doubt, everything related to healthcare policy these days is a bit overwhelming.

From Insulin Affordability to Access of all kinds, to the broken drug pricing system and overall healthcare reform, not to mention women’s rights and patient choice, impact of the new head of the Health and Human Services (HHS) that runs both the FDA and Medicare/Medicaid, the quality of our health based on environmental protections, and so much more…

March for HealthNow, our own Diabetes Community is spearheading a nationwide March for Health protest for Saturday, April 1, in Washington D.C. and other cities across the country. The goal of course is to make noise and bring attention to the issue of equitable and accessible healthcare, without any particular political slants.

Thanks to D-advocate Christel Marchand Aprigliano (who also happens to lead DPAC), for pushing to make this happen as a way to advocate for quality healthcare. You can learn more at @MarchforHealth and on their Facebook group with growing membership. You can also send an email directly to volunteer@marchforhealth.org.

With all of this going on, the #PrescriberPrevails campaign isn't moving as quickly as originally envisioned, but the work continues...

When the time comes for these efforts to more formally launch, we'll be the first to let you all know what’s happening and how you can get involved.

In the meantime, we encourage you all to take part in the March for Health near you, and keep advocating in your our own little corners of the world – encouraging your own doctors and care teams to push back on insurance companies that may be standing in the way of optimal treatment!

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.