“Insurers in Minnesota Can No Longer Profit From Selling Insulin” — Minneapolis StarTribune, October 8, 2019

“Insurers in Minnesota Can No Longer Profit From Selling Insulin” — Minneapolis StarTribune, October 8, 2019

Reporter Joe Carlson finally states plainly in a major city paper—the Minneapolis StarTribune—what T1DF, both in and out of federal courts, has been saying for the past three years: health insurers profit from high insulin list prices and the large rebates they negotiate from manufacturers. It is now, writes Joe Carlson, “illegal in Minnesota for insurers to take in more cash from members’ out-of-pocket payments for insulin than the net price for that medicine.” While insurers are also using high list prices to inflate premium rates and other benefit designs, point-of-sale transparency is a necessary first step towards an auditable net cost accounting standard in health insurance plans at the state and federal levels. 

T1DF has brought insurers’ leading role (and monopsony power) in a price-fixing scheme that endangers U.S. patients to the attention of the U.S. Senate H.E.L.P. Committee and Senate Finance Committee (in December 2017), to legal counsel of the Senate Special Committee on Aging (in 2018), to HHS on Medicare Part D (in 2018), to the Oregon state legislature’s Joint Interim Task Force on Fair Pricing of Prescription Drugs (in 2018) and to federal courts in New Jersey (insulin, glucagon, test strips) and more recently in Kansas (EpiPens). 

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Federal District Court Judge Expected to Rule on Intra-class Conflict Between Health Insurers and Individual Patients in EpiPen MDL

Federal District Court Judge Expected to Rule on Intra-class Conflict Between Health Insurers and Individual Patients in EpiPen MDL

In the multi-district litigation (MDL) against EpiPen manufacturers now underway in the U.S. Court for the District of Kansas, Judge Daniel D. Crabtree now confronts two critical issues common to the EpiPen litigation, the insulin pricing litigation, and other drug pricing class actions currently pending in state and federal courts. The primary issue is a direct conflict between the two plaintiff groups that comprise the joint plaintiff class now proposed by Plaintiffs’ counsel in the EpiPen case: individual patients and third-party payers (including health insurers). Secondary to the issue of conflict are apparent ethical breaches by Plaintiffs’ attorneys who seek to represent individual patients on matters related to the pricing of rebated brand drugs while protecting the conflicting interests of former and current payer clients.

T1DF has been closely interested in the EpiPen litigation because a ruling on this issue of conflict could revive T1DF’s campaign to open a concurrent litigation track against insurers regarding heavily rebated insulin and other diabetes pharmaceuticals. In order to proceed with litigation, T1DF must terminate a tolling agreement signed between the insulin litigation plaintiffs’ counsel and third-party payers. Judge Crabtree has signaled that the question of intra-class conflict brought to the Court’s attention by T1DF in January and June letters may have some merit. T1DF’s policy director Charles Fournier was present at the EpiPen MDL class certification hearing held on June 12 (Phase 2) in Kansas City. At that hearing, Judge Crabtree publicly raised the multi-billion-dollar question: Are insurers and other third-party payers co-victims, with patients, of a rebate-driven scheme to inflate EpiPen prices? Or are payers instead co-conspirators in the wrongful conduct they allege against manufacturer Defendants?

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T1DF financial report for year ending June 2019 - 100% individually funded, huge increase in public support

T1DF financial report for year ending June 2019 - 100% individually funded, huge increase in public support

On August 15 T1DF released its draft financial report for the accounting year ending June 30, 2019. T1DF’s revenues for the accounting year beginning July 1, 2018, including donated services, amounted to $35,077. 

T1DF remains 100% funded by individual donors, with more than 200 new donors contributing in the past year. We accept no funding from manufacturers, PBMs, or insurance companies, which allows us to remain independent from industry influence. We are grateful to every person who has supported our work financially. 

Thanks to your generosity, in this past fiscal year T1DF met the IRS’s “public support” test for 501(c)(3)s, with 63% of cash revenues coming from the general public ($34 average donation). Additional revenues were provided in the form of services donated by T1DF’s officers and board members. 

Learn more about the programs your contribution supports.

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Supporting emergency insulin refill bill SB 9 in Oregon

Supporting emergency insulin refill bill SB 9 in Oregon

On April 16 Charles Fournier, policy director for the Type 1 Diabetes Defense Foundation, commented in the Oregon House Committee on Health Care public hearing on emergency insulin refill measure SB 9. Sponsored by Oregon State Senator Peter Courtney, SB 9 is a version of the “Kevin’s Law” bills pioneered by Ohio resident Dan Houdeshell after his son, who had type 1 diabetes, died when an expired prescription kept him from getting the insulin he needed.

Charles offered T1DF’s support for SB 9 and—together with other Oregonians who brought up cost as a persistent barrier to insulin access—he reminded Oregon legislators that “there are far more people in Oregon every year who don’t fill an insulin prescription because they can’t afford to do so than people who have the money to pay but don’t have a current prescription.” He outlined for Health Care Committee members how instant enrollment in the existing Oregon Prescription Drug Program discount card program and implementing OPDP’s mandate to give discount card members access to OPDP’s existing low net price for insulin could also, in Oregon, address the cost-driven insulin access crisis.

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2018 Wrap-Up – Kicking Off 2019!

2018 Wrap-Up – Kicking Off 2019!

2018 was a groundbreaking year for the Type 1 Diabetes Defense Foundation. As January draws to a close, we’d like to thank our community of supporters—and talk about all that you helped T1DF accomplish last year.

With another activist group newly captured by billionaire-funded Arnold Ventures (a donor-advised fund associated with a foundation and a PAC, interested in drug manufacturing and other healthcare corporate and commercial ventures), T1DF is now the only nonprofit voice in the U.S. insulin pricing conversation that has not been coopted by corporate interests. 

We hope you’ll read on to see what you have helped T1DF make possible—in federal court, in the news, in Washington, DC, and in the world.

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T1DF voluntarily dismisses Boss v. CVS Health, sounds alarm on agreement between PBM Defendants and plaintiffs’ counsel

T1DF voluntarily dismisses Boss v. CVS Health, sounds alarm on agreement between PBM Defendants and plaintiffs’ counsel

Yesterday in New Jersey federal court, the Type 1 Diabetes Defense Foundation and its president Julia Boss—collectively the “Foundation Plaintiffs”—filed a Notice of Voluntary Dismissal in Boss v. CVS Health (Civil Action No. 17-01823). Boss and T1DF also voluntarily dismissed their claims in the related cases Bewley v. CVS Health (Civil Action No. 17-12031) and Prescott v. CVS Health (Civil Action No. 17-13066). The Voluntary Dismissal counters a Tolling and Standstill Agreement (“Agreement”) entered into between fourteen law firms, including In re Insulin Pricing Litigation’s interim co-lead counsel and Keller Rohrback, the MSP Plaintiffs (payers) and PBM Defendants (agents and subsidiaries of payers)—here described collectively as the “Joint PBM-Payer Enterprise.”

The Agreement, executed by the Joint PBM-Payer Enterprise in January 2018 but not disclosed to plaintiffs Boss or T1DF until December 27, 2018, aims at preventing prosecution of any claim against PBM Defendants. (Boss and T1DF were not parties to the Agreement, and dispute the validity and enforceability of the Agreement.) The Agreement specifically references Boss v. CVS Health (Article 9) and, if enforceable, would also preclude current named plaintiffs and part of the putative classes in the Bewley (glucagon) and Prescott (test strip) cases from advancing claims against PBM Defendants (Article 2). Prosecuting Boss v. CVS at this time would have required directly challenging the capacity of co-lead counsel in the insulin litigation to enter into an agreement for the sole benefit of those attorneys’ current and/or former payer clients. Boss and T1DF were unable, for a period of over 12 months, to secure litigation counsel and local counsel willing to represent them in opposing this Joint PBM-Payer Enterprise. Throughout 2018, the Agreement effectively protected payers and their PBM agents from public outrage as state and federal actors began to investigate payer-controlled cost sharing and rebate pass-through.

The filing of a Notice of Voluntary Dismissal cuts the procedural Gordian knot.

UPDATE: Order from the Hon. Brian Martinotti entered January 7, dismissing Boss. v. CVS Health without prejudice in its entirety and also dismissing without prejudice the Foundation Plaintiffs’ claims in the related cases is available here.

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In the Interest of Justice: New Jersey District Court sides with T1DF, establishes concurrent PBM/payer litigation track

In the Interest of Justice: New Jersey District Court sides with T1DF, establishes concurrent PBM/payer litigation track

INSULIN LITIGATION UPDATE - November 6, 2018. At the case management conference for In re Insulin Pricing, Judge Brian Martinotti ruled “pursuant to the interest of justice” that T1DF’s putative insulin class action, Boss v. CVS Health Corporation (Case No. 3:17-cv-01823) will be unconsolidated from the putative class action against insulin manufacturers, In re Insulin Pricing Litigation (3:17-cv–00699). Patients’ claims against PBMs and insurers for rebate capture and misrepresentation of plan cost will no longer be stayed, and can go forward independently from the manufacturer-only action.

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MMA fighter Anna Hyvärinen joins the fight for T1D civil rights and affordable insulin

MMA fighter Anna Hyvärinen joins the fight for T1D civil rights and affordable insulin

We are very pleased to welcome MMA fighter Anna Hyvärinen as the first brand ambassador for the Type 1 Diabetes Defense Foundation. Anna will be wearing T1DF’s logo on her jiu jitsu Gi and MMA fight gear in competitions coming up this summer and beyond. 

The Type 1 Diabetes Defense Foundation is the only U.S. nonprofit dedicated to the rights of people with type 1 and insulin-dependent diabetes. T1DF and its president Julia Boss (individually) are currently plaintiffs in several drug pricing lawsuits we initiated in early 2017, including Boss v. CVS (insulin pricing), now consolidated into In re Insulin Pricing Litigation (Case 3:17-cv-00699-BRM-LHG).

As a small advocacy 501(c)(3) that’s spent the past year fighting hard in a David-and-Goliath struggle on insulin, glucagon, and test strip pricing—pitting us against some of the largest corporations and class action law firms in the United States—T1DF is especially proud to see our blue diabetes justice logo on the powerful forearms and shoulders of 5’4” flyweight/strawweight Anna Hyvärinen.

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T1DF asks Oregon Gov. Kate Brown to deliver "lowest possible cost" to OPDP discount card holders

T1DF asks Oregon Gov. Kate Brown to deliver "lowest possible cost" to OPDP discount card holders

In a June 7 letter, T1DF asked Oregon's Gov. Kate Brown to address the oversight failure that has allowed the Oregon Prescription Drug Program to overcharge under- and uninsured Oregonians instead of fulfilling its statutory mandate to offer "lowest possible cost" on prescription drugs to OPDP discount card holders. OPDP discount card holders pay unrebated prices at the pharmacy counter on deep-discount rebated brand drugs like analog insulins. When individuals buy these drugs at the pharmacy counter, payers and bulk purchasers like Moda-administered OPDP receive large manufacturer rebates, amounting to 75%+ of list price. What happens to manufacturer rebates earned when OPDP discount card holders are asked to pay OPDP's current prices, $270.71 for a 10 ml vial Novolog and $269.85 for Humalog? These are not "lowest possible" prices. Even for-profit commercial enterprises like BlinkHealth and GoodRx now charge far less than OPDP does in its discount card program—BlinkHealth's Humalog price is $178.90 per vial, GoodRx prices Humalog at $177.87 Are discount card holders' earned rebates being transferred to other OPDP programs, while under- and uninsured Oregonians pay 3 or 4 times OPDP's net cost for their analog insulin?

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Drug transparency bill ignores role of insurers

Drug transparency bill ignores role of insurers

The health care debates of 2017 taught us that any conversation about the supposed premium impact of a specific drug or medical condition can be turned into an argument that people with pre-existing conditions should be pushed into high-risk pools or pay condition-specific premiums.

Health care cost legislation should avoid triggering stigma or workplace discrimination against people with disabilities or chronic medical conditions.

Oregon’s House Bill 4005 does the opposite. It directs insurers to tell the public that certain conditions are causing increased “spending.” And it bases its reporting on a definition—“‘Price’ means the wholesale acquisition cost”—so patently misleading that it’s tempting to believe HB 4005’s central purpose is to insert it into Oregon law, to prevent people harmed by insurers’ dual pricing from recognizing or taking action on their injury.

Oregon’s leaders know that insurers are negotiating low rebated net prices for themselves, while forcing patients to pay much higher list prices. They know insurers are leaving rebates out of the equation when they calculate the premiums we pay. Our lawmakers should now be demanding transparency and public reporting on the harm caused by insurers’ drug-pricing practices and the impact of those practices on individual cost-sharing and premium valuation—not passing a blame-shifting bill that’s opaque where transparency would do the most good.

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