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Drug Pricing

T1DF works to improve the regulatory, legal and social ecosystem essential to developing new technologies and therapies. We commit to inclusive policies that will deliver for all Americans with diabetes, insured and uninsured, equal access to standard-of-care pharmaceuticals and equipment. We also work to educate the public on diabetes drug manufacturing and pricing (beyond “it’s complicated”).

T1DF filed three putative class action lawsuits in early 2017 on the overpricing of insulin, emergency glucagon rescue kits, and blood glucose test strips. T1DF's actions seek net pricing disclosure to document where the money goes when a patient pays list price (or cost-sharing based on list price) for the insulin and other supplies she needs to stay alive.

Boss, et al. v. CVS Health Corp. et al. (insulin)
United States District Court, District of New Jersey, No. 3:17-cv-01823-BRM-LHG
Consolidated under In re Insulin Pricing Litigation, No. 3:17-cv-00699-BRM-LHG, in December 2017. Against T1DF's directions, legal counsel removed PBM/insurer defendants and related claims, including T1DF's injunctive relief for net price disclosure. A motion for reconsideration was filed in March 2018 to initiate a parallel litigation track against insurers and their PBM agents (pending). 

Bewley, et al. v. CVS Health Corporation, et al. (glucagon)
United States District Court, Western District of Washington, No. 2:17-cv-00802-RAJ.
Transferred to United States District Court, District of New Jersey, No. 3:2017-cv-12031-BRM-LHG.

Prescott, et al. v. CVS Health Corporation, et al. (test strips)
United States District Court, Western District of Washington, No. 2:17-cv-00803-RAJ.
Transferred to United States District Court, District of New Jersey, No. 3:2017-cv-13066-BRM-LHG.

These lawsuits challenge the rebate-capture schemes that have driven up point-of-sale prices to insured and uninsured consumers. The lawsuits focus on schemes where PBMs play a central role, managing a confidential network of reimbursement contracts that channel back to their payer/insurer clients a growing percentage of rising list prices in the form of fees, discounts, rebates, sales incentives and other price concessions. These rebates and price concessions, paid by manufacturers to insurers, are not passed through to consumers. For some analog insulins, the offsets may be as high as 70% of list price, possibly higher, with PBMs passing 90%-100% of those cost offsets through to insurers and self-insured employer plans—many of whom continue to base patient payments on list price. Payers' rebate-capture schemes have hurt patients’ health and finances. They also fuel social stigma by leading the public to believe that unrebated list prices are the actual cost insurers and government programs pay.


Civil Rights

T1DF’s current civil rights focus is on U.S. K-12 school access and accommodation, including Section 504 compliance and equal access to emergency care. T1DF supports equal access to educational opportunities for students with type 1 diabetes. We support accommodation within all district educational programs and all school-sponsored activities, including extracurriculars, field trips and bus transportation.

T1DF opposes policies that ask school staff to perform diabetes-related tasks in a volunteer capacity rather than as a function of their employment. We oppose the concentration of students with T1D into medically fragile schools.

Washington State K-12 emergency glucagon access has been a priority for T1DF since 2015. We seek training and mandating of non-nursing staff to deliver glucagon in a life-threatening emergency based on existing epinephrine legal frameworks. Washington State nurses’ refusal to train and direct school staff in glucagon administration was most recently restated by the Nursing Care Quality Assurance Commission in their July 2014 advisory opinion NCOA 4.0 (“Legal exceptions exist for emergencies limited to delegating injectable epinephrine for students with known anaphylaxis and intranasal medications for seizures (RCW 18.79.240, RCW 28A.210.330)”).[1] In December 2015 T1DF requested that the Washington State Nursing Commission Consistent Standards of Practice committee review and revise advisory opinion NCOA 4.0.

T1DF has also investigated policies of Washington public school districts where students with type 1 diabetes are concentrated into a single designated school (often the only district school assigned a full-time nurse). A March 2014 report by the Washington State Healthcare Authority and OSPI, titled “Recommendations to Fund Integrated School Nursing Services,” acknowledged that some districts, “for economic reasons, place students with chronic health conditions in an assigned school where a school nurse is available every day,” and noted that “the school nurse’s case load in these dedicated schools may exceed the recommended staffing levels.”[2]

[1] http://www.doh.wa.gov/Portals/1/Documents/6000/NCAO4.pdf. Accessed September 4, 2017.

[2] https://app.leg.wa.gov/ReportsToTheLegislature/Home/GetPDF?fileName=3ESSB5034_RecommendationsToFundIntegratedSchoolNursingServices_f1f3de72-c5fd-4cc7-9358-14030ac2fb74.pdf. Accessed September 4, 2017.