Thread by @carobanano

Thread in response to @LillyPad, for anyone who cares about-
#diabetes
#InsulinPrices
#pharma
#healthcare
#poverty
#health
#drugprices
ETC:

I've been a case manager/patient advocate at a safety net clinic & hospital for many years, working with pt assistance program recipients.

The launch by @LillyPad & @blinkhealth is good, but still problematic- b/c I've seen how Lilly and others place undue burden on patients.

Many don't know that with outrageous price hikes, Lilly's been gutting access through their PAP (patient assistance program) for years.

Enrolling in their PAP Lilly Cares used to be a snap. 2 page application. Patient info, Rx details, doctor signature, proof of income, done.

Proof could be a clinic letter if you were paid in cash. That was key to non-citizen patients. Lilly did not need a Social Security number.

You had to be a US resident, but in the physical sense only. If you were homeless, that could be vouched for by your clinic, like income.

Enrollees aren't moochers. They needed #insulin to live and stay out of the hospital. In the past few years, things have changed.

Post-Obamacare, Lilly required proof that a pt was not eligible for Medicaid or marketplace plan- often via letter from Medicaid office.

Then they restricted their voucher service. Used to provide online a voucher for 1 month supply to cover pt while application was processed.

Annual voucher was slashed to 1 LIFETIME voucher per pt. One vial only Lilly also required eligibility verification from doctor AND pharmacy

They cut their customer service access. Call center reps for enrollment ?s were laid off. Now Lilly Cares communicates mainly by...fax.

Phone wait times are regularly >20 minutes- think a clinic or pharmacist has that time to get a patient a voucher or help them apply?

In 2015, they started requiring tax info + the insurance denial paperwork. No more Form 4506-T (proof of non filing) or zero income letters.

This year, they restricted the program to 16 drugs and started rejecting any applicant who isn't a legal permanent resident.

The Lilly Cares application that was once 2 pages is now 8, plus the additional documents (insurance denial and last year's taxes.)

And outside of Lilly Cares- Community Healthcorps, a division of @AmeriCorps that sometimes helped patients enroll in PAPs, was eliminated.

Some called CHC wasteful; was notably shut down after a few mbrs provided emotional support to women after abortion buzzfeed.com/danvergano/bye…

Anyways, Lilly Cares had room to adapt w/ Obamacare. That's good! Number of uninsured plunged after the law passed. kff.org/uninsured/fact…

But Obamacare doesn't FULLY explain the 30% decline in Lilly patient assistance enrollment from 2010-15 (~67,000 fewer patients).

In the same period, Humalog went from $100 per vial to $255. I saw prices QUADRUPLE at local pharmacy from 2009-16. businessinsider.com/rising-insulin…

And under John Lechleiter, the Lilly CEO from 2008-16, company share prices increased by 58%. Source: bloomberg.com/news/articles/…

Now @LillyDiabetes has a discount plan with @blinkhealth. Any price reduction is better than nothing. But did you know...

...That it only benefits 10% of Lilly's patients? That the money paid doesn't count towards an insurance deductible? bloomberg.com/gadfly/article…

Or that the max discount (40%) only takes us back to 2013 prices? That patients need a smartphone/internet & credit/debit card to enroll?

Reminder: people w/out smartphone or regular internet are poorer- the ones who need a discount in the first place. (See Pew graphic 4 data)

And it's hard for some patients to pay with debit or credit card. Lots of patients pay cash or use money orders at a pharmacy.

Whatever your views on illegal immigration, the fact is: undocumented are a reality, and with no insurance available, they go to the ER.

Uninsured are 55% more likely to go to the ER than insured pts, contributing to >$245 billion cost of diabetes. diabetes.org/advocacy/news-…

CDC: Pts who don't take meds as Rx'ed have poorer health status, more ER use/hospitalizations/cardiovascular events cdc.gov/nchs/data/data…

Another reminder: anyone can sign up for emergency Medicaid for urgent hospitalization or surgery-- including undocumented immigrants.

SO... what can #diabetes & #healthequity advocates do as pharma profits while patients, taxpayers, and hospitals shoulder the burden?

I'll wrap up this (long, I know) thread with some recommendations. (Come on- you know ppl often read tweets/headlines but not articles...)

Let's push @blinkhealth to improve access to their service. Phone/mail order, accept money orders, effective outreach to doctors & clinics.

Don't say @LillyPad is ~sooo helpful~ & let them off the hook. After all, PAPs often used to justify price increases latimes.com/business/hiltz…

If GOP succeeds in repealing Obamacare & 30 million lose insurance as predicted, Lilly and other PAPs MUST loosen enrollment requirements.

So you can watch the news and pressure drug companies into expansion if, as predicted, millions lose Rx benefits urban.org/research/publi…

If you're among those who get invited to diabetes summits, bring up access for the poor. Every time. It's your call as a featured advocate.

Why your call, your duty? Because pharma is paying for your flights and meals instead of call center reps, drug vouchers, & insulin itself.

EXCORIATE the PBMs too. They play a big role in this mess with "black box" policies that add money to their pocket. barrons.com/articles/pharm…

Finally, support community health centers. Longtime healthcare providers for the poor who need these programs. saveourchcs.org

Come fight the good fight with me. Maybe this will be a blog post...anyways, thanks for reading. End of @LillyDiabetes thread. #Insulin4all