Improve Patient Adherence to Insulin Therapy

AAFP Pushes Payers to Make Insulin Pens Available, Affordable

September 23, 2015 02:40 pm News Staff
[Insulin pen on white background]

The AAFP recently appealed to government agencies and private payers responsible for overseeing the health care of Americans to ensure that patients with diabetes have access to the medical supplies they need to treat their disease.

In a Sept. 16 letter(1 page PDF) to CMS Acting Administrator Andy Slavitt, another to Assistant Secretary of Defense for Health Affairs Jonathan Woodson, M.D., and other letters to private payers, the AAFP urged all parties to "ensure that all health plan formularies under your responsibility cover insulin pens at the same tier as vial and syringe insulin injections."

Study Documents Need to Resuspend NPH Insulin

Ensuring inclusion in health plan formularies isn't the only issue on the table when it comes to insulin pens. According to research( just published in Diabetes Care, failure to resuspend NPH insulin administered via the pens could lead to serious health consequences.

Results from a small cross-over study that examined the pharmacokinetics (PK) and pharmacodynamics (PD) of resuspended versus nonresuspended NPH insulin after injection showed profound differences in both variables. Researchers assessed these factors after subcutaneous injection of resuspended (R+) NPH insulin (pen tipped end-to-end 20 times) or nonresuspended NPH insulin (pen maintained in fixed position either horizontally [R- horizontal] or vertically with tip up [R- up] or tip down [R- down]).

Compared with R+ NPH insulin, authors saw either decreased (R- horizontal and R- up) or increased (R- down) plasma insulin concentrations and PD activity over the course of the study. Duration of insulin action was shorter with R- up and longer with R- down administration compared with R+, and within-subject variability was as high as 23 percent for PK and 62 percent for PD.

"We believe there are benefits for both patients and the health system if insulin pens are placed on par with vial and syringe insulin injections in patient-centered formularies," said AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn.

He pointed out that the growing tide of diabetes sweeping the nation posed a "significant burden on both our patients and our health care system."

Blackwelder said many patients who require insulin to manage their disease had trouble using vial and syringe insulin injections and preferred insulin pens.

Pens are easier and more convenient to use," especially for children and patients with visual impairment or arthritis, said Blackwelder.

Importantly, the use of insulin pens improves adherence to insulin therapy, he added.

"Regrettably, many public and private health care plans have limited patient access to insulin pens on their formularies or (have) eliminated access altogether. For patients who have difficulty with vial and syringe insulin injections, such formulary policies hamper their management of their diabetes, potentially leading to unnecessary complications to the patient and costs to the health care system," said Blackwelder.

Those negatives could be avoided if drug formularies would just cover insulin pens at the same pricing tier as vial and syringe insulin injections.

"We urge you to adopt that approach for all health plan formularies for which your office is responsible," Blackwelder concluded.

The AAFP's appeal came on the heels of new evidence that that the incidence of diabetes in the United States is trending upward, fueled in part by an unchecked obesity epidemic.

Authors of a study published Sept. 8 in JAMA: the Journal of the American Medical Association reported that in 2012, more than half of American adults had either diabetes or prediabetes.

Furthermore, more than one-third of patients who met study authors' criteria for diabetes did not know they had the disease.