University Health Policy Report: Contemporary Health Issues

This report, prepared by a student, examines the contemporary health issue of rising insulin prices in the United States and the advocacy efforts of the National Coalition on Health Care (NCHC). The report highlights the organization's mission to achieve an affordable, high-value healthcare system. It details the prevalence of diabetes, particularly among American Indians/Alaskan Natives, and the financial burden of insulin on patients, including tragic stories of individuals rationing insulin. The NCHC's advocacy efforts, including pushing for transparency and lower prices, are discussed, along with the economic costs of diabetes. The report also outlines the NCHC's aims, objectives, and recommendations for policy changes, such as improving transparency in the supply chain, disclosing information, and sharing rebates with patients. The report emphasizes the need for affordable healthcare access and the importance of addressing systemic challenges to improve health outcomes for all Americans. It also explores the role of insulin resistance, the effects of high and low blood sugar levels, and the organization's commitment to a more effective and responsive health system.

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CONTEMPORARY HEALTH ISSUES AND POLICIES
Student’s Name
Course Name
Professor’s Name
University Name
City, State
Date

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CONTEMPORARY HEALTH ISSUES AND POLICIES
The National Coalition on Health Care has a role in enhancing health care opportunities for
citizens of America (American Diabetes Association, 2018). The organization was established
more than two decades ago with the aim of achieving a comprehensive change in the health
system. John Rother is the current president and the leader of the organization. Our organization
is a private, nonprofit and non-partisan organization of Organizations. NCHR represent over 80
other organizations that participate in healthcare provision and they include business, civil,
pensions and health funds, persons with disabilities and the minority, women, consumers
representation groups, healthcare providers, unions, children, patients, and medical societies
(Herron, 2017). The organization represents more than 100 million Americans who are
employees, congregants or members. Our organization recognizes our members as our strength
(Herron, 2017). We recognize that the diversity of our member organizations their leadership
experiences as well as their expertise makes our coalition powerful voice in the community
health policymaking. From its establishment in 1990, the organization has seen an adverse
change in the health care system that improves quality, accessibility, affordability and care that is
cost-effective (Herron, 2017). The reason why the organization is advocating for affordable
universal healthcare is that the current upwards trends in costs for healthcare and the expenditure
are unsustainable (Whitelaw, Fiorentino and O'Leary, 2018).
The Organizations Mission
“To bring together key stakeholders in order to achieve an affordable, high-value health care
system for patients and consumers, for employers and other payers, and for taxpayers”
”(Bartelds, Drayer and Wolfensberger, 2012).
Vision

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“To be a leader in promoting a healthy population and a more effective, efficient and responsive
health system that provides quality care for all” (Bartelds, Drayer and Wolfensberger, 2012).
Soaring Insulin prices as the health issue NCHC advocates
15.1% of American Indians/Alaskan Natives
There are approximately 15.1% Alaskan/America Indian who are suffering from diabetes. Lack
of insulin causes diabetes. The most affected population is the old people who are over 65 years
and above comprising over 25.2% who are undiagnosed and diagnosed amounting to 20
million(Davies et al., 2018). Diabetes type 2 is the most common type of diabetes. People with
diabetes type 2 accounts for more than 95% of all diabetes cases reported in America. Over
79,535 deaths occur every year due to diabetes, out of which only 5% originate from diabetes
type 1 which is much higher than HIV/AIDS and breast cancer combined (National Center for
Health Statistics (US), 2017). Insulin is the hormone that is produced by the islets of Langerhans
in the pancreas and functions to regulate the amount of glucose in the blood (Davies et al., 2018).
The affordability of insulin for persons with diabetes is a major concern in America today
(Lipska, Hirsch and Riddle, 2017). The costs of insulin especially insulin analogues has
significantly increased for the last two decades. For instance, pharmacy prices for 1 vial of lispro
or aspart or 1 vial of glargine or detemir both long and short-acting insulin analogues
respectively cost over $ 170. Even more expensive is the prefilled pen injectors. Despite the fact
that insurance may cover some of the costs the burden still remains a responsibility for the
patients in the form of copayment and higher premiums (Lipska, Hirsch and Riddle, 2017). For
patients who are underinsured or, uninsured insulin analogues are not feasible for them.
Over a century now, Insulin has remained the most effective treatment of diabetes but narrow
therapeutic index keeps hampering its use (Yang et al., 2018). Economic costs of diabetes in the

CONTEMPORARY HEALTH ISSUES AND POLICIES 4
US in 2017. There are several commercialized alternatives for blood glucose control available
(Davies et al., 2018). Even so, insulin treatment remains the most useful as evident by occasional
normalization of blood glucose and the danger of experiencing low blood glucose levels. There
is continuous development of several useful formulations and insulin analogues aiming to further
optimize the time action profile. Since many patients are not for injectable therapies oral and
inhalable formulations of insulin are representing a promising diagnosis in non-injectable
delivery with constituted areas of priority in insulin therapy refinement (Piero, Nzaro and Njagi,
2015). According to a 14th March 2019 article by BBC, the cost of insulin in the American
population is too way expensive. An example of this is a 36-year-old Laura Marston who has to
sell everything she has including her pet, apartments, retirement fund, furniture and her car to
afford insulin her body requires on a daily basis. It is important to address this issue among the
American population because of too high sugar levels due to lack of insulin results to nausea,
confusion, lack of vision, and at times organ failures (Yang et al., 2018). Economic costs of
diabetes in the US in 2017. On the other hand, too low levels of insulin cause loss of
consciousness, mood swings, seizures and heart irregularities. For many people in America, their
bodies produce insulin naturally as opposed to the case of Ms Marston case that has type 1
diabetics where insulin comes from pharmacy counter or in glass vials every month when she
can afford. A single vial of the insulin needed by Ms Marston today costs $275 (£210) if there is
no health insurance (Ritu Prasad BBC News. 14 March 2019).
Lack of insulin in the body may result in a form of diabetes. In this context insulin is the life-
saving drug that NCHC is advocating to ensure it is affordable to all Americans (Neville, 2017).
The organization is trying to push Congress to address the issue of the rising cost of insulin
(American Diabetes Association, 2018). Their efforts to push for the lower prices have seen Rep.

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Diana DeGette (D-CO) introduce the Protecting Access to Biosimilars Act of 2019 early April as
the first promise to address the issue. Also, the Energy & Commerce Committee has conducted
chains of hearings to the rising insulin prices (American Diabetes Association, 2018). The first
hearing was held on 2nd of April 2019 and was intended to scrutinize how much the rise in the
cost of insulin affected the consumers, patients, advocates and the providers. In 10th of April, a
second hearing was held to investigate how manufacturers of drugs and PBMs' contributed to the
rise in the cost of insulin.
The discoverers of insulin sold its patent at $ 1 in 1923 with the hope that its cost will remain
low for everyone to afford. Today insulin retail prices in the US are $300 from the three brands
of all insulin brands that control the market (Heinemann, 2016). With even all factors like
inflation considered the pricing is too high with over 1000% increase. The American stories of
rationing insulin have been making headlines in national news across the world as they die for it
(Heinemann, 2016). Since the discovery and manufacturing of first insulin in 1900 the price has
risen to 1000% in the insulin market place. This trend has left many American at the danger of
healthcare inaccessibility (Bolli et al., 2015). NCHC fights to ensure that there is affordable
healthcare for all Americans and insulin price increases over the years has remained their current
big concern (American Diabetes Association, 2018). Over 7.5 million people living with diabetes
in America are dependent on insulin for survival. Insulin is reduced in the pancreas to help the
body balance the blood sugar levels in the body.
According to the article by Ritu Prasad BBC News 14 March 2019, the most famous case is that
of Alec Smith a 26-year old who died in 2017 a month after exhausting her mothers’ insurance
policy (American Diabetes Association, 2018). He could not afford to buy health insurance or
commit $1000 a month for insulin despite working and earning a minimum wage (Bolli et al.,

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2015). A number of reasons why some Americans may not qualify for insurance qualify for
employer-sponsored insurance or losing their job not able to pay for their personal plan. NCHC
recognizes essential terms of discussion in this case that include:
 List price which is determined by the pharmaceutical companies in the US and uninsured
diabetes pays for this.
 The net price which is the profit accruing to the company after selling the drug
 Rebates which are discounts negotiated on drugs for insurance companies
 Deductibles defined as what the insurance policies say must be paid before the insurer picks up
the rest which amounts to over $10,000
 Co-payments are what are paid for prescription by an insured person out of pocket.
Insulin resistance results when there is an inability of the cells to absorb and use blood sugar
energy due to excess glucose in the blood (Fonseca et al., 2016). This increases the risks of
developing pre-diabetes which later may result in Type 2 diabetes (Piero, Nzaro and Njagi,
2015). The ability of the pancreas to produce enough insulin that overcomes the low absorption
rate diabetes is more likely not to develop making blood range to stay normal. Type 2 diabetes
develops from pre-diabetes when pancreas works increasingly hard to release more insulin so as
to conquer the resistance of the body to keep blood sugar levels low (verywellhealth.com). This,
in turn, reduces the ability of the pancreas to release the required amount of insulin and Type 2
diabetes kicks in (Powers et al., 2017). The Type 2 diabetes most known feature is the insulin
resistance (Fonseca et al., 2016).
Aims
 The aim of the NCHC is to ensure the affordability and accessibility of healthcare to American
citizens.

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 It aims at ensuring that all Americans who have insulin resistance afford it at friendly prices.
This aim is driven by the need to have a healthy American population as well as the
improvement of the economy (Heinemann, 2016). As of now, the organization has over 32
million Americans who have access to quality healthcare through the Affordable Care Act
(ACA).
Objectives
 The organization aims and objectives are to become the world leader in promoting populations’
health and be a more efficient, effective and responsive system health that advocates and
provides quality health for all. The organization already has over 80 organizations working with
it around the United States.
 To improve quality and reduce costs for health care in both public and private sectors by
addressing the systemic and interrelated challenges. The organization believes that these
challenges can only be through responsibilities sharing and encouraging effective collaborations
between healthcare key stakeholders (Heinemann, 2016). This objective id-driven by the fact that
the current upwards trends in healthcare expenditures are not dependable.
Recommendations
The NCHC recommends three important policies that can lower insulin prices significantly.
These three policies form the basis of the recommendations and they include:
 Improving transparency and passing discounts to patients. This is because the supply chain
involved from the manufacturer to the suppliers and to the patients is complex and opaque.
NCHC argues that this chain encourages prices to be ever higher as rebate and consolidation
limit the supply as well as hiding the real cost of the insulin (Davidson and Hebblewhite, 2018).

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There is a need for manufacturers to disclose more information concerning effectiveness as well
as all other entities in the supply chain report prices paid, rebate and discount received. It
recommends that rebates and discount be shared with the patients and also encourage
transparency to help patients in understanding their diseases and therapeutic effects on varied
types of insulin so as to make more informed decisions (Davidson and Hebblewhite, 2018). The
organization recommends that the government come up with policies encouraging transparency
in the selling of insulin. Congress is required to state-level initiatives or the establishment of
federal standards and disclosure required across the supply chain (Davidson and Hebblewhite,
2018).
 Promoting generic drug development and curbing patent abuses to avoid monopolies
given to the manufacturers who enjoy twelve-year proprietary formula protection
(American Diabetes Association, 2018). The organization argues that despite close to a
century since the first insulin was developed manufacturers continue to exploit the
patients and consumers of insulin. They recommend that Congress review the length of
exclusivity (Davidson and Hebblewhite, 2018). The generic insulin market place is not
very much embraced in the United States even as FDA began to approve biosimilars
(Peters et al., 2015). The Congress should authorize FDA as well as fund it to allow
generic approval of old versions of insulin without patent and demand that makers of
insulin meet high bars of the effectiveness of insulin for different formulations (Davies et
al., 2018). NCHC also recommends that strong solutions be put in place Medicare
Negotiation and Competitive Licensing Act and enable Medicare to negotiate on the
prices of drugs from the pharmaceuticals companies (National Center for Health Statistics

CONTEMPORARY HEALTH ISSUES AND POLICIES 9
(US), 2017). This is to enable Medicare to opt for the generic brand where agreement
fails with the pharmaceutical companies.
 Limiting the increase in compound prices (American Diabetes Association, 2018). There is a
tendency of drug companies increasing prices any time and does that even multiple times yearly
(Hua et al., 2016). NCHC recommends that reforms be put in place to prevent an increase in
prices that are not as a result of the cost of production or improved quality and effectiveness
(Hua et al., 2016). If this is not possible the NCHC recommends that Medicare have the authority
to enter a long-term direct contract with pharmaceutical companies using tools like arbitration so
as to minimize price increases (Gradel et al., 2018).
Without the federal government intervention to promote the generic drug development more
especially the insulin and biosimilars, the pharmaceutical companies will continue to increase the
cost of pertinent drugs which will deny healthcare to millions of patients hence endangering their
well-being (Mannucci et al., 2010). Considering the fact that there are approximately 7.5 million
insulin-dependent individuals in addition to juvenile diabetics, diabetic people will continue
suffering for lack of accessibility.

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