AADE Advocacy Update: November 2018-February 2019

AADE Advocacy Update: November 2018- February 2019

AADE has been actively engaged in advancing advocacy policies that support the work of the diabetes educator, reinforce the critical importance of diabetes education, and remove barriers that may affect a person with diabetes from self-managing their diabetes. The following summary provides an overview of the main areas of focus for AADE’s Advocacy Department this quarter.

Expanding Access to DSMT Legislation

  • 115th Congress Wrap-up: The Expanding Access to Diabetes Self-Management Training Act (H.R. 5768, S. 3366) did not pass in the 115th Congress, which was expected given that it was a new piece of legislation introduced late in the congress. Despite the bill not passing, AADE and members of the Diabetes Advocacy Alliance (DAA) worked to build solid congressional support for this legislation and have been working with our congressional champions to ensure the swift re-introduction of this legislation in the 116th We anticipate our sponsors will be ready to reintroduce the legislation in early spring. Below are highlights from our advocacy efforts in the 115th Congress:
    • Legislation was introduced in both the House and the Senate.
    • AADE worked with the DAA to conduct over 40 in person meetings with congressional staff members to build support for this legislation.
    • Staff worked with AADE’s Washington, DC-based consulting firm, Baker Donelson, to generate constituent support from diabetes educators to coincide with congressional meetings. Diabetes educators also met with their members of Congress in their home districts, including in the states of Georgia and Indiana.
    • AADE members sent close to 2500 congressional letters to generate support for the passage of this legislation.
  • Strategy for the 116th Congress: AADE has begun to strategize for the re-introduction and advancement of the Expanding Access to DSMT bill in the new congress:
    • As mentioned above, AADE is working with Baker Donelson on outreach to our congressional champions about reintroducing this legislation in the new congress.
    • The DAA is working on a cost-savings analysis that demonstrates how removing barriers to DSMT can result in a financial savings to the Medicare program. This type of cost-savings analysis is useful when speaking to congressional offices, as many inquire about the cost of such legislation.
    • AADE is seeking to strengthen AADE members engagement in advocacy and more actively engage members in grassroots activities.

Monitoring of Federal Legislation:

In addition to proactively advocating for the Expanding Access to DSMT bill this quarter, AADE also tracked other federal bills. Most notable include:

  • The Patient’s Right to Know Act/Know the Lowest Price Act: This legislation passed in the fall and bans “gag clauses” for pharmacies. This means that pharmacists are now permitted to inform customers that their medicine may be cheaper if they pay cash for certain drugs rather than using health insurance. There are also proposed regulatory changes that seek to update current Medicare regulations to reflect these new laws (see Medicare Changes to Part D and Medicare Advantage Plans under Regulatory Activities and Submission of Federal Comments).
  • Healthcare Landscape: AADE has been monitoring the healthcare landscape following the 2018 mid-term elections and has been tracking healthcare policy discussions as the 116th Congress takes shape. Discussions have focused specifically around maintaining protections for individuals with pre-existing conditions and drug pricing and transparency. Of note, Congressional Diabetes Caucus Senate co-chairs, Senators Shaheen and Collins, sent letters to United Healthcare, Aetna, and Anthem asking six questions to better understand how insurance companies can drive affordable access to insulin. Both the House and Senate have also held hearings on drug pricing with a specific focus on insulin. More hearings are scheduled for February. The Administration has also released a series of proposals, most recently addressing drug rebates. We are likely to see more congressional discussions surrounding insulin access and affordability as the new congress progresses.

Regulatory Activities and Submission of Federal Comments:

AADE tracked the following regulatory activity from the Centers for Medicare & Medicaid Services (CMS):

  • Medicare Physician Fee Schedule (MPFS) Final Rule: Staff prepared an analysis of the MPFS final rule which was shared via a blog post on the AADE Advocacy Forum and through DANA. This analysis detailed Medicare payment and policy updates for 2019.
  • Medicare Changes to Part D and Medicare Advantage Plans: In early August, CMS announced that they would now allow Medicare Advantage plans to use step therapy to help manage costs. Step therapy means trying a less expensive medication before you can try a more expensive medication. This can be especially problematic for people with diabetes and other chronic diseases who may have to “fail first” by trying a cheaper medication than the one originally prescribed by their health care providers. AADE sent a letter to CMS Administrator Seema Verma urging CMS to reconsider this policy change.  In December, CMS issued a proposed rule entitled the “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses.” This proposed rule further expands the ability of Medicare Advantage plans to use step therapy. The rule also discusses other provisions related to Part D medications, including formalizing the regulations related to the passage of the federal bills that banned gag clauses for pharmacies. AADE submitted comments in late January on these specific provisions.
  • Healthy People 2030: AADE engaged the Advocacy Committee and the Professional Practice Committee to review the proposed Healthy People 2030 objectives. AADE submitted comments on the proposed objectives.
  • CMS Request for Information on Accrediting Organizations and Consulting Arrangements: In December, CMS released a Request for Information (RFI) seeking public comment on Medicare-approved Accrediting Organizations (AOs) that provide fee-based consultative services to the Medicare providers and suppliers they accredit.  CMS is trying to determine if there are actual or perceived conflicts of interest between the AO’s accreditation and consultative entities. CMS will consider information received in response to this RFI to assist in future rulemaking. AADE is preparing a response to this RFI.
  • diaTribe Foundation Sign-on Letter to FDA: AADE joined the diaTribe Foundation and other diabetes organizations, including the ADA, in sending a letter to the FDA to address the October 17, 2018 meeting that looked at 2008 Guidance for Industry on evaluating cardiovascular risk in new therapies for type 2 diabetes.

State Activities:

  • Chief Science and Innovation Office Crystal Broj represented AADE at the Iowa CB meeting on November 17 and provided an advocacy update at the meeting. Crystal worked with advocacy staff on this advocacy update.
  • Michigan Medicaid began covering CGM on December 1. AADE coordinated with other stakeholders and submitted comments in response to their proposed coverage draft.
  • The AADE national office worked with the California CB to send a joint letter to California Children’s Services (CCS), a subset of California Medicaid (Medi-Cal), on a CGM coverage issue. This letter was in response to a policy change that resulted in decreased reimbursement for therapeutic CGM for those covered under CCS. This brought reimbursement for suppliers well below acquisition cost leading to disruption in care for children with diabetes under this program. AADE and the CA CB asked that CCS reconsider this policy. CCS responded that due to the influx of comments received, they would be reviewing the policy, and proposed a temporary solution to address the issue.
  • Staff engaged the Ohio CB to promote a lobby day for the Ohio Coalition to End Step Therapy that took place on November 13.
  • To assist in tracking state activities, the Advocacy Committee and staff have encouraged advocates to share advocacy stories on this Advocacy Forum on MyAADE Network. This quarter, members from Georgia, Missouri, and Pennsylvania shared updates to help mobilize diabetes educators in other states. Each advocacy story is different, which helps to demonstrate the many advocacy opportunities available to diabetes educators looking to get more involved in advocacy work. Below is a summary from the Advocacy Forum on the advocacy activities of the state referenced above:
    • Georgia: Diabetes educators have been working to pass non-medical switching legislation. Mandy Reece sent a letter to the editor which was published in a local newspaper. This was shared as an advocacy tool that could be utilized by other members. Mandy also shared a blog post about how to set up a meeting with your legislator.
    • Pennsylvania: Diabetes educators, including AADE Advocacy Committee member Lisa Laird, and other advocates joined a state senator and representative in a media event at the PA state Capitol to discuss type 1 diabetes awareness.
    • Missouri: Diabetes educators in the state worked with MO state legislators to pass legislation declaring November “Diabetes Awareness Month.” They also hosted two lobby days and continue to raise awareness for diabetes related issues.
  • AADE has also identified Medicaid coverage for CGM as another critical state issue for 2019 and is pursuing efforts to collect data on current state coverage requirements for CGM to better inform our advocacy strategy going forward. Staff envisions beginning this project in early 2019.

Member Engagement:

  • My AADE Network: We are continuing to develop our advocacy network through the Advocacy Forum. We are striving to create a robust network where advocates can share information and connect with one another.
  • New Toolkit on Non-Medical Switching: AADE developed a toolkit to address non-medical switching, which is now available on the AADE website under Advocacy.
  • Identification of State Grassroots Coordinators: Advocacy staff plans to work with the Advocacy Committee and the state CBs to ensure that each state identifies a state grassroots coordinator (SGC) to serve as the conduit for advocacy information between the AADE national office and the state CB. Please contact your state CB leader if you are interested in serving in this role!
  • January 23 Advocacy Tele-Townhall: The AADE Advocacy Committee hosted its first ever advocacy tele-townhall meeting on Wednesday, January 23. The townhall began with a series of updates from the Advocacy Committee and staff on current advocacy initiatives, like the Expanding Access to DSMT act, and state efforts like Medicaid coverage for CGM systems and non-medical switching.
  • Advocacy Webinar: Baker Donelson conducted an advocacy webinar on December 4. This webinar covered the Expanding Access to DSMT Act, the November elections, and the outlook for the 116th AADE offered CE for this webinar. Click here for the recorded version.
  • Advocacy Website: The Advocacy Department worked with the Marketing and Communications Department to update and revise this section of the website. The goal of this redesign was to simplify the information presented on this site to make it easier for AADE members to find information and take action.
  • Public Policy Forum: Planning is underway for the 2019 Public Policy Forum. This event is set to take place in Washington, DC May 20-21.
  • Communications: Advocacy staff continues to use AADE platforms like social media, FORWARD, blog posts, the Advocacy Forum, and the Volunteer Leaders newsletter to share advocacy information. We want to ensure that our advocacy efforts are being communicated through as many channels as possible.

Stakeholder Meetings:

AADE monitored and/or participated in key meetings this quarter. These include coalition meetings and governmental meetings:

  • AADE attended the November 7 DAA/Office of Disease Prevention and Health Promotion Healthy People 2020 diabetes stakeholder meeting on diabetes self-management education and support. Leslie Kolb, Chief Science and Practice Officer, presented at this meeting on DAA’s regulatory agenda and the Expanding Access to DSMT Act.
  • Staff and representatives from Baker Donelson attended the December 5 DAA quarterly in-person meeting in Washington, DC. AADE continues to participate in biweekly DAA calls and is active in the DAA prevention workgroup.
  • Staff attended (via webcast) the FDA Patient Engagement Advisory Committee (PEAC) meeting on November 15. This meeting focused on ways to encourage patients to participate in clinical trials. This meeting also looked at data collection and how online patient social media communities might provide valuable data in post-market surveillance of devices and products.
  • Staff joined CMS and other stakeholders in a listening session on the social determinants of health hosted by the National Committee for Quality Assurance (NCQA) and the CMS Office of Minority Health (OMH).
  • AADE continues to actively engage with the Health Equity Collaborative. Leslie Kolb co-chairs the Strategic Design Workgroup.
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