UPMC Health Plan recently announced a groundbreaking initiative to combat the diabetes epidemic among Pennsylvania’s Medicare population by reducing financial barriers for filling prescription drugs. Members of most UPMC for Life plans will see reduced co-pays on covered brand diabetic medications. The announcement comes as the national conversation continues on how to best reduce the cost of drugs for consumers who depend on them.
Diane Holder, president and CEO of UPMC Health Plan, explained that this initiative is part of the Health Plan’s comprehensive approach to helping people achieve the health outcomes necessary for them to enjoy longer, more active lives. “Living with diabetes is difficult for a variety of reasons, particularly for people on Medicare. Today we are addressing two of the most important things our members need to manage their diabetes: we are helping them understand how to get the help they need, and we are helping them to pay for it.”
Holder continued: “We will help our UPMC for Life members achieve long term diabetes management by reducing cost barriers they face in obtaining insulin and other diabetes medications. We also provide access to personal health care coaches to help them stay on track by taking their medications as prescribed and understanding the lifestyle changes they can make to better control their diabetes.”
Reducing the cost of medications is an important component to improving the quality of life for individuals with diabetes. But the real impact comes from preventing individuals from being diagnosed with diabetes in the first place, eliminating the need for expensive prescriptions completely. The key to prevention in diabetes, as well as many other chronic conditions? Small changes in day-to-day activities like exercise and nutrition. These lifestyle changes can have a crucial impact on overall health and wellness, preventing or reversing chronic conditions, at a fraction of the cost. UPMC Health Plan is strongly committed to prevention and effective management of chronic conditions and provides education, resources, and support to individuals to reduce barriers to healthy living.
A national epidemic
Type 2 diabetes is a long-lasting (chronic) condition that makes the body unable to consistently control sugar in the blood. It is usually caused by lifestyle factors such as nutrition and exercise, though some individuals are prone to the condition due to genetics.
According to the CDC, roughly 30 million Americans have diabetes and adult diagnosis have more than doubled in the last 20 years. In Pennsylvania, those numbers are higher. If left untreated, diabetes can cause serious health complications such as heart disease, stroke, blindness, and kidney disease.
The good news is there is a period of time before being diagnosed with diabetes – called pre-diabetes—during which individuals can stop or even reverse the disease by making small lifestyle changes to help their body get back on track.
A more holistic approach
Beyond prescription drug costs, there are many other barriers that make it difficult for people to prevent or manage a chronic condition on their own. UPMC Health Plan offers a variety of resources, tools, and expertise to help members start their journey to health and wellness.
For instance, prevention and management often starts at home with small changes people can make to their daily activities to decrease their risk of diabetes. But this can be easier said than done. UPMC Health Plan health coaches work with members one-on-one over the course of 6 to 8 weeks, providing the education, motivation, and support they need to achieve their goals. The programs address a variety of factors that can help prevent chronic conditions such as quitting tobacco, managing weight, physical activity, nutrition, and managing stress.
Sometimes barriers to health have more to do with the time and effort it takes for people to find and get the care they need. That’s why UPMC Health Plan enlists personal care managers who can help find the best doctor for a member’s needs, schedule appointments, explain doctors’ instructions after a visit, and connect members with community services.
Maybe a barrier to care is as simple as not knowing how to use the medications or equipment needed to manage a specific condition. In the case of diabetes, UPMC Health Plan offers self-management workshops, in which a certified diabetes provider can offer practical information, like how to operate an insulin pump, address specific individual concerns, and create a peer-support network of people who are facing similar challenges.
Finally, as part of the nation’s second largest integrated delivery and finance system, UPMC Health Plan members have access to expert providers—primary care doctors, diabetes specialists, patient educators, care coordinators—and cutting-edge diabetes research that comes out of the University of Pittsburgh.
Holistic approach leads to better results
Chronic conditions are an epidemic in the U.S. and the leading drivers of disability and
death in the country.
Cutting drug costs is crucial way of eliminating financial barriers to care, but
it’s not the only piece of the puzzle. UPMC Health Plan is putting together the
best minds in health care to develop innovative strategies that address the challenges
individuals with chronic conditions face, empower them to take charge of their
wellness, and complete the bigger picture—stronger, healthier, happier communities.
 (Centers for Disease Control and Prevention, 2019)
 (American Diabetes Association)
 (Centers for Disease Control and Prevention, 2019)