By Mahlon Meyer
Northwest Asian Weekly
Nate Miles
After a life of working as a domestic helper, his mother died from kidney failure brought on by diabetes.
“That gives me a little more reason for showing up every day,” said Nate Miles, Vice President of Strategic Initiatives at Eli Lilly and Company—the first company to bring insulin to the mass market.
“I know what it means for them, and if I can bring some relief, if I can help, that’s my job,” he said, in an interview.
On April 7, Lilly announced a program to decrease the price of insulin for nearly everyone dependent on it. The program, called the Lilly Insulin Value Program, ensures that anyone with private insurance or who is uninsured will pay no more than $35 in copay each month to secure the life-saving medicine.
On top of that, Lilly announced last month that it had secured a deal with the federal government so that seniors using Medicare Part D would also be eligible for the low copay for their insulin.
Eli Lilly, which along with other pharmaceuticals has come under fire in recent years for the rising prices of insulin, explained that the new program was in response to the COVID-19 pandemic, that was leaving diabetics even more vulnerable.
“We’ve seen the millions and millions of job losses people are experiencing all over the country and we recognized that a lot of those people have diabetes and use insulin,” said Greg Kueterman, a senior director at Lilly. “We know it is all the harder for people to afford their insulin if their income was cut off,” he said.
The program works by asking anyone in need of lower-priced insulin to call in to the company’s “solution center,” explain one’s situation, and the agents will come up with a solution. This can include sending out a co-pay card or, for those totally impoverished, directing them how to receive free insulin.
According to Lilly, the company has been distributing hundreds of thousands of injectable insulin cartridges, called KwikPens, to three relief agencies that in turn distribute them to free clinics where diabetics can obtain the charitable donations of insulin at no cost.
Direct Relief, one of the three national relief agencies that supplies clinics around the country with KwikPens, has so far received 236,810 of the devices from Lilly, said Lara Cooper, Managing Editor, Digital Content and Strategy. Direct Relief has shipped the KwikPens to 41 clinics that provide relief for those unable to purchase insulin, she said.
A program for all groups
When calling into the solutions center, the caller has the option of pressing a number for English or Spanish. But if you speak another language, press either button and speak to the operator in your own language, said Kueterman.
The operator will then make a recording and someone will call back in the language used.
Lilly can respond in around 40 different languages, he said.
Critics say the call-in centers are a hassle for people already stressed with loss of jobs and food.
“With this exceptional level of stress and worry on everyone’s plate, patients should not have to call a helpline or jump through more hoops to ask for help,” said T1, an advocacy group, in a statement. “Why not lower the list price and make insulin affordable at the counter?”
But Lilly said the call centers allow people to get discounts directly from the company, that would be impossible otherwise because of pre-existing agreements with insurance companies.
“It is difficult to lower the prices without people calling us for help because we have contracts in place with insurance companies,” said Kueterman. “The calls into the Solution Center only take a couple of minutes and we can provide co-pay cards on email within 24 hours,” he added.
The complications of insurance companies
Dr. Lisa Chan examines a patient at ICHS (Photo courtesy of ICHS)
Lisa Chan knows the frustrations of working with insurance companies. A doctor at the International Community Health Service (ICHS) in the International District (ID), she said that an insurance company had changed its policy every six months over the past year, making the insulin needed by patients sometimes out of reach.
One patient, a woman in her 60s, was hardly literate in her own dialect, Toishanese. It took six month of careful education and adjusting her dose until she was able to stabilize her blood sugar levels—and remain out of danger.
“It was almost a success story,” she said.
But then the insurance company changed its policy, no longer covering her insulin. Chan had to start again with a different type of insulin that required a whole new approach to eating and dosing. After another six months, the woman was barely stable.
But last month, the insurance company changed its formulary yet again. It now refused to cover the second type of insulin. And it restored coverage for the original insulin.
“This constant switching back and forth is dangerous,” said Chan, whose own father has diabetes.
“It could cause the blood sugar to get too low and could be lethal,” she said.
Cultural issues
Lilly’s campaign also includes the spread of education about diabetes, said Kueterman, who works with newspapers and media across the country.
Marginalized groups are challenged with a lack of access to information about diabetes, said Theo Bickel, Digital Communications & Events Specialist at ICHS, where 70% of patients are low-income and 80% are persons of color.
They also have higher incidences of diabetes than whites, with Asian Americans 40% more likely to contract the disease, Blacks 60% more likely, and Latinos 1.7 times more likely, according to the U.S. Department of Health and Human Services, Office of Minority Health.
Different ethnic groups also seem to have different myths that might discourage them from using insulin when needed. Alan Chun, a doctor who has worked at ICHS for 25 years, said Asian Americans tend to desire herbal medicines or bitter melon as an antidote to diabetes.
Among Latinos, there is a belief that drinking a cactus shake lowers blood sugar and can help with diabetes, said Lorena Wright, an endocrinologist at the University of Washington (UW) Endocrine and Diabetes Care Center.
What a person eats does play a major role in the development of the most common form of diabetes and how it plays out, said both doctors.
A particular challenge for Asian Americans is the traditional diet of white rice, which negatively impacts blood sugar.
Chan advises her patients to mix white rice with brown rice. But given the propensity of Asian Americans to eat together with family members, the advice is often hard to carry out.
“When you tell a patient to switch, you’re asking the whole family to switch,” she said.
Managing one’s diet has become even more difficult now that so many Americans either don’t have enough to eat, or are dependent on fast food or food banks given the social unrest, chaos, and unemployment brought about in the wake of the pandemic, she said.
The silent killer
At the same time, people may neglect getting help for diabetes because its symptoms may not manifest until too late.
One patient, an artist, refused to acknowledge he had diabetes, despite alarming blood sugar levels, and continued his lifestyle of drinking and smoking and unhealthy eating, because he showed no symptoms, said Chun. But one day, he collapsed from heart failure and ended up in the hospital.
Such denial may come particularly easy for Asian Americans because excessive fat is hidden inside the abdomen, which slows down the metabolism, making them susceptible to the disease, Chun said.
Until recently, the prohibitive cost of insulin made it difficult even for those with severe complications from diabetes to get the insulin they need. Patients originally from India, for instance, would solicit relatives to send them insulin from home, said Wright.
One patient had just had a kidney transplant caused by diabetes and needed massive doses of multiple medications, including insulin. But Medicare would no longer pay, and he had to give himself less insulin than he needed, threatening his life. Eventually, he took to smuggling it in from Canada, where insulin is cheaper and can be bought without a prescription.
Although the UW offers a program, funded by donors, for free insulin on a case-by-case basis, the man ended up leaving the state and procuring cheaper insulin of an older variety that is more complicated to use.
“There is no other country where insulin is as expensive as the United States,” said Wright. That is one of the reasons why the new Lilly program is a step in the right direction, she said.
“I think the Eli Lilly program is great,” she said. “Their copay used to be much higher.”
“So starting with COVID-19 and a lot of people hurting, it looks like the program is here to stay, it’s a good start,” she said.
The Lilly Diabetes Solution Center can be reached at (833) 808-1234.
Mahlon can be reached at info@nwasianweekly.com.