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Episode 33 – Diabetes Leadership Podcast

On this episode of HR Benecast we hear from George Huntley founding member and CEO of the Diabetes Leadership Council. Listen to hear how the Diabetes Leadership Council works to reduce overall spend for employers and those living with Type 1 and Type 2 diabetes.

Mike Stull (00:08) 

Hi, everyone, and welcome to this month’s episode of HR Benecast, your source for expert commentary and insights on current health benefits-related news and strategies. This is your host, Mike Stull.  

As we close another record-setting sales season, we are happy to report that we have 56 new clients this year that represent about $600 million in pharmacy spend for our programs. So, our best year ever by a lot, and obviously it means that our team is very busy in the implementation season this year. We know that it’s a busy time of year for benefits professionals as well, so if you’re looking for help from our team, know that we’re here and happy to help.  

We have a number of great events coming up. We hope you’ll join us on November 16th for our 2022 Annual Meeting. We’ll announce the recipient of our 2022 Excellence in Benefits Award and get an update from our legal team on key regulatory updates as well as results from a recent survey of self-insured employers. You can register for all events for Employers Health at employershealthco.com/events. Again, employershealthco.com/ events.  

I recently sat down with George Huntley, founding member and CEO of the Diabetes Leadership Council. George is a passionate advocate for people with diabetes. He’s a volunteer for numerous diabetes organizations and also served as the National Chair of the Board of the American Diabetes Association back in 2009. And then, from 2011 to 2015, chaired the ADA’s Legislative and Regulatory Subcommittee, which establishes the federal and state advocacy priorities for the association. So, a real interesting background. I hope you enjoy my conversation with George as it relates to effective care for diabetes patients from his perspective. 

 All right, George, it’s great to talk with you today. Could you start by giving our audience a little bit of an introduction?  

George Huntley (2:31) 

Thanks, Mike. 

It’s a pleasure to be here. I’m a patient living with type 1 diabetes for about 39 years. I’ve been a volunteer in the diabetes community for about 36 of those. 

I’ve got three family members living with type 1 diabetes in addition to myself, a sister, niece and great nephew. So, it’s definitely in the family and it’s a cause that is important to me. And we also have several family members with type 2. So not to discriminate between types 1 or type 2. It’s one of those things that is in the Huntley genes. 

Mike Stull (3:13) 

And could you talk a little bit about the Diabetes Leadership Council? Obviously, you have a personal connection to helping those with diabetes. But could you, could you talk more about the council itself?  

George Huntley (3:24) 

Sure. You know, the council is a group of past national chairs of the Board of the American Diabetes Association. And I’m a past national chair. 2009 was my year. It was great to be part of that organization. But when you’re done, we weren’t done. And so, we felt like we still had a lot to give to the advocacy of the world. We’ve dedicated decades of our lives to the cause. And there was a need for our particular set of skills, to use a Liam Neeson line, in the advocacy arena. And so, we banded together and formed the Diabetes Leadership Council back in 2013. A bunch of us. And we have grown from that little seed of a group to really being out there. And our cause was really being nimble. Our structure allows us to be nimble. We don’t have multiple layers to get to the board. We are the board. Now I’m the CEO, but I started on the board. We can jump on something without waiting for our next quarterly call.  

Our sole focus is advocacy. So, we don’t have to be diverted with other mission activities. 

We’re here to advocate for patients, for their affordable access to care, for what they need to manage their diabetes. We know the issues very well because we’ve been in it and live it. And we can jump on things quickly at the federal and state level. 

Mike Stull (5:09) 

And we know what attracted our two organizations to learn more about one another was your work specifically targeted to employers and benefits professionals at those employers. Could you talk about how your work related to employers fits into that overall mission of advocating for patients?  

George Huntley (5:32) 

Yeah, sure. Well, employers cover about half the country through their health insurance. 

So, it’s really important to address employers and help them with their plan design so that they can provide effective coverage for people with diabetes. I have a particular perspective there because in my other day job, in addition to being CEO of the Diabetes Leadership Council, I’m also the COO and CFO of a professional services firm based in Indianapolis, Indiana, called Theoris Group. And in that role, I have been the plan administrator of a self-insured health plan for over two decades. We have employees across the country. And so, it’s a multi-state self-insured ERISA-based employer plan, a health plan. And so, I know what an employer needs if you think about it. Employers, we’re trying to run a business. So, health care is ancillary to that. I’m trying to run a services business. I need health care in order to attract and retain employees. But I don’t necessarily, and most employers don’t necessarily all, understand all of how the health care system works and the mechanisms behind it. And they hire consultants, brokers, administrators, et cetera, to guide them through this. They rely on those third parties. But some of those third parties aren’t giving them everything they need to get all of the plan design the way that is in the best interest of their own business, of the employer’s business and their employees. And so, we talk to them about that. 

Mike Stull (7:19) 

Yeah. For those who know me, I’ve been at Employers Health for 18 years now. And one of the first things that we did when I started here was called the Akron-Canton Diabetes Coalition. I always enjoyed calling it the ACDC. We felt like real rockers.  

But it was a group of diabetes education nurses from the local hospitals. And one of the things that I always said to them was, you know, think about this from an employee benefits perspective. If you could design the plan, what would be the benefits that you would want as a patient with diabetes and what would make the most sense? And I never really got a great answer from that. So, it’s great that you all are putting out actual recommendations to employers about what type of benefit design would help those patients with diabetes. 

George Huntley (8:19) 

Well, one of the things that employers need to understand, and I applaud the ACDC. That’s fantastic. And maybe you can help the employers get back in the black with regard to health care. I’ll be here all day.  

But, you know, importantly with diabetes is for employers to understand what it takes to manage it. It is a difficult disease to live with. It is not simple. It’s not easy. It’s 24-7. You know, and every day is different. So, you can eat the same thing and do the same things and have different results. Take the same amount of your insulin or other medications because there are so many variables that are impacting blood sugar. 

And employers don’t necessarily know that. Health care providers don’t always understand that. And so, understanding that the patient is on his or her own most of the time is critically important to grasping the importance of providing them what they need to manage the disease. 

You know, I like to, you know, if you’re a fan of Rent, the Broadway musical, 525,600 minutes in a year, you’re lucky out of those 525,600 minutes, you’re lucky as a patient to spend 100 of them with a health care provider. And so, you’re making medical decisions every day multiple times a day in your food intake, your medication intake, all of the things that you’re doing to manage your diabetes. And when you understand that, it starts to hopefully sink in that it’s really in everybody’s best interest to give the patient what they need in order to be successful, the tools and the technology and the medications they need to be successful because it’s, you know, it’s a lot more expensive if you don’t manage it. 

And, you know, you think about the costs of diabetes and everybody talks about how expensive this disease is, and the costs are coming from the complications, not the management. So, when you think about the complications, you’re talking about heart attacks, stroke, end stage renal kidney failure, amputations, ER visits by low blood sugars, etc. Those are what’s driving the cost. It’s the tail wagging the dog, the medications and the tools. That’s the investment that you should be making to allow and prevent those other costs from happening. Obviously, it’s better for the patient, but it’s significantly better for the health plan as well. And many, many studies will show that. A study from Express Scripts just this June saying if they capped all diabetes medications at $25, the plan saved 16% on overall diabetes costs. This came out of Express Scripts the June of this year. We’ve known this for years, but it’s now starting to come out and the investment is worth it in the management of it because that’s what the patient needs. And the tools that they need are technology. Many of us need an insulin pump. Many of us need continuous glucose monitors. They are not necessarily one size fits all. Not everybody drives a Chevrolet or a Ford. You want to have the tool that works for that patient. 

So, give them, again, back to that 525,600 minutes, give them what they’re going to need. They’ve got to live with it for a lot of minutes. So, give them what they need as that part and make sure that it’s accessible and affordable so that they actually take it and they use it because that’s what’s really important. So, we talk to them about those kinds of things.  

Mike Stull (12:21) 

Are there other specific examples of things that employers can do to make the benefit more attractive or more affordable for patients with diabetes for these management tools? 

George Huntley (12:35) 

 So, a couple of things, sure. One, we talk about passing rebates through to patients at point of sale and that’s beyond just diabetes. That’s something that is every drug out there. The average rebate on a branded drug is about 48%. It’s probably closer to 50 now. So rough figures, half the list price of a drug is a rebate that comes back through to the employer in a plan. Share that with the employee during the deductible period. They’re paying a premium for access to the plan. Give them the premium. If they go to the doctor, they go to the hospital, they’re getting the benefit of the plan network discount even during deductible, but they’re not getting that network discount on the drug side unless the employer designs the plan specifically that way. That’s not necessarily the default. So, we talk about that because that can literally cut the cost in half for an employee during that deductible period. And you’ll give away an apple in the lunchroom, a pedometer, a t-shirt, tell them to go walk, and then you’ll charge them twice, double the cost for whatever drug they need to take in order to actually really manage their chronic diseases. So, in the case of insulin, that rebate is 75 to 80 percent. So, it’s a really big deal. So, we do talk about that.  So, the employer has to peel that onion a little bit to say, am I really driving my people to the lower-cost drug? First and foremost, is it even available on my formulary? And secondly, is my plan design driving them to that behavior? And don’t take that for granted. You used to be able to, but you can no longer take that for granted.  

Mike Stull (15:33) 

Yeah, I think it’s something we’ll certainly take a look at in terms of, and I think that’s something employers don’t necessarily think about all the time is, yeah, they expect that tier one is generics, but it’s really down to the PBM. The PBM determines what actually gets charged the tier one copay or coinsurance versus the plan design. So that’s an interesting point.  

For those with high deductibles, I know a lot of our plans have a preventative drug list in place that charges either no copay or a flat dollar copay for diabetes medications. Are you seeing employers that you work with adopt those preventative drug lists?  

George Huntley (16:17) 

We are, and I think that’s come a long way. I think a couple of things. I mean, the IRS in 2019 came out and clarified that you can put chronic disease management drugs on the preventative list. It didn’t have to be already on the one that US Preventative Services Task Force came out with. So, insulin, as an example, can be put pre-deductible because there were gray questions on that, prior to that. But 2019 is not that long ago. People take a little bit of time to, oh yes, I can actually do that. And we are seeing that because it makes economic sense, and more and more studies are showing if you lower the cost of chronic disease maintenance, you lower your overall cost for the plan. And it’s the drug side of a plan versus the major med side of a plan. 

The major med side of the plan is where most of the cost is happening. You’re looking at 80%, 85%, 90% of a plan cost is over there. Trying to cut on the drug side, you’re going to pay two, three, and sometimes tenfold on the other. 

Mike Stull (17:23) 

So, in terms of management, we talked about some of the new technologies in terms of continuous glucose monitors and insulin pumps, things like that. I know there are a lot of companies out there knocking on employers’ doors with some new patient management program around diabetes and other chronic conditions. I’m curious if there are specific things from a patient perspective. Are there certain attributes to those types of programs that are helpful that employers should look out for?  

George Huntley (18:03) 

I would say accessibility and user-friendliness of the program. An employer is going to know their population. Is their population a manufacturing plant? Are their population spread out remotely across the country? What kind of employee base? How are you best interacting with them? Fundamentally, we want to make it easier for the patient. The employer is going to understand how to reach their population of employees, whether they’re all remote or whether they’re all working in the factory behind the front office, because that really informs the media and the technology you need to use to reach them. But the information needs to be easy and accessible and informative, whether it’s recipes that they can track, whether it’s how they track their blood sugars, whether it’s how they track their physical activity. Giving them tools. I wouldn’t say forcing them to use them. Giving them tools as an option. Again, everybody runs their lives differently, but we all need to be able to keep track of some of these things as we manage our diabetes, and the tools and giving them those options are a win. Giving them access to a counselor, a nutritionist, a diabetes educator through these tools, that’s the real win.  

Mike Stull (19:33) 

Absolutely. From a public policy perspective, I know your organization does a lot of advocacy. Are there specific public policy recommendations that you all are active on right now?  

George Huntley (19:50) 

We’re very active right now on, obviously, the cost of insulin is the number one thing for people with diabetes. It just got included in the Inflation Reduction Act for Medicare. It did not get in for commercial plans, so we’re now working, there’s a bill, the Insulin Act, that we are supporting and the whole community is behind to try to get that covered with basically a co-pay cap for the cost of insulin in the commercial plan, the ERISA plan, the plans you and I are talking about here today. Beyond that, we talk about, there have been rebate pass-throughs, same things I’m talking to employers about. We talk about access to biosimilars and generics. We talk about access to obesity medications. If you want to talk about preventing diabetes, there’s a Treatment and Reduction of Obesity Act that Congress has out there. They haven’t moved on it in a bit. 

Medicare Part D law, when it was enacted in 2006, it said in there, thou shalt not spend any of the Part D money on weight loss drugs because there were none back in that day. As we sit here today, there are very viable options. We talk to employers about this as well. You’ll pay for bariatric surgery, but you won’t pay for the drug that might have prevented that surgery. That surgery is a heck of a lot more expensive than the drug. There are options now, but we need to get that covered in Medicare and we also need to get that covered in employer commercial plans.  

There’s a stigma around diabetes. Diabetes is a genetic disease. It’s a disease. Obesity is a genetic disease as well. It is not the patient’s fault. Yes, we can all wish we had walked more and exercised more, but there are people that walk more and exercise more and they are still obese. It is a disease that we have got to recognize as such and treat it scientifically and medically and environmentally in order to get the health result and honestly, the cost result from it. We talk about that and that’s another area of advocacy for us. 

Mike Stull (22:27) 

George, your organization along with some other patient advocacy groups recently filed a lawsuit over the Department of Health and Human Services around the copay accumulator adjustment rules. Could you talk a little bit about why your organization feels those rules are so detrimental to diabetes patients? 

George Huntley (22:54) 

 Sure. Diabetes Leadership Council, the Diabetes Patient Advocacy Coalition, we are affiliated organizations. Also, we joined the HIV and Hepatitis Policy Institute in this lawsuit we filed in late August.  

Copay accumulator adjustment programs basically take the manufacturer coupon assistance away from the patient and divert it to the plan. The patient is in a situation where they are in their deductible. 

It is their responsibility to buy the drug. The plan has said the drug costs x, let’s say $500. The patient has to go come up with that $500. They have found a coupon to help them with that, but whether they got that coupon from the manufacturer or from a relative or a GoFundMe page, the patient was responsible for funding that $500. If on a $2,000 deductible, the insurance plan should get four doses of that drug, if you will, four months’ worth of that drug for free. Then the patient should then have to be past their deductible and into a copay. 

In these accumulator programs, the patient is never getting out of the deductible because that coupon amount, which the patient was responsible for, is not getting credit for it. They never get out of the deductible. A couple of things happen. The coupon expires. It’s a limited period, so they can’t get through the whole year. Now they’re midway through the year and they can’t afford their drugs.  

The plan has received the deductible a couple of times now because the patient’s got to pay it and the manufacturer’s coupons paid it. What we hear is, oh, this is driving patients to more expensive drugs, but the reality is 90% of these in that vicinity are for drugs that do not have a lower cost alternative. The patient doesn’t have a drug to go to. They need this one. These coupons are essential for them to get it. It’s not really driving the patient to a more expensive drug away from a less expensive drug. CMS is even admitting that in their ruling. We believe it’s against the Affordable Care Act in the definition of employee cost sharing. It’s definitely an arbitrary and capricious ruling because the ruling that came out said they can treat it either way. That’s really not a rule. That’s the basis of what we’re going after here. 

This is beyond diabetes. It’s impacting patients with diabetes. It impacts patients across all chronic diseases, which is why we’ve joined with the HIV and Hepatitis Policy Institute. 

Mike Stull (25:43) 

Yeah. I think plan sponsors what we’ve seen, particularly since the passage of the Affordable Care Act, is that the drug prices just continue to go higher and higher and so they provide these co-pay cards to shield participants from the high cost of the drugs. Then it gets stuck on the plan on the back end. The unfortunate part about all of it is that it’s the patient that ends up getting stuck in the middle of the battle between the plan sponsors, the PBMs, and the pharmaceutical manufacturers over the excessive prices that they’re charging for some of these medications. It’s one of those issues where you see the reasoning on both sides, and it just stinks that it ends up being patients stuck in the middle. 

George Huntley (26:43) 

Yeah. That’s exactly right. It’s the patient getting stuck in the middle. That’s where we’re advocating. That’s the one party in this group that should not be the one that’s burdened the most. That’s unfortunately what’s happening by this policy.

Mike Stull (26:59) 

Absolutely. Well, we appreciate, George, you taking time out to tell us about the work that you and your organization are doing. Obviously, diabetes is huge for our plan sponsors. You mentioned the connection that you have to it within your own family. Certainly, the populations that our, our clients, that they cover, all deal with a higher and seems like a growing incidence of diabetes patients. As always, a very timely topic, and we appreciate your perspective on it. 

Could you talk a little bit, just last thing, could you just tell employers where they can go to learn more about your organization? 

George Huntley (27:40) 

 Oh, sure. Absolutely. Diabetesleadership.org, quite simply. Send us a note, hit a contact us. We’d love to be in a dialogue with you. If you have any questions about what you can do, plan design, there’s an employer section on our site with some of the webinars that we’ve held and materials that we’ve got specifically for them to review. So welcome there.  

And thank you for having me today. I appreciate the opportunity to speak. 

Mike Stull (28:09) 

All right. Thanks, George. Thank you to George. 

I’m sure everyone living with diabetes thanks you and the Diabetes Leadership Council for your tireless advocacy. Again, you can learn more about George and the work of the Diabetes Leadership Council at diabetesleadership.org. 

Before we go, I want to thank our sponsors for helping to make this podcast possible, and also for supporting us and providing many of the great employee benefits related events and content that you see throughout the year. So, thanks to our annual supporters, CVS Health, OptumRx, and Elixir, and our executive supporters, Delta Dental, Para Therapeutics, Pfizer, and USRxCare. Visit employershealthco.com/supporters for a full list of sponsors. 

Again, don’t forget to submit your questions by completing the field on the landing page. There’s a link there that says submit your questions here, and then be sure to subscribe to HRBenecast to be notified when the latest episode is out, and so you can hear answers to your questions. 

There’s always something new at Employers Health, so be sure to follow us on our social media accounts, including LinkedIn and Twitter to stay up to date.  

So that’s it for this month’s episode. Thank you again to George and everyone at the Diabetes Leadership Council for the great work that they do, and thank you for taking the time to listen, for your continued membership, participation, and interest in Employers Health. 

Be well, and we’ll see you soon. 

In this podcast

Michael Stull, MBA

Employers Health | Chief Sales Officer

Since 2004, Mike Stull has been a contributor to Employers Health’s steady growth. As chief sales officer, Mike works to expand Employers Health’s client base of self-insured plan sponsors across the United States.

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George J. Huntley

Diabetes Leadership Council | Chief Executive Officer

George Huntley is a founding member of the Diabetes Leadership Council and currently serves as CEO of both the Diabetes Leadership Council and its affiliate, the Diabetes Patient Advocacy Coalition.

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