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In the late summer and fall of 2007, VVA put together a
white paper on the VA formulary, and circulated it on Capitol
Hill and elsewhere. Among other things, it showed that the
VA pharmaceutical formulary was much more restrictive than
either DoD or Medicare regarding new treatment medicines
for control of diabetes. We said that the VA was again being “penny
wise and pound foolish” because the so-called “savings
they made by effectively denying veterans and their clinicians
access to the best pharmaceuticals available were miniscule
in comparison to the expense of the damage done by diabetes
being not as well controlled and the damage done by the resulting
secondary conditions, both of which meant many more very
expensive acute care hospitalizations.”
Sen. Daniel
Akaka (D-Hawaii) wrote to the Undersecretary for Health regarding
this issue. The VA’s reply was
that there was no problem, that they were “the world
class” leaders in treating diabetes, even though the
evidence made it clear that this was not the case. As usual,
the VA maintained that it knew more than anyone else, including
DoD, the Medicare people, the American Diabetes Association,
and certainly more than veterans’ advocates.
After waiting
for five months, in March 2008 the Veterans Health Administration
quietly added the therapeutic category “long-acting
insulin” to the VA National Formulary. “This
is a significant victory for veterans with diabetes,” said
VVA President John Rowan. “The addition to the VA formulary
of newer therapeutic categories of drugs such as long-acting
insulin brings the VA closer into agreement with treatment
for diabetes in the rest of the country. This is a very positive
action that we have long advocated for.”
Of the approximately
5.5 million veterans who receive VA health care services,
some 20 percent, or 1,020,000, are diabetics. By comparison,
the American Diabetes Association estimates that some 7 percent
of the American population has diagnosed or undiagnosed diabetes.
The VA prevalence of diabetes can be attributed to the average
age of the veteran population (62), the predominance of men
(97 percent), and a higher rate of smoking than the general
population.
A recent
study by the VA Pharmacy and Therapeutics Society on the
implementation of new insulin glargine for patients with
diabetes revealed significant differences in implementation
between VA regions and treatment facilities, as well as problems
with the adoption of new therapies and the VA’s formulary
process, and the use of insulin glargine in the VA. The addition
of long-acting insulin to the National Formulary should improve
care across the VA system.
The evidence is overwhelming that
sub-optimal diabetes care results in drastically increased
costs, as well as poorer quality of life and worse clinical
outcomes, such as blindness, cardiovascular diseases, amputations,
and kidney problems.
The
benefit of long-acting insulin to help control blood-glucose
levels is that the patient generally does not have to take
as much insulin or as often. The patient has to monitor blood
sugar levels less often and has to take insulin less often.
Fewer needle sticks means better patient comfort and compliance.
Better blood-glucose control leads to fewer adverse complications
and a better quality of life.
Patients with diabetes or those
who believe they have diabetes should consult with their
physicians. The conditions that lead to diabetes include
being overweight, hypertension, raised cholesterol and lipids
levels, and smoking. The characteristic symptoms of diabetes
are excessive urine production, excessive thirst, increased
fluid intake, blurred vision, unexplained weight loss, and
lethargy.
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©2006-
2008, Vietnam Veterans of America. All Rights Reserved. 8605 Cameron
Street, Silver Spring, MD 20910