A Public Plea For Pharmacy Benefit Policy Change on Modern Diabetic Supplies

As of January 2025, my copay for a 90-day supply of an insulin pump prescription jumped to over three times what I was paying in 2024.

I received a letter from my Pharmacy Benefits Manager (PBM), Express Scripts, that laid out this change quite bluntly:

“All diabetic supplies, including CGMs, insulin pumps, blood glucose meters, and their associated supplies, are considered brand-name products. Effective January 1, 2025, members will pay the brand copayment for higher-priced CGMs and their associated supplies (sensors, pods, and receivers), as well as insulin pumps and their supplies. Most of these higher-cost supplies will be preferred Tier 2 products. Other diabetic supplies (e.g., low-cost needles, syringes, lancets, and test strips) will continue to be available at the generic price ($13 copayment).”

The kicker here: an insulin pump is a specialized medical device, and there is no generic alternative listed for this kind of prescription when pricing medications.

This means the more affordable alternative is reverting back to multiple daily injections (MDI) with higher risk of health complications, high A1c levels, hypoglycemic episodes, and a lower quality of life as a type 1 diabetic.

Numerous scientific research studies have proven that insulin pumps (sensor-augmented or otherwise) are more effective at stabilizing blood sugar, safely improving quality of life, and lowering A1c levels than injection therapy. More importantly, pumps reduce risks of serious long term health complications when compared to manual injections. I’m including just a handful of these studies below:

Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy

Effects of insulin pump vs. injection treatment on quality of life and impact of disease in children with type 1 diabetes mellitus in a randomized, prospective comparison

Impact of insulin pump on quality of life of diabetic patients

Health-related quality of life and treatment satisfaction in the Sensor-Augmented Pump Therapy for A1C Reduction 3 (STAR 3) trial

Long-term efficacy of insulin pump therapy on glycemic control in adults with type 1 diabetes mellitus

Long-acting insulin analogs versus insulin pump therapy for the treatment of type 1 and type 2 diabetes

Personal anecdote time. I used injection therapy from Christmas 2005 when I was diagnosed with Type 1 diabetes (thank you Santa) until June of 2019, at which point I switched to using an insulin pump which has drastically improved my overall health and quality of life, and eliminated my fear of severe hypoglycemia, which I used to struggle with, especially in college. Not to mention all of my endocrinologists strongly and consistently advocated that I switch to a pump for years leading up to 2019. They were always disappointed, from a medical perspective, in my opting for daily injections before I experienced the benefits of pump therapy.

Now, as of January 2025, the price of a 3 month supply of that same insulin pump prescription has suddenly spiked 360%. Categorizing insulin pumps, sensors, and receivers as “brand-name” (Tier 2, to use PBM terminology) implies the existence of a “generic” (Tier 1, lower copay) version we can fall back to with the same health protections. However, there is no generic version of those pumps; they are all under the brand-name umbrella according to the PBM letter included above. Note what the letter from the PBM says:

Other diabetic supplies (e.g., low-cost needles, syringes, lancets, and test strips) will continue to be available at the generic price ($13 copayment).”

This means diabetic consumers like myself have to choose between paying significantly higher prices out of pocket for modern treatment or reverting back to multiple daily injections (MDI) which is scientifically proven to be an inferior method of diabetes management with serious long term health risks.

This 2025 policy shift forcing sudden higher copayments for modern treatment options poses a public health problem. Diabetes is already a major problem in South Carolina. A 2024 Blue Cross Blue Shield article reports that one in seven adults in South Carolina have been diagnosed with diabetes, and an article from the South Carolina Department of Public Health outlines that diabetes is a leading cause of death in the US, and the THE leading cause of kidney failure, lower-limb amputations, and adult blindness. To top that off, it also outlines that diabetes diagnoses are on the rise. Diabetes Free SC, a statewide initiative aimed to align actions against diabetes and improve the state’s public health, says that “diabetes imposes a staggering burden of $11,000 every minute on our state”. Wow.

We have no cure for Type 1 diabetes. Our only option, as it stands in 2025, is to treat it. As such, it is harmful to a large portion of the population to make the modern treatment option over three times more expensive in out of pocket cost than what it was previously in 2024.

I am pleading on behalf of all Type 1 diabetics in South Carolina for diabetic supplies like insulin pumps, continuous glucose monitors, meters, sensors, receivers, and transmitters to not be treated by Pharmacy Benefit Managers as “brand-name” prescriptions when there is no comparable “generic” alternative that delivers the same quality of life or the same level of control over the disease. To put this more clearly, injection therapy supplies should not be treated as generic alternatives to insulin pump therapy supplies because injection therapy poses risks to short and long term health that insulin pumps do not pose.

I’m sharing my story here because I believe that sharing our experiences is the first step toward making change. We need to continue advocating for better healthcare policies and raise awareness about how pricing decisions like this impact our lives. If we don’t, we risk putting vital tools for managing diabetes out of reach for many people who depend on them.

If you’re reading this and you’re facing similar challenges with the cost of diabetes care, you’re not alone. I encourage you to speak up, share your story, and advocate for affordable access to the tools that make a difference. Diabetics should not have to choose between health and financial stability.

Thank you for taking the time to read my story. I hope it sparks some form of conversation. If this resonated with you in any way, if you know someone with whom it might resonate, or if you have a connection to someone who can directly influence this kind of policy change, or if you’re down to just chat over coffee about tech and art and music and such in Greenville, I would love to talk with you.