Senator: Broadband for all Americans will improve access to health care

Lowering drug prices, putting more emphasis on wellness and lifestyle, and providing broadband access to all areas of the country are keys to improving patient care in the United States, according to Senators Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.).

The co-chairs of the Senate Diabetes Caucus shared their insights as part of the Oct. 19 session of Washington Post Live.

The Post recently reported Americans are not expected to live as long as other wealthy nations, due partly to sharp increases in chronic disease that started well before the COVID-19 pandemic. Collins said the drug overdose crises is causing increased premature death, and a lack of attention to prevention is contributing to chronic disease.

“I think we need to put more emphasis on prevention, on wellness, on lifestyle factors,” she advised. “There’s more and more research that identifies lifestyle factors as major contributors to diseases.”

Another key contributor to poorer health is the shortage of healthcare professionals, particularly in rural states like Maine.

During the COVID-19 pandemic, Collins took a call from a selectman (municipal officer) living on an island in Maine, who was worried how his constituents would get proper healthcare. His area did not have broadband to access telehealth services, and reaching the nearest healthcare facility involved a ferry ride and an hour-long drive.

Collins said she and Shaheen worked together to negotiate $65 billion into the infrastructure bill to bring broadband to all Americans. “That’s going to help improve our life expectancy, because it means no matter where you live, you’ll be able to do telemedicine at least,” she said. “That’s going to be very helpful.”

However, much of the conversation between the senators and Washington Post Live General manager Kathy Baird centered on efforts to lower drug prices.

“The system is rife with conflicts of interest and perverse incentives,” Collins said, referring to how pharmacy benefits managers (PBMs) are typically paid a percentage of the list price for the drugs they choose for an insurer’s formulary. “That encourages the manufacturers to have high list price because they want their brand of insulin to be chosen for the insurer to use for its beneficiaries.” She did not propose banning PBMs but argued their compensation should be a flat fee payment plan.

Shaheen agreed PBMs are driving up drug costs, but she noted there has been some legislative progress toward limiting drug prices. The 2022 Inflation Reduction Act capped insulin prices at $35, but that only applies to people on Medicare. However, young people with Type 1 diabetes need insulin to survive, and they are not included in Medicare.

Shaheen and Collins have been working on federal legislation since 2019 that would include capping out of pocket costs for drugs like insulin. “Twenty-five states have already done [this], so we know this is something that people think is a good idea,” she said.

The Collins-Shaheen legislation would also reduce prior authorization requirements and make it easier to bring generics and biosimilars to market — generics are non-branded version of chemical drugs, while biosimilars is the term used for non-branded versions of biologic drugs.

Biosimilar insulin is one of the real challenges, Shaheen noted. “Getting those biosimilars into the market would really help with the list price, and then it addresses the PBMs when it comes to insulin.”

Collins explained there was an insulin biosimilar introduced in the market in the past year or so, but it was not chosen by any PBM for inclusion in a single insurance formulary. “The company relaunched its biosimilar at a higher price, and then it got chosen,” she reported.

Despite the years of work led by Collins and Shaheen, the efforts to reduce rising drug prices have faced stiff challenge from the powerful and effective pharmaceutical lobby on Capitol Hill. “I think now people are beginning to understand what the impact of those high drug prices are, and [they] are being louder in terms of contacting their senators, their representatives,” Shaheen said, adding there is a huge cost for the federal government for not addressing PBM reform and the high cost of prescription drugs.

“Diabetes is one of the most expensive chronic illnesses we have in this country,” she noted. “We have 37 million people who have diabetes, and if we could address the high cost of insulin, that would be a huge saver for the federal government.”

However, there is growing bipartisan support to address this issue, she assured. “We’re seeing legislation to address some of those PBM excesses come out of both the Finance Committee and the Health Committee in the Senate, and … we’ve seen legislation go through the House committee as well.”

“Diabetes doesn’t care if you’re a Democrat or Republican,” Collins assured. “It’s been very rewarding to work on the special diabetes program, which provides research dollars and has led to tremendous breakthroughs in the technologies, including continuous glucose monitors which help test the blood sugar and avoid the needless blood tests day after day. We’ve seen the difference that technology can make.”

Shaheen highlighted promising work by Lonza and Vertex to produce islet cell therapy, which she believes may be a cure for diabetes. “They already have one person who has been insulin-free for three years,” she shared, adding the partnership is conducting clinical trials. However, they face what the senators called “bureaucratic challenges” from FDA. “Hopefully, the FDA will continue to allow them to move forward with those clinical trials, but it’s very exciting what’s happening there,” Shaeen said.