Vicky Ferrante, RD, CDCES, a dietitian and diabetes educator at Cheshire Medical Center, is on a quest for health equity for diabetes patients. This past year she led a successful effort to convince a government agency to expand its coverage for patients with diabetes. She defines health equity as giving everyone the opportunity to achieve the best health possible.
The agency was NH Medicaid, which had ruled that a new tool for controlling diabetes— the InPen—would not be part of its formulary, and therefore not covered by Medicaid. For Ferrante, who serves as Cheshire’s diabetes coordinator and diabetes care and education specialist, this ruling meant that many of the patients she worked with would not have access to the benefits of the new technology.
“They would be told they have to pay out of pocket for something that’s very expensive,” Ferrante said.
The InPen utilizes Bluetooth technology to calculate insulin doses and logs them on a smart phone device app, preventing patients from mistakenly giving themselves an extra dose. It also tracks insulin levels throughout the day and calculates the carbohydrates in a meal. Most insurance programs and Medicare cover the cost, but Medicaid doesn’t. The pen is priced at $549, which is not affordable for Medicaid recipients.
The manufacturer, Medtronic, has a program where people can pay just $35 for the pen, but Ferrante said even that is too much for many of her patients.
“They are faced with questions like, do I get that or get food? Do I get that or pay my heating bill? It shouldn't be a decision that you have to make," she said."
To persuade NH Medicaid to include the InPen in its formulary, she began circulating a petition to doctors, nurses and educators at Cheshire as well as around the Dartmouth Health system.
In the petition, it was noted that not having access to insulin can lead to complications like amputation, kidney disease, blindness and heart attack, which are costly health conditions that Medicaid would have to pay for. After she submitted the petition this past fall, it took just a few weeks to hear back, and the news was good. NH Medicaid would include the InPen in its formulary.
“I jumped for joy,” Ferrante said. “The situation with my patients is familiar, so it goes right to my core,” she said. “It’s inspired a huge passion in me.”
Ferrante has type 1 diabetes herself and understands well the challenges her patients face with affordability. During a time when she didn’t have health insurance that covered insulin, she struggled to pay the monthly cost of $1,000.
Her work extends to helping all patients who have difficulty affording insulin, even with health insurance. She works to get them manufacturers’ coupons or referred to Dartmouth Health’s Medication Assistance Program (MAP). The MAP program, which has eligibility requirements, helps patients obtain medications from pharmaceutical companies, either free or at a reduced cost.
“Our patients need these tools and resources to manage their diabetes and to be healthy,” Ferrante said.
In just the last nine months, more than 100 of Cheshire’s type 1 and type 2 insulin-dependent diabetes patients were put on insulin pumps, insulin patches or smart pen technology with the program. Her next quest is to petition Vermont Medicaid to put the InPen on its formulary. She has already petitioned Massachusetts. And, in the near future, when the newly designed insulin pumps come on the market, she’s ready to petition for those as well.
“I will petition whoever I have to to get it for my patients,” she said. “I just don’t stop.”
Ferrante encourages Cheshire patients with diabetes to reach out to their provider if they are having difficulty affording medication or are in need of resources to help with their diabetes goals.
For more information on Cheshire’s diabetes education program, visit cheshiremed.org/diabeteseducation.