The Role of Law in Health Services Delivery: Diabetes and State-Mandated Benefits

Diabetes is a chronic and systemic disease that has reached epidemic proportions. An estimated 17 million Americans have diabetes (5.9 million of which are undiagnosed), and an additional 16 million individuals are considered to have pre-diabetes. Studies have shown that timely screening and referral are necessary to maintain healthy blood glucose levels and slow the progression of diabetes-related complications. Furthermore, lifestyle changes (i.e., altered diet and physical activity) can prevent or delay the onset of Type 2 diabetes for high-risk individuals.The Division of Diabetes Translation at the Centers for Disease Control and Prevention undertook an analysis of diabetes-related legislation across the nation. More specifically, state laws, rules and regulations mandating health insurance coverage for diabetes-related supplies and services were examined according to Sample Purchasing Specifications for Services Related to Diabetes—an evidence-based model of standards of care for persons with diabetes.

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Impact of State Laws That Extend Eligibility for Parents' Health Insurance Coverage to Young Adults

PEDIATRICS ◽

10.1542/peds.2011-1505d ◽

2012 ◽

Vol 129 (3) ◽

pp. X3-X3

Keyword(s):

Young Adults ◽

Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

State Laws

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The Complex Cancer Care Coverage Environment — What is the Role of Legislation?

The Journal of Law Medicine & Ethics ◽

10.1177/1073110520958879 ◽

2020 ◽

Vol 48 (3) ◽

pp. 538-551 ◽

Cited By ~ 1

Author(s):

Christine Leopold ◽

Rebecca L. Haffajee ◽

Christine Y. Lu ◽

Anita K. Wagner

Keyword(s):

Cancer Care ◽

Insurance Coverage ◽

Cancer Therapeutics ◽

Health Insurance Coverage ◽

Cancer Therapies ◽

Cancer Treatments ◽

Difficult Situation ◽

Cell Therapies ◽

State Laws ◽

Anti Cancer

Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immunooncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications — including high prices and often limited evidence of efficacy at approval — compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates.

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