First to Zero

Ending Out of Pocket Healthcare Costs for Rhode Island One Drug at a Time

A message from Helena: 

 

Leading the decision to put people over profits and stop selling tobacco at CVS was the proudest moment of my career, and it’s time to take a similarly bold approach to eliminating out-of-pocket costs for diabetes and asthma medication in Rhode Island. In a state of only 1.1 million people, we can be a national leader in delivering high-quality, affordable healthcare to people in every community. My ‘First to Zero’ plan will make Rhode Island the first state in the country to eliminate out-of-pocket costs associated with diabetes and asthma medication.

 

We all know the old phrase, “an ounce of prevention is worth a pound of cure.” When it comes to life-saving medications, the data proves the point. From insulin for diabetes to statin drugs for heart disease, modern science has invented incredible medication. Unfortunately, in the United States that medication can come at an unaffordable cost, especially for seniors. But it doesn’t have to be that way.

 

Right now, we’re getting the worst of both worlds with high costs and comparatively lower compliance with medication. People pay more and overall health outcomes are worse. If we can eliminate as many out-of-pocket costs to Rhode Islanders as possible, then we can both improve health outcomes and actually reduce costs over the long-term.

 

For the first time in nearly 20 years, Washington is finally starting to address this problem–but there’s more we can do here in Rhode Island. With a $15 million annual investment and partnership with policymakers, insurance companies, private employers, and the federal government, my ‘First to Zero’ plan will make Rhode Island the first state in the country with $0 copays for diabetes medication and over time, asthma medication as well.

 

We will start by ensuring that when it comes to diabetes, no Rhode Islander will ever have to go without medication because of costs. Over time, we will use the long-term savings generated from better care to add additional life-saving therapies to the program, like long-term control medication for asthma and HIV medication.

 

Fighting back against the special interests is never easy and this won’t happen overnight, but I know that we can come together to make these life-saving medications affordable for all Rhode Islanders.

 

Take a look at my plan and send feedback to helena@helenafoulkes.com!

 

Thank you,
 

Helena

POLICIES


 

Diabetes Medication

92,821 people in Rhode Island have been diagnosed with diabetes, while an estimated 23,000 more have it but don’t know it. That’s nearly 1 in 10 Rhode Islanders and a diabetes diagnosis means an average of nearly $10,000 in medical costs each year. Communities of color are disproportionately impacted by diabetes– in the United States, black adults are nearly twice as likely as white adults to develop type 2 diabetes.

 

The CDC notes that properly managing diabetes can drastically increase long-term healthcare outcomes and reduce costs. In fact, “Effective blood sugar management can reduce the risk of eye disease, kidney disease, and nerve disease by 40%.” Given that 1 out of every 4 dollars in US healthcare costs goes towards treating people with diabetes, doing everything we can to make sure people can afford and take their medication is important for both health outcomes and expenditures.

 

Sadly, more than 16% of adults making less than $50,000 a year don’t take their prescriptions for diabetes because they simply can’t afford it. The private sector has already taken note of this and in 2020, CVS started offering no out-of-pocket expenses on diabetes treatment for patients in its healthcare plans, noting that in the long run this will actually save money because of better health outcomes. CVS estimates that, as a result, “improvements are estimated to save $156 per member per year.”

 

Rhode Island enacted important legislation capping copayments for insulin at $486 dollars a year, which is an important first step but in a time of record-breaking inflation, still a barrier to treatment. The recent federal legislation also reduces Medicare insulin co-pays to $426 a year (from $608). Both of these steps make diabetes treatment the best place to fully eliminate copays.   

 

  • Private Insurance: To ensure full implementation, Helena will work with both policymakers in the state and the private insurance industry. This will likely include initial state financial support in exchange for Rhode Island capturing a percentage of the expected savings from higher compliance.
     

  • Seniors: Rhode Island’s ability to interact directly with Medicare is limited, but Helena’s ‘First to Zero’ initiative will create a rebate program to ensure that seniors are fully covered.
     

  • State Workers, Medicaid, and Other Populations: As Governor, Helena will work to redesign these programs to ensure that all participants have zero copays for diabetes medication.

Expanding Beyond Diabetes Medication
 

As residents, insurance companies, and the state government all start seeing savings, the Rhode Island Department of Health will issue an annual report showing exactly how much savings are generated each year. As Governor, Helena will use those savings to add additional drugs to the program.

 

Asthma treatments will be the next to tackle given the massive savings generated from receiving proactive, regular asthma treatment. Today more than 125,000 Rhode Islanders have asthma and each spend an average of $529 a year towards hospitalizations, many of which could be prevented or severely reduced with strict adherence to treatment.

 

The implementation of the Affordable Care Act is a great example of how this works in practice. After Rhode Island’s uninsured rate significantly decreased, ER visits for patients have decreased 30% since 2012. That means healthier Rhode Islanders and less spending.

 

HIV medication is another area where the same type of drug compliance savings may be able to be found and would be the likely third candidate for this program.

Cost Breakdown
Diabetes
2023
2024
2025
2026
2027
State Support
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
Potential Savings
$0
$750,000
$1,500,000
$3,750,000
$7,500,000
Asthma
2023
2024
2025
2026
2027
Potential Saving
$0
$0
$37,500
$187,500
$937,500
State Support
$0
$375,000
$750,000
$1,875,000
$3,750,000
HIV
2023
2024
2025
2026
2027
Potential Savings
$0
$0
$0
$0
$0
State Support
$0
$0
$18,750
$93,750
$468,750

Fighting for Every Penny for Rhode Islanders

From pharmaceutical manufacturer rebates to additional federal funding, there are a number of ways both the state of Rhode Island and its citizens can reduce their drug costs, but far too many people in our state are simply unaware. That is why as part of the ‘First to Zero’ initiative, the state will launch an awareness campaign in addition to a website and hotline accessible in multiple languages where Rhode Islanders can learn about their best options to further reduce drug costs.