The importance of insulin donations for children in 43 low- and middle-income countries.

Diabetes mellitus is rapidly becoming one of the major diseases affecting people's health globally. Over half of 100 million diabetes patients who need insulin to survive, especially in low- and middle-income countries (LMIC), are not able to get this medicine and die prematurely. Since 2000, insulin-producing companies have started support programmes with a component of insulin donations to children and youth with type 1 diabetes in 43 LMIC. Based on their experiences we conclude, contrary to common belief, that the diagnosis, treatment, and prevention of fatal complications in children with type 1 diabetes in LMIC are very possible in practice, with large improvements in survival, mean body weight, mean glucose levels, and frequency of complications. Medicine donations can never offer a sustainable solution and we now propose a ten-step transition process towards a fully sustainable national diabetes care and prevention programme for children and youth with diabetes type 1.

On reimbursement reforms and stockpiling of prescription drugs: the case of insulin.

OBJECTIVES: To show that care should be taken in studies which aim at linking prescription drug prices to purchased quantities due to anticipation and stockpiling effects. METHODS: Using purchasing records for a 20% random sample of the entire Danish population, the effects of increasing co-payments are estimated using fixed effects techniques. RESULTS: The results indicate that insulin-takers react to announced changes in reimbursement policies by stockpiling on their medications. CONCLUSION: Using before-and-after comparisons to identify the price responsiveness of prescription drug demand can be very misleading, when changes in co-payments are announced.

Adoption of a new technology in a Veterans Affairs national formulary system with local implementation: the insulin glargine example.

A study group gathered by the Pharmacy & Therapeutics Society reviewed data on the Department of Veterans Affairs (VA) health care system's implementation of a new technology (insulin glargine) for patients with diabetes. It examined local implementation of VA criteria for nonformulary use of insulin glargine in 21 VA treatment facilities that were surveyed about the issue. The examination found differences in the use of insulin glargine across the 21 treatment facilities and in the approach to implementing the criteria for nonformulary use of insulin glargine used at the individual VA treatment facility level. Differences were identified regarding the respective roles of endocrinologists and PCPs in prescribing insulins, including insulin glargine. The study group urges further short- and long-term research to better understand the utilization, cost, and health outcome implications of the implementation process for the nonformulary criteria. Lessons learned from such research could benefit other health care systems and formulary committees.