Diabetes Pharmaceuticals State Mandates

10/10/2016

NCSL Surveys 2016 Insurance Plans and State Laws Mandating Diabetes Coverage

A total of 29.1 million people in the United States have diabetes, equal to 9.3 percent of the total population as of 2014. An estimated additional 86 million adults age 20 and older have “pre-diabetes,” a condition that can still be halted, according to the Centers for Disease Control and Prevention (CDC). About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 in the United States. The CDC data report released in 2008 confirmed that diabetes is the largest and fastest-growing chronic disease in the nation.

Diabetes has become a costly chronic condition in the United States. According to the Health Care Cost Institute, medical costs and productivity loss attributable to diabetes were estimated to be $245 billion in 2012.

  • From 2009 to 2013, people with diabetes spent on average 2.5 times more out of pocket than people without diabetes.
  • An individual with diabetes spent $1,922 out of pocket on health care services in 2013 while an individual without diabetes spent $738.
  • Among members with health insurance and a claim for any diabetes drug, 6% were Type 1, and 94% were Type 2.
  • Among people with a health insurance insulin claim, 24% were Type 1, and 76% were Type 2.

State Actions

Forty-six states and D.C. have some type of diabetes statutory mandate for coverage. State legislatures were the first to take the lead in connecting diabetes patients’ treatment needs with health insurance coverage. In the 35 years since California and then New York became the first states to require or “mandate” expanded private market health insurance coverage for diabetes treatment, such state laws spread nationwide. These state laws set an early and enduring commercial standard for providing covered treatment for patients diagnosed with diabetes. They provide an assured floor of reimbursed coverage for every individual enrolled in individual and small-group health plans. While the legal language and the enforcement details vary among states, in most, the state’s insurance department is tasked with administering the law, including recording violations by insurers. Enforcement can include civil fines, disapproval of a proposed benefit package, and for patients, expedited external appeals to obtain drugs initially denied.

Diabetes state law mandates-2016 by NCSL

“Mandated” benefits versus “Mandated offeringexplained: For diabetes coverage, two states have opted for a middle-ground approach that requires each state regulated health insurance company to offer at least one (or more) health plan design option that covers required treatments including medication, but that same insurer may offer and sell other health plans that omit such coverage. Full mandates require every state regulated health policy to cover the mandated benefit. In all 50 states, the price, including annual premiums, up-front deductibles and copayments may vary according to the overall extent of policy coverage. Separately, the Affordable Care Act (ACA) has a non-discrimination provision that no longer allows higher premiums solely because a patient is diagnosed with a condition such as cancer, MS or diabetes.

Who is covered by state mandates, explained: For the past 40 years states have had the authority and option to regulate health insurance, including benefits, providers and covered populations for in-state policies, with one major exception and exclusion. While policies generally sold to individuals and small or medium sized employers and classified as “fully-insured” are state regulated (40-45% of the total nationwide), policies administered as “self-insured” typically by large employers (200 to 500,000+ employees, about 55-60% nationwide) are only regulated by federal laws and the U.S. Department of Labor, frequently termed "exempted by ERISA."

NCSL 2016 DIABETES SURVEY

For 2016, NCSL conducted the first publicly available 50-state survey, Health Insurance Required Coverage Related to Diabetes Prescription Drugs. This survey and report provides an in-depth examination of insurance coverage for prescription drugs used in the treatment of diabetes.  The survey shows:

1) the extent and variety of current diabetes medication coverage in each state and

2) comparative results in the 46 states with laws mandating or offering diabetes coverage.

Survey Sample: The report sampled the lowest-premium bronze and silver-metal level plans offered by private insurers for sale on the state and federal insurance marketplaces in plan year 2016. In cases where the lowest-premium silver and bronze metal level plans were offered by the same carrier, a second silver-level plan was included. While the survey was extensive, it is not a full representation of health insurance coverage in each state. Almost every state has dozens of other, generally higher priced, plan options, classified as "bronze" at 60% reimbursement, "silver" at 70% reimbursement; "gold" at 80% reimbursement and "platinum" at 90% reimbursement.  These higher-priced plans tend to have at least the same, or more comprehensive coverage as those surveyed, and are not detailed in the survey results reported here.

The sample plans reflect trends among policies sold primarily on health exchanges, which nationwide provide coverage to a varying 11.7 - 13 million Americans. Health plans sold outside of exchanges typically have similar lists (or "formularies") of available drugs but can vary for specific products.  

Diabetes Products: The plans were analyzed to determine coverage for 80 differently named brand-name and 20 generic drugs used in the treatment of diabetes, for a total of upwards of 100 prescription drug products surveyed. Insulin products are included because of their widespread importance to diabetes treatment, although they are usually not taken in pill or capsule form.  All available products were included and tallied for each surveyed plan; the column totals below may vary slightly due to "branded generic" products, which compete for availability, although considered identical by the FDA for medical treatment purposes. Individual patient intolerance to a coating or dye or extended release feature, or a young or old age, may lead to a prescriber-designated use of one specific manufacturer's product.

Disclaimers: Drug product counts by state or color coding (below) are intended only as comparative background information. They are not an indication of medical needs, effective outcomes or satisfaction regarding treatment for diabetes. NCSL information is not intended as medical or legal advice, nor promoting or endorsing any particular products or treatment options.


NCSL survey results revealed that: 
1) Diabetic patients can gain access to almost all currently approved medication, but there are some significant variations by insurer, by state and by health plan category.
2) The diabetes treatment state 
mandates provide, or coincide with, a broad assurance of access to treatment, and insurance coverage and reimbursement, for those enrollees once they are diagnosed with diabetes.  
3) The state mandates do
not legally guarantee coverage for individual medications by name or by brand. Those decisions are made by a combination of a) the patient's physician or prescriber, b) the health insurers' published medication formulary or "preferred drug list (PDL)" and, c) since 2014, the benchmark "essential health benefits (or EHB)" plan for the state, as required by the Affordable Care Act and approved by HHS.

Map of diabetes drug coverage in health insurance

NCSL’s report found that for the selected surveyed plans in all 50 states and D.C.:

  • 30 states and D.C. had at least one of the two surveyed plans listing 50 or more brand choices.
  • All states and D.C. show varying coverage of selected brand name drugs, offering anywhere from 12 to 60 drugs. [details inTable 2]
  • All states and D.C. provide coverage for at least 11 or more of selected generic drugs.
  • In 45 states and D.C., the surveyed health plan with the larger number of generics covered 15-20 products. By comparison, in 35 states the surveyed plans with less coverage covered 15 to 19 products. More restricted coverage of 5 to 10 generic products occurred in just four states (Alaska, California, Colorado, and New York) and D.C.
  • The four states that do not require any diabetes coverage, nonetheless had surveyed plans that covered a slightly larger number of drugs. Each such state offered 49 or more drugs within their more expansive (usually "silver") insurance plan surveyed.
  • The state plan surveyed with the most coverage, South Dakota, offered 60 distinct drugs.
  • None of the states with a state insurance law that requires "offering" diabetes coverage (e.g., Missouri, Mississippi, and Washington) covered fewer than 41 drugs. 
  • Colorado and the DC have the lowest coverage, offering 15 or fewer drugs in at least one surveyed insurance plan. Both state populations met the average national diagnosed diabetes rate, 9.1 percent, or less. In 2014, 6.9 percent of Colorado adults were diabetic and 9.1 percent of the District of Columbia’s adults were diabetic.
  • West Virginia had a diagnosed diabetes rate at 12 percent and their surveyed plan with the most coverage provided 57 drugs.

Diabetes Drug Coverage by State (2016 Health Insurance Policies) - TABLE 1

50-state table of diabetes drug coverage by state

 State diagnosed diabetes percentages (as reported by CDC) and NCSL’s report reveal some trends by state, such as:

  • Seven out of the eight states that covered all surveyed drugs in six distinct drug classes have state insurance law diabetes mandates.
  • All 50 states and D.C. provided coverage for the same seven generic drugs at the lowest-cost tier level in at least one of their insurance plans,
    (These drugs are: acarbose, glimepiride, glipizide, glyburide, glyburide and metformin combination, metformin, and pioglitazone).
  • Some states with lower diagnosed diabetes percentages tend to provide less guaranteed coverage on specific diabetes drugs than those states with higher diagnosed percentages.
  • While diabetes mandates have increased required drug and equipment coverage, there are multiple factors that influence or affect the list of states with higher coverage quantities.  These non-state law factors include: marketing strategies by commercial health plans, the list price or "average wholesale price," and the actual discounted price obtained by each insurer. The prescribing decisions and practices of individual physicians and other licensed prescribers also can be a factor - if few patients' prescriptions require a specific product it may not be listed.  

State Laws Mandating Diabetes Coverage

For more information about state laws mandating diabetes coverage, visit NCSL's detailed report, Diabetes Mandates State Laws.
The tables and map above include enacted state laws passed since the first mandates in California (1981) and New York (1993). Use links below to go directly to state-based information:

Insurance Plan Tier Levels

Health insurance formularies and preferred drug lists (PDL) must be provided to patients as explanations of prescription drug coverage and approximate costs for each specific product. Insurance plans often use tier levels to indicate patients’ out-of-pocket costs in the form of a copayment or coinsurance, for each product. They typically provide two to four (occasionally up to six) “tiers” to explain product prices. Drug tier designations frequently indicate which products are “preferred” and “non-preferred.” Non-preferred products are generally categorized into tier levels with higher out-of-pocket costs for patients.

Many insurance plans—especially those with the lower-end monthly premium costs—have annual high deductibles that must be paid by patients before the plans will begin to cover prescription drug costs. For this reason, purchasers and enrollees are generally advised to research and compare formularies before purchasing an insurance plan. Generic drugs are usually offered at lower cost tier levels by insurance plans. This is one way patients and insurance carriers keep prescription drug costs down.

Brand-Name Diabetes Drugs

Generally, patients with more severe conditions are more likely to be prescribed newer, sole-source or brand medications that patients with less severe conditions. Additionally, some diabetes patients may require more than one drug to effectively control their blood glucose levels. Several drug classes are only available as brand-name drugs.

Survey Results: The survey revealed several sole-source prescription medications that were offered in all 50 states and D.C. within selected insurance plans. All insurance plans offered patients access to various types of insulin. Within the plans surveyed, the other drug class available in all 50 states and D.C. was Dipeptidyl Peptidase 4 Inhibitors (DPP-4), which promote the release of insulin from the pancreas after eating a meal see Treatment Classes Table below.

Six additional brand-name drugs identified in NCSL’s survey were also listed among Medscape’s top 100 most prescribed brand-name medications in the U.S. through June 2015.

Generic Diabetes Drugs

Brand-name drug manufacturers are given patents for their products for a specified time and once they expire, they can be manufactured by others and sold as a generic drug. Generic drugs are required to scientifically demonstrate that their product is bioequivalent—performs in the same manner—to the original drug. The price decreases that occur are generally attributable to factors outside of state jurisdiction, such as market competition and lower operating expenses for generic-drug manufacturers.

Survey Results: NCSL found that patients with diabetes can gain access to nearly all currently approved medication, but there are significant variations by state, insurer and plan category. The survey examined two insurance plans in every state, including their formularies and cost tiers, to measure the amount of diabetes prescription drugs covered.

Coverage for specific drugs may vary based on insurance plan. According to Express Scripts’ 2015 Drug Trend report: Approximately 53 percent of diabetes prescriptions were filled with generic versions of medications in 2015. According to the NCSL survey, plans in all 50 states and the District of Columbia included the following generic drugs in at least one insurance plan: Acarbose, Glimepiride, Glipizide, Glyburide, Glyburide/Metformin Combination, Metformin, and Pioglitazone.

Metformin, a widely used generic diabetic drug, decreased in price from $1.24 to 31 cents per pill between 2002 and 2013. According to Medscape, metformin was one of the top ten most prescribed generic medications nationwide in 2014, with about 61.2 million authorized prescriptions in their survey. It also is widely available outside of insurance through low-cost monthly programs offered by large chain stores. Insulin, one of the most common diabetic drugs, is not manufactured as a generic drug in the U.S., although the FDA approved the first “follow-on” insulin product, "glargine" to treat diabetes in December 2015.  The effects on consumer access and cost are not yet determined.

Legislative Options.  NCSL’s 2016 state survey data provides examples of how many and which medications are available, and what tier (copayment) level is required from enrollees. States may choose to review their current mandate statute and their 2016 and 2017 "Essential Health Benefit state benchmark."  NCSL Members may request these detailed results for their individual state.

Federally Mandated Diabetes Benefits

Private Insurance Plans Obtained on a Health Insurance Marketplace

Under the terms of the Patient Protection and Affordable Care Act (ACA), as of 2014, all insurance carriers selling federally “Qualified Health Plans” (QHP) must provide coverage for certain prescription drugs, prescription medical devices, and medical examinations related to diabetes or diabetes prevention. These benefits, known as Essential Health Benefits (EHB), include a new class of preventive benefits, which are summarized in the following chart, obtained with information from healthcare.gov.

Essential Health Benefits Covered Under Marketplace Plans

Classification

Payment/Reimbursement

Diabetes (Type 2) screening for adults with high blood pressure

Preventive care benefits for adults

No copay or coinsurance, regardless of deductible

Diet counseling for adults at higher risk for chronic disease

Preventive care benefits for adults

No copay or coinsurance, regardless of deductible

Obesity screening and counseling

Preventive care benefits for adults

No copay or coinsurance, regardless of deductible

Height, weight and body mass index (BMI) measurements for children ages 0 months to 17 years

Preventive care benefits for children

Free when provided by an in-network provider (Medicaid and Marketplace plans)

Obesity screening and counseling

Preventive care benefits for children

Free when provided by an in-network provider (Medicaid and Marketplace plans)

Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes

Preventive care benefits for women

Free when provided by an in-network provider (Marketplace plans)

Preventive and wellness services and chronic disease management

Essential Health Benefit

Covered by all marketplace plans

 

Medicaid

In addition to the benefits required for private health insurance plans obtained on a Health Benefits Exchange or Marketplace, the ACA also mandates certain benefits related to diabetes for state-administered Medicaid plans. To qualify for coverage under a Medicaid plan, a person must meet specific state and federal income requirements. Medicaid coverage is beyond the scope of this state survey.

Diabetes Pharmaceuticals by Treatment Class

Drug Class

Number of Brand-Name Drugs in Class

Brand-Names of Drugs in Class

Generic-version of Drug(s) Available for Purchase (Y/N)

Alpha-glucosidase inhibitor

2

Glyset; Precose

Y

Amylin analog

2

SymlinPen 60; SymlinPen 120

N

Antidiabetic

1

Proglycem

N

Biguanide
(generic: Metformin)

5

Fortamet; Glucophage; Glucophage XR; Glumetza;  Riomet

Y

Bile Acid Sequestrant

1

Welchol

N

Dopamine receptor agonist

2

Cycloset; Parlodel

Y

DPP-4 inhibitor

4

Januvia; Nesina; Onglyza; Tradjenta

N

DPP-4 inhibitor- biguanide combination

6

 Janumet; Janumet XR; Jentadueto; Kazano; Kombiglyze; Kombiglyze XR;

N

DPP-4 inhibitor-thiazolidinedione combination

1

Oseni

Y

GLP-1 receptor agonist

5

Bydureon (QL); Byetta; Tanzeum; Trulicity; Victoza

N

Glucagon

2

GlucaGen® HypoKit®; Glucagon Emergency Kit (QL)

N

Inhaled insulin powder

1

Afrezza

N

Insulin

24

Apidra; Apidra Solostar; Hagedorn NPH; Humulin (Insulin injection); Humulin 70/30; Humulin N; Humulin R; Humalog (Insulin injection); Humalog Kwikpen; Humalog 50/50; Humalog 75/25; Lantus (insulin glargine injection); Lantus SoloStar; Levemir; Novolog (Insulin rapid-acting); NovoLog 50/50; NovoLog 70/30; Novolin; Novolin N; Novolin R; Novolin 70/30; Relion R; Toujeo Solostar ; Tresiba

N

Meglitinide

2

Prandin; Starlix

Y

Meglitinide-biguanide combination

1

Prandimet

Y

Sodium-glucose co-transporter 2 (SGLT2) inhibitor

3

Farxiga; Invokana; Jardiance

N

sodium-glucose co-transporter 2 (SGLT2) inhibitor-biguanide combination

3

Invokamet; Synjardy; Xigduo XR

N

Sodium-glucose co-transporter 2 (SGLT2) inhibitor-DPP-4 inhibitor combination

1

Glyxambi

N

Sulfonylurea

7

Amaryl; Diabeta; Glucotrol; Glucotrol XL; Glynase; Micronase

Y

sulfonylurea- biguanide combination

2

Glucovance; Metaglip

Y

Thiazolidinedione

2

ACTOS; Avandia

Y

Thiazolidinedione-biguanide combination

3

Avandamet; Actoplus Met; Actoplus Met XR (e.g., only Actoplus Met and Actoplus Met XR are offered as generic)

Y

thiazolidinedione-sulfonylurea combination

1

Duetact

Y

 

Drug Treatment Class Coverage by State- TABLE 2: Several widely prescribed drug treatment classes were chosen to further examine by comparing amount of drugs covered in each class by state. The classes chosen are listed in columns 2-7 in the Table #2 below.

DPP-4 Inhibitors and SGLT-2 drug classes had the most coverage overall, with 35 states and D.C. providing coverage on all surveyed drugs within each class in at least one plan. The table below includes average levels of coverage across all drug classes according to drugs surveyed to provide an in-depth look at class coverage across states. 

Extent of Coverage by Selected Drug Class

TABLE #2

States

DPP-4 Inhibitors

DPP-4 Biguanide Comb.

GLP-1

SGLT-2

SGLT-2 Biguanide Comb.

SGLT-2     DPP-4 Inhibitor Comb.

TOTAL # DRUGS

(Total - 4)

(Total - 6)

(Total - 5)

(Total - 3)

(Total - 3)

(Total - 1)

AL                                   

4

6

5

3

3

1

AK

4

5

5

3

3

1

AZ

4

5

4

3

0

0

AR

4

6

5

3

2

0

CA

2

0

0

1

0

0

CO

2

2

2

3

2

0

CT

4

5

5

3

3

1

DE

4

5

5

3

3

1

FL

4

6

5

3

3

1

GA

4

5

3

1

0

0

HI

4

5

5

1

1

0

ID

4

5

5

3

3

1

IL

4

5

5

3

3

1

IN

4

5

5

3

3

1

IA

4

5

4

2

2

1

KS

4

6

5

3

3

1

KY

2

3

4

3

3

1

LA

3

5

5

3

3

1

ME

3

3

4

2

1

0

MD

4

6

5

3

3

1

MA

3

4

5

3

3

1

MI

4

5

5

3

3

1

MN

3

4

4

2

2

0

MS

3

3

3

2

2

0

MO

4

6

5

3

3

1

MT

4

5

5

3

3

1

NE

4

6

5

3

3

1

NV

4

5

5

3

1

1

NH

3

4

4

2

2

0

NJ

4

5

5

3

2

1

NM

3

5

3

2

0

0

NY

2

3

2

2

1

1

NC

4

5

5

3

3

1

ND

4

5

5

3

3

1

OH

4

5

5

3

2

1

OK

4

6

5

3

3

1

OR

4

6

3

3

3

1

PA

4

6

5

3

3

1

RI

3

4

5

3

3

0

SC

4

6

5

3

2

1

SD

4

5

5

3

3

1

TN

4

4

3

2

2

1

TX

4

6

4

3

3

0

UT

3

4

3

2

2

0

VT

4

5

5

3

3

1

VA

4

3

4

2

0

0

WA

3

3

4

2

2

0

WV

4

5

5

3

3

1

WI

3

4

2

2

0

0

WY

4

5

5

3

3

1

DC

4

5

5

3

2

0

50-State Average for Treatment Class

3.6

4.7

4.3

2.7

2.3

0.7

Source: NCSL Diabetes drug coverage survey, July 2016.  Added: 8/28/2016
 

 

DIABETES DRUG CLASSES EXPLAINED

Alpha-glucosidase inhibitor: A class of oral medications for type 2 diabetes that decrease the absorption of carbohydrates from the intestine, resulting in a slower and lower rise in blood glucose throughout the day, especially right after meals.

Amylin analog: Amylin is a 37 amino acid polypeptide hormone that is secreted with insulin from the beta cells in the pancreas. In diabetes, as less insulin is secreted there is also a deficiency of amylin. Amylin assists insulin in postprandial glucose control. It inhibits glucagon secretion, delays gastric emptying and signals satiety, suppressing the intake of food.

Amylin analo are stable synthetic compounds, which are administered subcutaneously before meals, and work similarly to the physiological amylin.

Biguanide: Oral type 2 diabetes drugs that work by preventing the production of glucose in the liver, improving the body’s sensitivity towards insulin and reducing the amount of sugar absorbed by the intestines.

Bile Acid Sequestrant: Drugs that]bind bile acids in the intestine and increase the excretion of bile acids in the stool. This reduces the amount of bile acids returning to the liver and forces the liver to produce more bile acids to replace the bile acids lost in the stool. In order to produce more bile acids, the liver converts more cholesterol into bile acids, which lowers the level of cholesterol in the blood.

Dopamine receptor agonist: Drugs that work by binding to dopamine receptors on dopaminergic neurons (the neurons that normally synthesize and use dopamine) in the neurotransmitter’s absence. Stimulation of the receptors increases dopaminergic activity in the brain.

DPP-4 inhibitor: DPP-4 inhibitors are a class of prescription medicines that are used with diet and exercise to control high blood sugar in adults with type 2 diabetes. DPP-4 inhibitors lower blood sugar by helping the body increase the level of the hormone insulin after meals. Insulin helps move sugar from the blood into the tissues so the body can use the sugar to produce energy and keep blood sugar levels stable.

GLP-1 receptor agonist: The glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of injected drugs for the treatment of type 2 diabetes. They mimic the action of GLP-1 and increase the incretin effect in patients with type 2 diabetes, stimulating the release of insulin. They have additional effects in reducing glucagon, slowing gastric emptying, and inducing satiety.

Glucagon: Glucagon is a hormone produced by the pancreas that, along with insulin, controls the level of glucose in the blood. Glucagon has the opposite effect of insulin. It increases the glucose levels in blood. Glucagon, the drug, is a synthetic (man-made) version of human glucagon and is manufactured by genetic engineering using the bacteria Escherichia coli. Glucagon is used to increase the blood glucose level in severe hypoglycemia (low blood glucose).

Inhaled insulin powder: Rapid-acting inhaled insulin that is administered at the beginning of each meal.

Insulin: A hormone that helps the body use glucose for energy. The beta cells of the pancreas make insulin. When the body cannot make enough insulin, it is taken by injection or through use of an insulin pump.

Meglitinide: A class of oral medicine for Type 2 diabetes that lowers blood glucose by helping the pancreas make more insulin right after meals.

Sodium-glucose co-transporter 2 (SGLT2) inhibitor: A new group of oral medications used for treating type 2 diabetes. The drugs work by helping the kidneys to lower blood glucose levels.

Sulfonylurea: A class of oral medicine for Type 2 diabetes that lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes.

Thiazolidinedione: A class of oral medicine for Type 2 diabetes that helps insulin take glucose from the blood into the cells for energy by making cells more sensitive to insulin

Definitions containing linked text are quotes and paraphrases of third-party sources.

 

Additional Resources

 

  • NCSL Diabetes Overview -  online reports, NCSL publications and recent news. Updated summer 2016

  • As Costs and Use Rise, Diabetes Drugs Are Growing Driver of Pharmacy Benefit Spend  [Read full article] - "The studies included 3.9 million members with both Type 1 and Type 2 diabetes. Among members with a claim for any diabetes drug, 6% were Type 1, and 94% were Type 2. Among people with an insulin claim, 24% were Type 1, and 76% were Type 2. In the first study, researchers found that (of those 3.9 million studied) in the first half of 2011, all diabetes pharmacy claims cost $106 million, but by the first half of 2015, those costs had risen 168% to $285 million. - Health Business Daily, May 31, 2016.

Acknowledgments

Selected survey results on this webpage have been reviewed by several experts in the pharmaceutical field.

  • Delegate Don Perdue of West Virginia and Senator Linda Parlette of Washington state, both of whom are licensed pharmacists, played a helpful part in identifying academic experts with broad knowledge of products and practices.
  • Joshua Neumiller, Vice-Chair and Associate Professor of the Department of Pharmacotherapy, Director of Experiential Services, and the Diabetes Spectrum Editor-in-Chief at Washington State University’s College of Pharmacy has reviewed and contributed to the diabetes pharmaceutical table and glossary.
  • Dr. Robert Stanton, Assistant Dean of Experiential Learning and Associate Professor of Pharmacy Practice at Marshall University in West Virginia, contributed narrative content and a descriptive diabetes pharmaceutical chart.
  • Megan Peterson, clinical pharmacist at Valley Health Systems, Inc., a network of non-profit health centers in West Virginia and a Tri-State leader in the delivery of primary healthcare. She reviewed draft materials.

Their information has contributed to this NCSL report and webpage and we thank each of them for their material and efforts.

NCSL acknowledges the support of Boehringer Ingelheim Pharmaceuticals, Inc. for this research project.

With the exception of quotations and citations from other sources, NCSL’s survey project staff remain solely responsible for the content and description of the diabetes survey.

Project staff: Ashley Noble is a policy specialist for the Health program in the Denver office. Richard Cauchi is a Health Program director in the Denver office. Savannah Robinson served as research and assistant editor for the project. Andrea Pascual also served as a research assistant, Dec. 2015-Jan. 2016.