Chairman Hunt and Members of the Committee on Commerce and Consumer Affairs,
On behalf of the more than 230 people living with cystic fibrosis (CF) in New Hampshire, we are writing to express our support for HB 1571. As the cost of prescription insulin and other diabetic supplies have risen drastically over the past decade, so too have patients’ out-of-pocket costs, which threaten access to care for those who depend on these medications and supplies. We commend New Hampshire for passing HB 1280 in 2020 to limit insulin copayments to $30 dollars per 30-day supply. HB 1571 would build on this legislation to limit copayments for continuous glucose monitoring devices (CGMs) and other diabetic supplies like test strips and sensors. We urge you to vote “yes” on HB 1571 to help ensure access to these vital supplies and equipment for people with cystic fibrosis-related diabetes (CFRD).
Cystic fibrosis and CF-related diabetes
Cystic fibrosis is a life-threatening genetic disease that causes the body to produce thick, sticky mucus that clogs the lungs and digestive system, which can lead to serious infections in the lungs and pancreatic insufficiency. CF requires an intensive daily treatment regimen to address its many manifestations and eighty-six percent of CF patients also have at least one health complication in addition to cystic fibrosis, including cystic fibrosis-related diabetes, asthma, sinus disease, and others.
Cystic fibrosis-related diabetes is one of the most common complications experienced by people with CF, occurring in over four percent of adolescents and nearly one in three adults living with CF. Due to the disease’s progressive nature, CF can cause scarring or “fibrosis” of the pancreas, which can lead to insulin deficiency and CFRD. Like type-1 and type-2 diabetes, treatment for CFRD relies on insulin and additional supplies such as continuous glucose monitors, test strips, insulin pens, syringes or needles, lancets, and alcohol swabs.
Access issues associated with CFRD
Unfortunately, due to the high cost of insulin and other prescription drugs, many people with CF — even with the help of financial assistance — are forced to make difficult spending tradeoffs that can impact their health. According to a 2024 survey conducted by the Cystic Fibrosis Foundation and the Dartmouth Institute, over a third of people with CF delayed at least one aspect of their CF care in the last year — including but not limited to skipping medication doses, taking less medicine than prescribed, filling a prescription, or skipping a treatment altogether — due to cost concerns. Diabetic supplies are commonly classified as durable medical equipment and often do not have adequate coverage with commercial insurers, frequently leading to high out-of-pocket costs for people with CF. Those living with CFRD who do not have consistent access to insulin or accompanying supplies, like CGMs, may be unable to properly manage their blood sugar levels, putting them at increased risk of irreversible damage, costly hospitalizations, and declining health outcomes.
The cost of CGMs, test strips, and other diabetic supplies places additional financial strain on patients who may already struggle to afford their care. Almost 70 percent of people with CF have experienced a negative financial challenge in the last year due to their high-cost medical bills such as experiencing difficulty paying for basic living expenses like rent and utilities, the inability to accumulate savings, or taking a second job to make ends meet. Limiting copayments for CGMs, test strips, and other necessary diabetes supplies will help mitigate some of the financial burden that accompanies managing cystic fibrosis and CFRD.
We urge you to vote “yes” on HB 1571 to help ensure access to CGMs, sensors, test strips and other diabetic supplies for people living with CF. Thank you for your attention to this important issue.