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response to module 2, first class
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1.Identify some situation you believe is unjust or unfair to a group of persons. Who or what is benefiting from this situation? Do you benefit, and how? (MO 1, 4) Merriam-Webster defines “Unjust” as unfair, “characterized by injustice .” Paying astronomical amounts of money for life saving medications such as insulin is as unjust as it gets. Like oxygen, insulin is needed to survive. How does one justify putting a price on others lives. Diabetes is not a matter of inconvenience, it is a matter of life and death. My father now age 76, has steroid-induced type1 diabetes that was diagnosed in his 50’s. He has had difficulties with respiratory issues from childhood asthma, that over time with environmental exposures in the workplace and pollution had progressed to emphysema. Over the years he was prescribed oral steroids to treat these acute exacerbations, and finally in his 50’s his pancreas gave up. The diagnosis, steroid induced type 1 diabetes, and it did not go away after that round of prednisone was completed. Steroids are effective medications used often for several differing medical diagnoses but a downfall of their use is steroid-induced hyperglycemia which must be considered when prescribing any type of steroid (World J Diabetes., 2015). My father uses insulin multiple times a day to survive and keep up with his dietary intake because his body no longer makes insulin. Insulin use costs money. The pharmaceutical companies charged astronomical amounts for it and the insurance companies were not covering enough of the costs to allow for seniors with limited income to cover the copays or deductibles. (Davidson, M. B., 2023). At about $100 per bottle of 1000 units, my Dad uses at least 5 bottles a month. $500/month on a limited income. That type of financial hardship makes people have to improvise. When they don’t have the means to pay for what they need, it was discovered that diabetics are changing their dosing to make the insulin last longer, skipping doses altogether, or worse not even getting prescriptions filled, resulting in higher blood glucose levels and complications (Davidson, M. B., 2023). This disparity results in preventable deaths and internal physicaldamage with increases in monies spent towards diabetic complications, from patients, insurers and even the facilities that take on the uninsured or under insured populations (Zargar et al., 2022). Overall the quality of life and care are at a deficit because of the upfront astronomical cost of the lifesaving medication. As a nurse attempting to care for patient dealing with this disparity there is no benefit. Patients are not able to be engaged in successfully managing this chronic illness when their focus is stuck at step one, obtaining the lifesaving medications. Lack of medication causes the patients to alter dosing causing a void in the communication between them and their healthcare providers. However, this disparity has not affected the trust our patients have in their providers even as
the financial struggles continue and the patients health declines the patient/provider trust maintains (Rolfe, A. et al., 2014). On the other hand, pharmaceutical companies that make insulin benefit directly from the cost, citing research and development, but dispensing a 100 year old medication. Maintaining that the small changes to insulin that have been made over the years have had to be patented to keep up with the current market research, and the increase demand of diabetics needs, has kept the pharmaceutical companies in a monopoly over the production of insulin which allows them to gouge this vulnerable population. (Rajkumar, S. V., 2020). Thankfully in the past year pharmaceutical companies have began to realize the bottom line benefits to cost reduction of this life saving medication. The prices from companies have been reduced and capped off at what they deem reasonable prices. In addition, congress has a current voluntary test within CMS under the Medicare prescription drug benefit with a monthly capped copay of $35 under certain plans that opted in, but it is set to expire on December 31, 2025. (Congress.gov, 2024) This is an unfortunate situation our patients and family members face. Hopefully, we continue to move towards the reduction of costs and the availability of new and differing treatments until we can absolve the issues of diabetes altogether.