Dear Governor Lee:

On behalf of the 115 million Americans living with diabetes and prediabetes, thank you for your ongoing work to address the coronavirus pandemic. As you no doubt understand, this unprecedented public health crisis poses a unique and significant threat to Americans with diabetes, both from a health perspective due to the impact of diabetes on our immunity, and from an economic perspective given the large numbers of lower-income Americans who live with diabetes and who are trying to balance the high cost of medication and supplies against potential job loss, reduced work hours, and future income uncertainty.

Unfortunately, as people in the state lose their jobs, many are also without health insurance. This is especially problematic for Americans living with diabetes who could now potentially face significant out-of-pocket costs obtaining prescription medications and supplies, including insulin, and who already are among the most vulnerable to the pandemic due to their compromised immunity.

Approximately 7 million Americans with diabetes rely on insulin to live. Yet the cost of insulin has skyrocketed, nearly tripling between 2002 and 2013. A national survey conducted by the American Diabetes Association found that nearly a quarter of all insulin users were impacted by the high cost of insulin, with many reporting rationing insulin due to cost. Not taking the prescribed amount of insulin places people with diabetes in jeopardy of serious and life-threatening health complications, and may make us more vulnerable to the coronavirus, adding to the burden of the pandemic on the state while compromising our health further.

Swift action must be taken to make this life-sustaining medication affordable so we can keep people with diabetes healthy and out of ERs and hospitals at a time when these facilities are coping with a rapidly increasing number of COVID-19 patients. To address these challenges, we urge you to:

• Eliminate cost-sharing for insulin in state-regulated health insurance plans. ADA acknowledges that the Tennessee legislature is considering Senate Bill 1718 (Robinson), House Bill 1832 (Dixie), House Bill 1931 (Hodges), and Senate Bill 1939 (Briggs), legislation that caps copayments on insulin at $100 for a 30-day supply. Our request is that the zero-dollar copayment provision stay in place throughout the coronavirus emergency and that you urge the legislature to pass SB 1718/HB 1832 or HB 1931/SB 1939 as soon as possible to continue to protect your constituents with diabetes when the crisis
• Ensure Americans living with diabetes who lose their job due to temporary unemployment due to the current pandemic have continuous access to health insurance, including by potentially automatically enrolling these patients into Medicaid, prohibiting the removal of people from Medicaid and state regulated health insurance plans if they fail to pay or are late in paying premiums, temporarily waiving documentation requirements for continued Medicaid eligibility, expanding special enrollment periods in your state throughout the declared state of emergency, and other available

We stand ready to support your efforts to take these bold, yet urgent steps to protect the state from further fallout of the pandemic and blunt the impact on Americans in your state who live with diabetes. Feel free to contact Gary Dougherty, ADA's Director of State Government Affairs, at gdougherty@diabetes.org for any resources you may require.

We appreciate in advance your efforts to stand with us, on behalf of Americans living with diabetes, who face extraordinary vulnerabilities and challenges during this crisis.

Respectfully,

Tracey Brown, Chief Executive Officer