Moving Abroad for Better Diabetes Care

Anyone who lives with diabetes in the United States knows that affording care, and specifically insulin, is becoming more and more difficult as prices on insulin and essential medications continue to rise. A recent Yale study even showed that 1 in 4 people with diabetes have rationed their insulin due to cost, which can quickly lead to serious complications and even premature death. In our recent study , an overwhelming 44% of respondents reported struggling to afford insulin.

Our lack of a strong social safety net is leaving some patients feeling as though they have no other options for affordable care, and some patients have even resorted to crossing the border into Canada and Mexico to buy cheaper insulin, where federal price caps prevent runaway pricing on essential medications and prescription drugs. In light of all this, some people with diabetes have even daydreamed of completely relocating to another country for better care, where health coverage is centralized, universal for all people, and where medications are more affordable. The United States is the only rich country in the world that doesn’t guarantee healthcare for all its citizens.

Meet Liz Donehue, a comedian, writer, and American expat who has lived with type 1 diabetes for the past ten years. She moved abroad a few years ago to find better diabetes coverage, and I chatted with her about her experience moving to the Czech Republic.

What made you want to leave the United States? 

I left the United States for many reasons, but one of them was that the motion to repeal Obamacare passed in the House in 2017. Most of my employers didn’t provide health insurance, so the enactment of Obamacare in 2013 was a life-saving situation. Healthcare and insulin had never been unaffordable to me, but then again I was fortunate enough to have my parents support me in times of need, especially after I aged out of their insurance at age 26. I have never rationed insulin due to cost, only at times when the pharmacy or my endocrinologist made an error during insulin refills.

Why did you choose the Czech Republic? 

Part of the reason I chose the Czech Republic was that their visa process was relatively easy compared to other countries. I also chose the city I’m in, Brno, because of the cost of living. Having moved from Seattle, my cost of living went down by 66%. Other candidates included Poland, Vietnam, and Cambodia, but I had previously been to CZ and they had the most advanced healthcare system out of the four.

What was the deciding factor that made you move?

I had recently been laid off from my job, and I had just gotten out of a relationship. Essentially there was no true reason that kept me in Seattle, so I started to look at other options, especially where there was available socialized healthcare. I did research for about four months before moving, and I was able to secure an apartment online for myself and my cat who I brought with me. I’m living here permanently and my visa is through my current employer.

Will you become a citizen? 

I’m not a Czech citizen and as a “third country national” (non-EU), I will need to have lived in the country for ten years before I can apply. When I first arrived and waited for my freelance visa to process, I had to get private insurance through an international company for my application.

Typically, how expensive is diabetes care and insulin in your new country? 

During this wait, about five months, I was paying out of pocket for appointments and medications. But because it’s CZ, the costs pale in comparison to what they are in the US. A pack of five Humalog pens costs $18 here as opposed to $556 back home without coverage. When I got hired by my current employer, they took over paying for my healthcare costs, about $98 a month. I paid this for myself while I was self-employed, but everything was covered. There are no prior authorizations and the notion of pre-existing conditions doesn’t exist here.

Additionally, monthly insulin supply costs me nothing. I take Humalog and Tresiba daily and my test strips are also free of charge and included with my health insurance costs paid for by my employer. I get new prescriptions every 90 days whether I ask for them or not, so I now have a surplus of insulin and I don’t need to worry about refills.

Do you miss anything about the US healthcare system? 

I think the major thing I miss about the US healthcare system is the access to current technology. The system in CZ, while affordable and readily accessible, doesn’t have the technology to download glucometer readings, for instance. I also need to provide my own samples of urine for quarterly testing instead of having it done in the office. The medical equipment and tools are often metal and sterilized as opposed to plastic and designed for one-time use, which I’ve heard is a practice left over from the communist era.

Are you ever planning on moving back to the US? 

My move to CZ was an act of self-preservation. In the US, for some reason, health insurance is tied to a person’s employment. As long as that system is in place or there is no enactment of a system like Medicare for All, I can’t move back to the US. The pandemic has increased my concerns, and right now, I could go back to the US to visit, but I would not be let back into the Czech Republic just on the basis that I was IN the United States as the situation is worsening by the day. I feel healthier [living here] but I’ve also been taking extreme precautions due to the pandemic since I’m immunocompromised.

Thank you for your time, Liz. We really appreciate you sharing your story with us!

Have you ever considered moving abroad for better health coverage and diabetes care? Why or why would you not move abroad? Share your thoughts below; we would love to hear from you!

Source: diabetesdaily.com

Can You Manage Diabetes Well Without Lots of Money?

If you live in a country like the United States, where the majority of health insurance is privatized and there is no strong social safety net, it can feel as though managing a chronic disease like diabetes requires nothing but lots of money. And it does. As of 2017, diabetes cost the United States a staggering $327 billion dollars per year on direct health care costs, and people with diabetes average 2.3x higher health care costs per year than people living without the disease.

Diabetes is also devastatingly expensive personally: the cost of insulin has risen over 1200% in the past few decades, with no change to the chemical formula. In 1996, when Eli Lilly’s Humalog was first released, the price for a vial of insulin was $21. In 2019, that same vial costs around $275. Studies show that 1 in 4 people ration insulin simply due to cost. Diabetes Daily recently conducted a survey study, with almost 2,000 participants, of which an overwhelming 44% reported  struggling to afford their insulin.

So where does this leave patients who don’t have tons of money to spend on insulin and supplies, or who don’t have adequate health insurance coverage for the technology to help prevent complications? Can you manage diabetes well without lots of money? The short answer is yes. The long answer is a bit more complicated.

Best Practices for Managing with Less

If you have insurance coverage, but are unable to afford a continuous glucose monitor (CGM) or insulin pump, it’s advisable to follow best practices for optimal diabetes management. According to the Mayo Clinic, one should test their blood sugar:

  • Upon waking
  • Before meals and snacks
  • Before and after exercise
  • Before bed
  • More often during illness
  • More often when traveling or changing a daily routine
  • More often if on a new medication

One study has even shown that following a lower carbohydrate diet can improve health outcomes, reduce complications, and cut down on medication costs for people living with diabetes.

The study goes on to say that, “…insulin dependent diabetics can expect to half or third their insulin requirements. Less insulin injected results in more predictable blood sugars and less hypoglycemia.” However, no patient should ever feel pressured to follow a low carbohydrate diet solely to control the cost of their medications. There can be more effective ways to manage the cost of medications and supplies.

Photo credit: Adobe Stock

No Matter What You Think, Get Coverage

People with diabetes need health insurance coverage. In the short term, this makes sense, as insulin and things like insulin pumps, continuous glucose monitors, syringes, and test strips are expensive. But it also makes sense long term as well. People with diabetes can face serious complications as they age: diabetes is the leading cause of adult blindness and amputations, and is a leading cause of stroke, kidney failure, heart disease and premature death in its sufferers. Having health insurance helps pay for things like surgery, preventive screenings, doctors’ appointments and follow-up care, and any additional medicine and needs that’s needed.

It may seem cheaper to forego coverage, but don’t. Check to see if you’re eligible for Medicaid in your state. If you are, this comprehensive coverage will help you access affordable medication, doctors’ visits, emergency and preventive care. If Medicaid is not an option, see if you qualify for a tax subsidy on the federal or your state’s health exchange. There, you can find a range of affordable options that will cover your diabetes care and (especially) insulin prescriptions.

Get Help Paying for Insulin

Even if you have health insurance coverage, the cost of your insulin may be prohibitively high. According to the CDC, between 2007 and 2017, the percentage of adults aged 18-64 enrolled in a high deductible health plan rose from 10.6% to 24.5%. These plans have a high dollar amount that consumers must meet before their plan kicks in to help pay for things like prescriptions or hospital stays. Some high deductible health plans have deductibles as high as $10,000. This means that someone with diabetes could potentially pay the full $275 a vial for their insulin, every time they fill their prescription, until they reach their $10,000 deductible. These types of plans are cheaper monthly (have lower premiums), but don’t offer great coverage.

If you need help paying for your insulin, you can get low cost insulin through these assistance programs:

  • Eli Lilly’s $35 Co-Pay Program: Launched in early April in response to the COVID-19 crisis, Eli Lilly is introducing their Lilly Insulin Value Program, which allows anyone with commercial insurance and anyone without insurance to fill their monthly prescriptions of insulin for $35.
  • Novo Nordisk: Novo Nordisk has recently launched a $99 program, where people needing insulin assistance can purchase up to three vials or two packs of FlexPen®/FlexTouch®/Penfill® pens or any combination of insulins from Novo Nordisk Inc. for $99.
  • Sanofi: Launched in 2019, Sanofi’s program allows people living with diabetes in the United States to pay $99 for their Sanofi insulins (with a valid prescription), for up to 10 boxes of pens and/or 10 mL vials per month.
  • Medicare: Medicare recently unveiled a pilot program that would cap the cost of insulin. The Medicare Part D Senior Savings Model would cap insulin co-payments to $35 per month, starting in January 2021. Seniors must sign up for a plan that will qualify under the pilot during the open enrollment period, which is October 15 through December 7.
  • Buy a State-Regulated Health Plan: If you live in Colorado ($100 per prescription per month), Illinois ($100 per 30 day supply), Delaware ($100 per 30 day supply), New York ($100 per 30 day supply), Utah ($30 per 30 day supply), West Virginia ($100 per 30 day supply), Maine ($35 per 30 day supply), New Mexico ($25 per 30 day supply), Virginia ($50 per 30 day supply), Washington ($100 per 30 day supply), or New Hampshire ($30 per 30 day supply) and you buy a state-regulated health plan, you are eligible for a copayment cap on insulin (implementation dates pending, but Colorado was the first bill to be implemented and it went into effect January 1st, 2020).

Check the fine print of any health insurance plans on the federal or your state’s exchange to see if they are eligible for the copayment cap. More states are introducing legislation in 2021, so keep an eye out for a bill proposing some similar changes in your state!

Get Help Paying for Supplies

Several companies have launched affordability programs in response to the COVID-19 pandemic. A few new programs are:

  • Dexcom: Is offering up to two shipments of 90-days of Dexcom G6 Continuous Glucose Monitoring System supplies, with each shipment consisting of one transmitter and three boxes of three sensors for $45 per 90-day supply shipment. For existing customers only, if you qualify.
  • Omnipod: Is offering a six-month supply of products (60 pods) free of charge. The program is focused on current US customers who have lost jobs and health insurance as a result of the pandemic.
  • One Drop: This online subscription package charges the consumer a monthly fee, and you get access to cheaper test strips, online personal health coaching, and a mobile app to track your progress. If your health insurance doesn’t adequately cover test strips, this can be an affordable and effective way to go.
diabetes advocacy

Photo credit: T1International Instagram

Advocate for Change

If you see or are experiencing injustice, you should always try and advocate for change. This means writing letters to your elected officials, calling your members of Congress, petitioning your health insurer, testifying for bills that support better health care coverage, and raising your voice to improve policies that will benefit all people living with diabetes. Get involved in the diabetes online community on Facebook or Twitter. Sign up to become an advocate with T1International. Donate to your favorite diabetes charity who’s working to make things better.

Show up at your state capitol and talk to people about what it’s like to live with diabetes, how expensive it is, and how crucial good coverage and affordable medications really are. You can live a great life with diabetes, but coverage, laws, regulations, and policies can always be better. And things won’t improve until we have everyone at the table, advocating for change.

How are you able to manage well with less to spend? What policies or changes would you like to see in the US healthcare system that would make management easier for you? Share this post and your story, below!

Source: diabetesdaily.com

COVID-19 Preparedness: Tips for Obtaining Extra Diabetes Supplies

As the Coronavirus (COVID-19) cases continue to grow, with many alarming reports in the news, the CDC has recently advised for at-risk populations (including those with diabetes) to prepare and to stay home as much as possible. For someone with a medical condition that often requires constant care and a supply of medicine, preparing for potential quarantine may also mean stocking up on extra medical supplies. Of course, this also means an additional financial expense, placing an additional burden on this patient population.

Here are some basic tips to consider for anyone with diabetes who is preparing get started on obtaining some extra supplies without incurring very high costs:

  • Contact your healthcare provider and ask them for samples of the medication(s) that you need.
  • Reach out to your health insurance company to determine if they will authorize a payment for an extra supply (sometimes called a “vacation” supply) of the medication(s) you need.
  • If needed, discuss with your healthcare provider any alternative medication(s) that may be cheaper than the ones you currently use, in case you decide to pay out-of-pocket for an extra supply. There are insulin preparations that can be purchased over-the-counter at a very reasonable price, but be sure to discuss the ins and outs of using these preparations with your provider, as they have different activity profiles than prescription insulin formulations.
  • See if you qualify for insulin savings through the manufacturer. Reach out to the company that makes your specific insulin(s) and/or visit their website(s) to determine which program(s) they offer and what you may be eligible for.
  • Consider purchasing the ReliOn brand of blood glucose testing supplies from Walmart, which tend to be much more affordable than if you were to pay out-of-pocket for an extra supply by another brand.
  • Look into using a service like DiaThrive or Livongo, which can allow you to obtain unlimited blood glucose testing supplies at a fixed price.
  • Consider using a mail-order pharmacy, so that you can minimize leaving your residence to obtain medical supplies.

Also, have a look at this checklist form the Diabetes Disaster Response Coalition to keep you on track as far as being prepared with diabetes essentials during an emergency situation.

Do you have any advice for people with diabetes who are trying to make sure they are prepared with enough medical supplies for an extended amount of time? Please share this article and your thoughts in the comments below.

Source: diabetesdaily.com

Insulin Co-Payment Cap Bills

America has a unique problem: prescription drug prices are too expensive for many people. In 2018 alone, 1 in 5 Americans (or 37 million non-elderly adults) went without a prescription drug due to cost. One of the most egregious examples of the high cost of prescription drugs is the rising cost of insulin in the United States. There are over 34 million Americans with diabetes, and at least 8 million are dependent on insulin to live. The list price of insulin has nearly tripled since 2002 and the average price of the drug has increased by 64% since 2014 alone. Most tellingly, a pivotal Yale study recently reported that as many as 1 in 4 people with diabetes have rationed their insulin due to cost. So, what are lawmakers doing about the problem?

Insulin co-payment caps have become a wildly popular idea by state lawmakers to curb the price of insulin for some insured patients in their states. Notably, Colorado was the first state in the nation to pass such legislation, making national news in May 2019. The bill, which caps monthly co-payments (for some insured patients) at $100, went into effect on January 1, 2020.

The main bill sponsor, Representative Dylan Roberts, said, “Colorado is leading the way with this measure, but this is just a first step. We won’t stop until all the pharmaceutical companies and drug middlemen start taking more accountability and stop gouging patients with their high costs.”

Other states have followed suit. The Illinois Governor signed into law similar legislation this past January (although the law doesn’t take effect until January 1, 2021), and there are currently similar bills pending in 36 other states.

insulin sensitivity

The average cost of a vial of insulin in America is over $300. | Photo credit: Adobe Stock

This is great news for many people with diabetes. The average cost of a vial of insulin in America is over $300, and people with insulin-dependent diabetes often require multiple types and vials of insulin per month, which can drive up the price (to live!) into the thousands. Capping co-payments, or essentially “carving” out a $100 co-payment (especially for people on high-deductible health plans who are paying the full list price of insulin until they hit their deductible, which can sometimes be in the high-thousands) can save people thousands of dollars and will undoubtedly help save lives.

Some people may think this solves the insulin pricing crisis, but it doesn’t. These bills are a great start to bring attention to the exorbitant cost of prescription insulin, but there are many people who don’t qualify under these new laws. State legislatures only have jurisdiction over state-regulated health plans, and thus cannot determine pricing on ERISA plans, or health insurance plans that are fully or partially managed by the federal government, such as Medicare, Medicaid, or the Veteran’s Health Administration. Additionally, any large, private employer plans would not fall under the law. Most importantly, anyone who’s uninsured does not receive protection under this law, and must still pay the full list price of insulin at the pharmacy counter.

For states that have expanded Medicaid, this doesn’t pose as much of a problem, as more people are covered by some sort of insurance (Medicaid co-payments are usually set between $1-3). States with robust exchange programs also benefit more under these laws, as by definition these are state-regulated plans that are subject to the co-payment caps. But for people who don’t qualify for Medicaid, cannot afford a health exchange plan, and find themselves without insurance, they’re still stuck paying these outrageous prices, which is sometimes a matter of life or death.

And the problem isn’t going away. The Health Care Cost Institute reported that the price of insulin doubled in a span of four years, between 2012 and 2016. According to their report, the average price a patient with type 1 diabetes paid for insulin in 2012 was $2,864 but that doubled to $5,705 by 2016.

Why is the cost for a nearly 100-year-old drug continuing to rise? For one thing, there are no generic competitors, and only three companies manufacture the drug. Secondly, insulin products are protected under patent laws, which allow the manufacturer to sell a product unchallenged in the market before a generic can be introduced. Novo Nordisk, Eli Lily, and Sanofi, the three main insulin manufacturers, have continued to “tweak” their insulin products in order to extend their exclusivity rights and hold onto their patent longer, without facing competition from generics. In fact, Sanofi has filed lawsuits in the past against Merck and Mylan to prevent them from going to market with a generic version of Sanofi’s Lantus insulin. Additionally, our government (unlike most other countries in the world) does not negotiate drug pricing with pharmaceutical companies, and thus there are no regulations on how high pricing can be set.

This national crisis has even gotten the attention of current and former Presidential hopefuls: Mayor Pete Buttegieg, Senator Amy Klobuchar, Senator Elizabeth Warren, Senator Bernie Sanders, Tom Steyer, and even Vice President Joe Biden have all called out insulin specifically when talking about outrageous drug pricing.

Congress has also started paying closer attention, and H.R. 3, the Lower Drug Costs Now Act has been introduced that would allow for The Centers for Medicare & Medicaid Services to negotiate drug prices on certain drugs (including insulin) to lower the costs, among other measures. Co-Chairs of the Congressional Diabetes Caucus, U.S. Representative Diana Degette and Representative Tom Reed, have also introduced the Insulin Price Reduction Act, which, if enacted, would decrease the price of insulin nearly 75% for Americans, to costs equal to those in 2006. These are all great first steps to addressing American’s cries for help, and to help reduce the burden millions of people with diabetes are facing every day.

Any legislation will have its pros and cons, but people with diabetes suffering due to high drug pricing don’t have to suffer in silence any longer. Politicians are taking note and action, and one day I hope we can all declare the crisis solved.

Have you been negatively affected by the high price of insulin in the United States? Share this article and post your story in the comments below, we’d love to hear from you!

Source: diabetesdaily.com

Ways to Save Money on Diabetes Expenses

Diabetes is an expensive disease. According to the Journal of the American Medical Association (JAMA), diabetes is the costliest disease in the United States. In 2017 alone, over $327 billion dollars was spent on people with diabetes and their needs, and that number has only increased since, as prevalence and incidence of the disease have risen as well.

Diabetes is also expensive, personally. Between medications, doctors’ appointments, time off work and school, buying healthy foods, and committing to an exercise routine, it can be troublesome to keep on top of all the bills and expenses. A landmark Yale study recently showed that as many as 1 in 4 people with diabetes have rationed their insulin, simply because it’s too expensive.

So, how do you prepare for the cost of a new type 2 diabetes diagnosis? In part 2 of our 4-part series, we dive into how to protect yourself from the high costs of diabetes.

Prescription Assistance Programs

Talk with your doctor or pharmacist about prescription assistance programs. They can help you get free or lower-cost drugs, especially if your income is low or you don’t have health insurance. Online resources, such as RxAssist, can also point you in the right direction towards prescription drug cost relief.  You can also get lower-cost care at a Federally Qualified Health Center, if you meet certain eligibility requirements.

Take Advantage of Your Employer’s Section 125 Plan (If They Have One)

These flexible spending arrangements let you contribute up to $2,650 per year (pre-tax!) to spend on out-of-pocket expenses for things like prescription drugs and copays for doctor visits. These plans usually adhere to a “use it or lose it” policy, so make sure you’re spending down anything left over in these accounts towards the end of your enrollment year (usually in December every year).

Enroll in Medicare

Many people 65 and older are not enrolled in Medicare, but if you’re diagnosed with diabetes, it’s highly recommended that you take advantage of this program. Medicare Part B covers a portion of bi-annual diabetes screenings, diabetes self-management education classes, insulin pumps and glucometers, and regular foot and eye exams. Medicare Part D covers insulin expenses. Learn more about the Medicare application process here.

Mail Order Your Supplies

If you’re able, use mail order to get recurring medications and supplies (you can sign up through your existing pharmacy). Oftentimes, you can buy a 90-day supply of your medicine for a single copay, instead of three separate copayments for three separate months. Mail-order supplies are bulk packaged and shipped to your home. This can be an excellent alternative if it’s hard to leave your home, and if you know you’ll need the same medication consistently, for months at a time. It’s also helpful in saving you money. Additionally, a lot of (over the counter) supplies can be bought in bulk from online retailers like Amazon for a fraction of the price you’d pay at a traditional pharmacy.

Ask Your Doctor About Generic Drugs

Although there is no generic form of insulin, many pills taken for type 2 diabetes are available in generic form. A bottle of Glucophage (60 tablets) costs around $80, but the generic form (metformin) will cost you about $10. Talk to your healthcare provider about generic options that are available to you.

Taking these small steps can add up to big savings over time, and can help you to live a long, healthy life, without the threat of complications. Plus, saving money on your diabetes supplies can help you invest in other (more fun) areas of life!

Have you found ways to better budget for your diabetes? How have you saved money for this costly condition? Share this post and comment below!

Source: diabetesdaily.com

World Diabetes Day 2019: The Most Important Issues We Face

Today is World Diabetes Day. What are the most important issues that you face as a person with diabetes? See what the online diabetes community had to say.
Source: diabetesdaily.com

How and Why People With Diabetes Stockpile Supplies

For people with diabetes, an interruption to insulin supply is quickly life-threatening. It’s also seriously problematic to endure a disruption in other diabetes necessities like glucose test strips or CGM (continuous glucose monitor) sensors or insulin pump cartridges. Many people with diabetes strive to have a small stockpile of back-up supplies because what do we do […]
Source: diabetesdaily.com

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