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

$35 Insulin on Medicare Pilot: Is This the Beginning of Affordable Insulin for All?

On Tuesday, President Trump held a press conference announcing a new pilot program for seniors on Medicare that would cap the monthly co-payments of insulin to $35. The announcement was attended by senior executives of two main insulin manufacturers, Eli Lilly and Novo Nordisk, and staff from the American Diabetes Association, as well as the Surgeon General, Jerome Adams.

In typical Trump style, midway through his announcement, he proclaimed, “I don’t use insulin. Should I be? Huh? I never thought about it, but I know a lot of people are very badly affected.” While this comment has created a wave of groans and eye-rolls throughout the diabetes online community, the core of his message is more important: seniors in America will now be more able to comfortably afford their insulin.

For everyone on earth, insulin is a necessary hormone to live. People without diabetes produce insulin endogenously, whereas people with diabetes must take insulin exogenously. Without adequate access to affordable insulin, people with diabetes face serious complications, such as kidney failure, blindness, amputations, and premature death. Unfortunately, the rising costs of insulin over the past few decades have become a major barrier to appropriate management of diabetes. American seniors are some of the hardest hit by the rising costs, who are partially-retired or out of the workforce completely, often trying to survive on smaller, fixed-incomes.

Trump remarked, “Today I’m proud to announce that we have reached a breakthrough agreement to dramatically slash the out-of-pocket cost of insulin. You know what’s happened to insulin over the years, right? Through the roof.”

The pilot program will take effect starting in 2021, and would be part of the enhanced Medicare Part D Senior Savings Model, to which over 1,750 standalone Medicare Part D and Medicare Advantage plans have applied to participate in, according to the Centers for Medicare and Medicaid Services (CMS).

s$35 Insulin on Medicare Pilot

Photo credit: Adobe Stock

This is a welcome respite from the high cost of insulin for American seniors on Medicare, who, despite being covered by health insurance, sometimes have to pay hundreds if not thousands of dollars for their monthly insulin prescriptions.

Despite the multitude of executive orders and policy decisions the Administration has made to chip away the Affordable Care Act, this enhancement of American’s largest healthcare social safety net was met with applause from seniors all across America, many of whom have cooled their support of the President since the beginning of the COVID-19 pandemic and our nation’s response to it. This is an excellent first step to ensuring that our aging Americans can afford the insulin they need to take care of themselves.

It is estimated that Medicare beneficiaries (generally Americans over the age of 65) who use insulin and join a plan participating in this pilot could see average savings of $446, or 66% for their insulin every year. The pilot is funded in part by insulin manufacturers who will pay $250 million in discounts over the five years of the pilot. There has been a positive response from Medicare Part D plans nationwide, and CMS predicts coverage in the pilot will be available in all 50 states, D.C., and Puerto Rico. Medicare beneficiaries will be able to enroll in a pilot-participating plan during traditional Medicare open enrollment, which is October 15th-December 7th, 2020, for Part D coverage that begins on January 1, 2021.

1 in 3 Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more types of insulin, so this change isn’t insignificant. Out-of-pocket spending on insulin by seniors in Medicare Part D quadrupled between 2007 and 2016, from $236 million to $968 million, putting a harsh burden on millions.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services said, “We think that this creates a foundation and a platform to fix some of the problems that we have in the Part D plan (of Medicare). It’s time for that program to be updated.”

While this is a great first step, the pilot is only slated to last for five years, and it will only apply to the Medicare population- generally, people living with diabetes who are 65 and older. This begs the bigger question: how do we afford our insulin before we are eligible for Medicare? How can we ever hope to make it to that point, if insulin is unaffordable every step of the way? Men with type 1 diabetes have an average life expectancy of 66 years, compared with 77 years among men without it. Women with type 1 diabetes have an average life expectancy of 68 years, compared with 81 years for those without diabetes. Realistically, this may not even help people who have diabetes for very long.

We can only hope that this initiative creates enough momentum for the federal government to start capping the actual price of insulin, for the other 7 million Americans who rely on it every day to survive.

Source: diabetesdaily.com

How to Navigate Unemployment with Diabetes During the COVID-19 Crisis

The US economy is in a tailspin from COVID-19. Unemployment claims across the nation are up to record highs, with 6.6 million Americans filing claims just last week. Job losses across the service sector are particularly hard hit, as state-wide “stay at home” orders go into place closing anything from bars, shops, restaurants, and coffee shops to yoga studios and gyms.

Economists are predicting that over 47 million Americans could lose their jobs, totaling a 32% unemployment rate, which has, until recently, been unheard of. Unfortunately, for many Americans, health insurance is closely tied to employment, and if you suddenly find yourself unemployed with diabetes, panic can quickly arise. Here are some resources that can help you navigate these new waters:

See If You Qualify for Medicaid

36 states (and DC) have expanded Medicaid, which allows a working adult to make up to 138% FPL to qualify for coverage. Eligibility varies by state, but Medicaid offers excellent coverage for free or extremely cheap insulin and diabetes supplies. Applying for coverage and checking your eligibility is quick and easy.

Buy a Plan on an Exchange

Through the Patient Protection and Affordable Care Act of 2010, individuals (due to a qualifying life event like losing a job or getting married) can buy a health insurance plan on what is called an “exchange.” These are either run by your state of residence or through the Federal government. This simple website lets you compare plans and choose what’s best for you and your budget (you can also look at things like monthly premiums and deductibles, to make sure the insulin you need is actually affordable). Be sure to shop around for what will fit your needs best!

Jump onto a Family Member’s Insurance

If you’re under the age of 26, you can still maintain coverage on your parents’ health insurance plans, so if you’ve recently lost a job, you may be able to join their plan for the time being.

Additionally, if you’re married and your spouse has health insurance through their employer, losing your job is a qualifying event to jump onto their health insurance coverage. The rates may be higher since it’s not through your employer, but you can still get the coverage you need and the insulin you require. Employers may offer health insurance to same-sex or opposite-sex domestic partners, similar to coverage for married couples, although this can vary by state. Check with your spouse’s employer for eligibility requirements (proof of domestic partnership or marriage, etc.) and costs associated with coverage.

Time May Be on Your Side

Health insurance is offered on a monthly basis, so if you’re laid off from work the first week of the month, you will still have coverage for the remaining three weeks of that month. Take advantage of this time by reordering any and all supplies you’ll need (try mail-order to get a 90-day supply), and schedule any doctors’ visits (take advantage of telehealth appointments during the pandemic) or renew prescriptions that are almost out.

COBRA

COBRA stands for The Consolidated Omnibus Budget Reconciliation Act, and it gives workers (and their families) the right to continue their group health benefits for a limited amount of time after a job loss. COBRA is notoriously expensive; individuals must pay both the individual portion of the plan and the employer’s portion (since you’re no longer an employee at the company, you now will have the cover both, plus an administrative fee, totaling 102% of the health insurance policy).

Some people prefer this option, because it offers continuity of care (same coverage policies, same doctors, same pharmacy), until they can find similar or better coverage somewhere else. To qualify, the employee has to have already been enrolled in their employer’s health insurance plan before losing their job/qualifying life event. COBRA coverage is only offered for a limited amount of time (up to 3 years).

Losing your job during a global pandemic while living with a chronic disease is scary, but hopefully choosing one of these options will help you navigate your new reality a little bit better. Have you been negatively affected by COVID-19? Have you recently lost your job and/or health insurance? What have you done to get insurance quickly? Share this post and comment below; we love to hear your stories.

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

How Does Medicare Cover Diabetes in 2019?

By Danielle Kunkle In simple terms, diabetes is a condition that causes your blood to have high quantities of sugar. This happens because the natural insulin that your body produces is lacking in quantity or otherwise unable to turn the glucose into energy as it should. Diabetes can affect all age groups, but 25% of […]
Source: diabetesdaily.com

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