Why #insulin4all Advocates Targeted Beyond Type 1

Beyond Type 1, the diabetes nonprofit, found itself in hot water recently after the organization sent a letter stating its apparent opposition to LD673, a proposed bill for an insulin safety net program in Maine. The Maine bill is modeled after Minnesota’s popular Alec Smith Insulin Affordability Act, and guarantees that people with diabetes can access inexpensive insulin in an emergency.

The letter stated that LD673 would “create not only administrative burdens to the Maine government and pharmacies in the state, but also unintended additional out-of-pocket expenses to people living with diabetes.” The organization seemed to argue that its own GetInsulin.org program, a partnership with the major insulin manufacturers, rendered further legislation “duplicative” and unnecessary. 

Some diabetes advocates were outraged at Beyond Type 1’s stance, and accused the nonprofit of favoring the big pharmaceutical companies over people with diabetes.

Late last week, the organization appeared to modify its stance with a new letter, this one explicitly supporting Maine’s new bill. Was it all just a misunderstanding, or did rowdy online activism cause Beyond Type 1 to change its tune?

LD673

Alec Smith, the Minnesota bill’s namesake, died of diabetic ketoacidosis (DKA) in 2017, at the age of 26. At the time, he had recently aged out of his parents’ health insurance plan, and the cost of his insulin had skyrocketed to about $1,300 a month, around half of his total earnings. 

Smith’s mother believes that he died because he could not afford to pay for the insulin that he needed to live. She has become a noted insulin activist, and helped turn his death into a major rallying cry for people protesting the nation’s outrageously high insulin prices.

Minnesota signed the Alec Smith Insulin Affordability Act in April 2020, to widespread acclaim in the diabetes community. 

The new bill in Maine, named An Act To Create the Insulin Safety Net Program, would similarly aim to provide cheap, emergency insulin to those with an urgent need. The emergency insulin would carry a maximum cost of $35 for one month’s supply. The bill also mandates standards for the insulin manufacturers’s otherwise voluntary patient assistance programs (PAPs).

The Letter

In the letter that would cause an uproar, Beyond Type 1 never explicitly stated opposition to the new legislation. Whatever its intentions, however, it’s fair to say that the organization strongly implied its opposition.

The letter argues that state-level legislation such as LD673 is no longer necessary, because nationwide circumstances have changed dramatically since the Alec Smith act was passed in Minnesota:

At the time of its passage, GetInsulin.org did not exist, nor did the urgent need programs offered by the manufacturer. Additional insulin copay, cash pay, and patient assistance programs became available after the Minnesota bill became law that insulin manufacturers’ patient assistance programs (PAPs) are enough to fill the gap in assistance, and that the state statute is not needed. 

While insulin is still disgracefully expensive in most of the US, it is true that there are now more avenues for patients in need than there were only a few years ago. Part of that is due to the success of advocacy efforts, such as the one that coalesced around Alec Smith’s death, that turned insulin affordability into a political hot topic. The Covid-19 pandemic has also shined a spotlight on healthcare inequities, pushing the insulin manufacturers to expand their affordability programs in the last year.

The Beyond Type 1 letter also concentrates heavily on extolling the GetInsulin.org website. GetInsulin.org is essentially a user-friendly portal for the PAPs, aggregating the information from all three major insulin manufacturers in a single space. The website was created in partnership with the big pharmaceutical companies and is at least partly funded by them, facts that raise the suspicions of many people with diabetes, who are often inclined to see Big Pharma as an adversary rather than a partner. 

Are PAPs Really Good Enough?

Patient assistance programs can be valuable and even life-saving resources for people struggling to afford insulin. In some cases, PAPs may even provide more generous support for patients in an emergency than that mandated by the Alec Smith Act and Maine’s proposed law. And because these patient support programs have a reputation for being difficult to access and navigate, there’s no reason to doubt that GetInsulin.org provides a valuable public service.

For insulin affordability advocates, that’s not nearly good enough. The Shot, a weekly digest of insulin affordability news, put the case plainly:

While it’s true that patient assistance programs have become more robust … the programs, like Beyond Type 1’s GetInsulin.org, are voluntarily offered by the companies — often at no cost to them as PAPs are generally tax deductible. The Maine bill, like the Minnesota one that precedes it, locks the companies into providing assistance that patients would otherwise have no guarantee will exist tomorrow.

The PAPs are only reliable as long as the manufacturers don’t dilute them in the future (or disband them entirely). Given that many Americans now feel that insulin is practically a byword for medical exploitation, one can hardly be surprised when people with diabetes regard these programs with suspicion.

The big three – Eli Lilly, Novo Nordisk, and Sanofi – are reliable opponents of government efforts to cap insulin prices. And it would seem that PAPs owe their recent expansion more to the immense public relations pressure that manufacturers have lately had to endure than to any one corporation’s sense of generosity or public service.

Experts do agree that insulin manufacturers do not alone bear the blame for high insulin prices. Manufacturers, pharmacy benefit managers, insurance companies, and pharmacies all benefit from high insulin prices, and our byzantine healthcare market incentivizes all of them to push for price increases. Patients can’t easily vote with their wallets, and are therefore left with little recourse to effect meaningful change.

Insulin affordability continues to be a disaster in the diabetes community. Insulin rationing due to high cost is widespread in the United States, a situation that has probably only gotten worse since the dawn of the pandemic and the economic devastation that has followed. 

The upshot of Beyond Type 1’s argument to the Maine legislative committee was that the PAPs, as accessed through GetInsulin.org, are pretty much good enough. If this wasn’t what the organization intended to communicate with its letter, it made a bad mistake – and on an electric issue.

Online Reaction

Insulin access advocates discovered the letter online, and were outraged. Several accused the organization of corruption and betrayal:

Twitter personality Miss Diabetes illustrated a particularly devastating comic, featuring a caricature of Beyond Type 1 co-founder Nick Jonas:

source: @miss__diabetes

A little context: when Beyond Type 1 was founded in 2015, the organization avowed a principled refusal to accept money from the pharmaceutical industry. Things have changed. Now, according to their website, “Beyond Type 1 partners with pharmaceutical companies, including insulin manufacturers, when the organization finds that doing so furthers mission and impact.” 

This isn’t unusual. Most other prominent diabetes nonprofits also accept Big Pharma money (#insulin4all campaigner T1International is one notable exception). Nevertheless, Beyond Type 1’s position on this issue seemed unusual. The American Diabetes Association, for example, took the opposite stance and penned a letter in support of the bill. 

BT1’s About-Face

Despite the controversy, Beyond Type 1 kept silent for weeks, further disappointing some in the diabetes online community.

In response to a request for comment, a Beyond Type 1 spokesman told Diabetes Daily that the original letter was written not to oppose the legislation but “with the intent of providing information to legislators about existing programs and tools for people with diabetes who are insulin-dependent.” 

Additionally, the spokesman said, “Our team has followed the community response closely, and we know some have interpreted our testimony as one of opposition.”

Soon thereafter, the organization sent a new public letter to Maine’s legislative committee, claiming that it did support LD673, and that it always had:

We’re writing today to clarify and state unambiguously that Beyond Type 1 does support the passage of this legislation. This legislation will help individuals in Maine who may be struggling under urgent or ongoing circumstances to access affordable insulin due to high list prices. Our hope is that people with diabetes who need financial assistance to pay for this life-essential drug may find it through existing programs or potentially those created through Maine’s efforts.

After news of the new letter broke, Hilary Koch, a Maine resident and a Policy Manager for T1International, declared victory on Twitter – but also qualified her celebration with a reminder of how much work needs to be done to achieve universal affordable insulin access.

One can only guess as to the effect that Beyond Type 1’s clarification might have the bill’s chances. Lawmakers may well have already been inclined to support the bill. Just last year, Maine passed more sweeping legislation capping insulin costs for those with state-regulated insurance.

 

Source: diabetesdaily.com

How Insulin Rebates Work

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

A major contributor to high insulin list prices that is often misunderstood – because it is designed to be complex and opaque – is the Pharmacy Benefit Manager (PBM) and rebate system. Rebates are a percentage of the list price of a medication, given by a drug manufacturer to a Pharmacy Benefit Manager (PBM), in order to be listed on the health insurance plan formulary or placed in a pharmacy.

Essentially, rebates function a bit like a “broker’s fee” of sorts and can account for 30-70% of the cost a person has to pay at the counter for insulin if they don’t have insurance, or if they are paying the full cost of insulin until they hit their insurance deductible. The PBM takes a portion of the rebate as their own profit, then gives the remainder to their client, which can be the federal government (Medicare), an employer’s health plan, or a standalone health insurer.

Insulin manufacturers choose to participate in this system that drives list prices up because it benefits their business – by giving PBMs a large cut of their profits, their products get placed on insurance formularies more often, leading to more sales. This system creates up to 70% of the current list price of insulin in the US, and it doesn’t have to be this way.

Rebates – They Don’t Mean What They Sound Like

The math is infuriating, but here’s the heavily-simplified basics of how rebates work – if you made a product for $5 and wanted to sell it, you may set the price at $10, to create a $5 profit. With that $5 profit, you can invest back in your company to create better products, pay yourself – whatever you want to do with your $5.

But let’s say you want your product to be in more places and available to more people. You might hire a middle person to place your product in new stores across the country, and they’ll charge a fee, which is reasonable.

When you begin, their fee is $1. So that you can keep your $5 profit, you raise your price to $11. Still reasonable. But over time, your middle person makes themselves indispensable and knows it. You’re making way more money because of how many products you’re able to sell, so you’re not about to drop your middle person.

And oh oops – you also signed a contract with your middle person to ensure you’ll always get your product placed in these nation-wide stores, so you’re locked in. And part of that contract was a promise that you won’t lower your price, since that would impact your middle-person’s profit.

And oh oops – your middle person also has contracts with your competitors, and the contracts signed with those competitors make it so that if your competitor gives the middle person a little bit more of their profits, your middle person won’t sell your product in certain stores for a year. You can fix this by raising your own price to give the middle person more profits, so you can kick your competitor out of a store the next year.

So now, your product costs $50. It’s the same product – you’ve never improved it. Your customers are receiving no more value than when the product costs just $10. Over time, you wanted to make more money from it, so your profit is now $10.

It’s still $5 to make your product.

You get $10 profit, doubled from your original earnings.

And your middle person? They’re making $35, 70% of the list price, off a product they don’t make or even touch.

But you’re definitely not going to get rid of your middle person, because they’re the reason you’re able to sell so many products and make the money that you do.

For a regular product like a water bottle, no worries, your customer will just go somewhere else.

But what if your product was water, and your customer needed it to survive?

The Role of Pharmacy Benefit Managers (PBMS)

PBMs are third-party intermediaries who negotiate prices and drug placements on insurance formularies between pharmaceutical companies and insurance companies. Sometimes they are standalone companies, other times they are attached to national pharmacies or insurance companies.

For their negotiating services, they take a share of the profits from prescriptions. This share is known as ‘rebates.’ They also profit from “administrative fees” for each unit of drug sold, which can be up to 5% of the list price.

Speculated about for some time but difficult to prove because of private contracts (fully legal through the US system, which is notoriously bad at regulating drug pricing) is the sheer amount of cash being collected by PBMs. Originally created to help get needed drugs to patients more efficiently, PBMs have unfortunately become a key agitator to high out-of-pocket drug costs.

From a January 2021 Senate Finance Committee report, we now definitively know that “…drug manufacturers increased insulin WAC [wholesale cost], in part to give them room to offer larger rebates to PBM and health insurers, all in the hopes that their product would receive preferred formulary placement. This pricing strategy translated into higher sales volumes and revenue for manufacturers.”

The big legislative stumbling block we now face is just how reliant on PBMs the US healthcare system has become. In a more simple system, a pharmaceutical manufacturer could provide their medications to a pharmacy for direct disbursement to patients who require them. But in a system with a shaky foundation to start with and many players in the space, across private and public entities, the water gets significantly muddied.

To keep PBMs happy, ensuring they negotiate the placement of each manufacturer’s insulin on insurance formularies, rebates for insulins have increased exponentially, particularly since 2013.

In July 2013, Sanofi offered rebates between 2% and 4% for preferred placement on a formulary. The same product in 2018 provided a 56% rebate. That’s more than half of the out-of-pocket cost of insulin being handed to companies that don’t make the insulin.

This is one example, but every single insulin manufacturer does this. As the report states, “What is clear is that the money that flows through PBMs is nothing short of enormous. As discussed throughout this report, rebates have grown at a rapid pace in the insulin market in recent years, which is not true in all therapeutic markets.”

The Bigger the PBM, the Greater the Power

The three largest PBMs – CVS Caremark, Express Scripts, and Optum Rx – wield significant power in the market commanding large rebates. Lilly documents show that they offered a 22% rebate to a small PBM, but offered Optum Rx a 68% rebate for the same products in order to get placement in Medicare’s Part D prescription plan. As noted in the report, this robust ability to negotiate has led to “…some PBMs securing rebates as high as 70% in recent years.”

Manufacturer contracts with PBMs, previously confidential but exposed by the Senate Finance Committee report, are written in percentages. This means that it is to the PBMs’ benefit to encourage list price increases, making their portion of payout larger.

PBMs actively encourage manufacturers to raise the list price so that they may receive more money, and use threats of removing insulins from insurance formularies as leverage. The bundling of multiple products (increasing one product’s rebate amount to get other products included) is also a tactic used in PBM and manufacturer negotiations, especially in exclusivity contracts.

“As Eli Lilly explained to its investors in 2019, failing to secure formulary placement can “lead to reduced usage of the drug for the relevant patient population due to coverage restrictions such as prior authorization in formulary exclusions, or due to reimbursement limitations which result in higher consumer out-of-pocket cost, such as non-preferred co-pay tiers, increased co-insurance levels, and higher deductibles.”

The Bottom Line

The US healthcare system is deeply broken, and insulin pricing is one of the clearest examples that an unregulated drug pricing system motivated by profit will always put cash flow over patient lives. PBMs and the rebate system exacerbate the problem, but every participant within the system is at blame. Each entity has chosen profit over people.

Significant rebate reform and an overhaul or removal of the PBM system could slash the list price of insulin by up to 70% and would impact not just insulin, but many medications and devices that are subject to the rebate system. Robust federal healthcare reform could create a system where drug prices could be negotiated on a federal level, and current proposals like rolling back prices to more reasonable levels could be a step.

A deeply broken system requires layered solutions. Without a full overhaul, we risk fixing the insulin pricing issue with a bandaid, while driving up prices and limiting access to other life sustaining medications and life changing technology.

Substantial healthcare policy change takes the voice of many, and individual advocates make a resounding and impactful difference. If you are looking to get involved with diabetes access advocacy, start here. Reach out and get to know your state’s congressional representatives in the House and Senate. Make sure they know your personal experience and how issues of healthcare, drug pricing, and access impact you.

Source: diabetesdaily.com

New Dexcom Update: Your G7 Questions Answered

Last month, we chatted with Jake Leach, Dexcom’s chief technology officer (CTO) to get the latest scoop on the release timeline and new features of the Dexcom G7 continuous glucose monitor (CGM), a highly-anticipated diabetes technology that will be released in 2021. Many follow-up questions from our readers prompted us to follow-up further.

Without further adieu, here are your questions about the G7 answered:

There is no calibration, correct?

“This is correct.”

What about pharmacy vs. supplier distribution for the G7?

“We continue to focus on making CGM more accessible and easier to obtain for patients. Pharmacy is our preferred distribution channel and we have expanded pharmacy access for Dexcom CGM by nearly 80% since December 2018. This strategy will not change for G7.”

Now that the product is disposable, would this no longer be considered durable medical equipment (DME) and thus covered differently by insurance companies?

“The disposable aspect of the product has no impact on reimbursement.”

Do you anticipate working on integration with all the major pump companies?

“As the first iCGM on the market, and still the only one indicated for use with automated insulin delivery systems, Dexcom G6 is the forerunner in the category of interoperability and are advocates of patient choice in insulin delivery. G7 will be no different. With Insulet’s Omnipod 5 preparing for a first half of 2021 launch, we feel that our leadership in this category will result in us having integrations with the leading tethered pump on the market in Tandem’s Control.IQ, and the leading tubeless pump in Omnipod 5.

We are also very excited about the development progress that Lilly and Novo Nordisk are making in their Bluetooth connected smart pen technology and we continue to believe that the solutions we’re working on with those two teams will enable significant improvements in the user experience and ease the burden of diabetes in the MDI population, which represents the vast majority of intensive insulin users across the world.

Two years ago we stated that we believe that by 2023, 50% of our insulin intensive customer base will be using a connected insulin delivery device in combination with our CGM, and we believe that we are on track to hit that mark. Connected systems are truly the future of diabetes technology and we are working to extend our leadership in the category with these key partners and the tools that we have created to support these integrations, including our Dexcom artificial pancreas algorithm technology.”

Is there any evolution with the readout frequency (to be more frequent than every 5 minutes)?

“Patients and [providers] both tell us there isn’t a need for CGM systems to provide a glucose readout more frequently than every five minutes. This is especially true since Dexcom CGM has an Urgent Low Soon predictive alert that can warn users 20 minutes in advance of a severe hypoglycemic event (55 mg/dL), which helps give them time to take appropriate action before an event occurs.

Will G7 be approved for different wear locations (besides the abdomen)?

“We are conducting pivotal trials with the G7 in multiple wear locations, including abdomen and upper arm.”

Dexcom G7

Image source: Dexcom

In addition, Jake Leach had the following to say, highlighting his enthusiasm for the new developments:

“With G7, we’ve taken all of the great features that we’ve established with G6, features that have resulted in market-leading patient satisfaction scores, and have made them even better. G7 is a real time, factory calibrated continuous glucose monitor with iCGM level performance, a simplified application and start-up process, and a faster sensor warm-up time. We’ve packaged all of this into a fully disposable form-factor that is 60% smaller than our current G6 wearable and introduces significant cost reductions across the manufacturing process. This G7 wearable technology is paired with a brand-new app experience that includes real time glucose information combined with personalized insights designed to further enhance the unique value users get from Dexcom CGM. Take all of these features together and you can understand why we are so excited about G7 as a key driver of the growth story that we’ve laid out today.”

Are you excited to test drive the G7 CGM? Please share your thoughts in the comments!

Source: diabetesdaily.com

Diabetes Life Hacks: Tools to Help You Thrive

Living with diabetes is a full-time job and one we never applied for. It can be mentally exhausting and emotionally and physically draining. I know I am always looking for any tips or tip-offs that can help me with my diabetes management–whether it be technology, travel perks, or even a new app that tells me to get my act together.

I asked the diabetes online community to share any and all fun tips and tip-offs that can help make our lives a little bit easier and enjoyable.

Here are the top 9 diabetes hacks that the diabetes online community shared:

Dexcom G6 Sensor

1. Restarting Dexcom Sensors

Did you know that you can extend your Dexcom G6 sensors beyond the 10-day cut off? There are quite a few ways to go about it depending on your transmitter code. You can find the right method to use here. This will save you a few pricks and pokes and some money too.

2. Free Admission to National Parks

People living with diabetes (or any other condition that falls under disability) can apply for free lifetime access to US national parks. You can obtain your pass through the mail which involves a $10 dollar processing fee, or you can get it in person to avoid the extra charge. This is a great perk that everyone should take advantage of at some point in their lifetime!

Sulli the Diabetes Guru

3. Sulli the Diabetes Guru

Roche Diabetes Care created a voice-activated assistant in the homes of people living with diabetes. This virtual source of support and information is available around the clock and free of charge on Amazon Alexa and on Google Assistant. Sulli the Diabetes Guru responds to important questions like “What is high blood sugar?”, “Is it okay to eat before my blood test?” as well as sets reminders to take medication and can even tell you where to find the closest blood monitor retailer!

Medal from Lilly Diabetes

Photo credit: Clare Fishman

4. Lilly Diabetes Journey Awards

Did you know you could receive a medal for your valiant effort of managing your diabetes? This program recognizes people who have managed their type 1 diabetes successfully with insulin for 10, 25, 50 and 75 years. Each recipient receives a beautiful award, engraved with their name, along with a signed letter from Lilly’s CEO, Dave Ricks, acknowledging and encouraging their continued dedication. This program helps celebrate each other’s victories and hopes to inspire others living with diabetes.

People living with type 1 diabetes or parents of children with type 1 diabetes in the United States can complete and submit the Lilly Diabetes Journey Awards application here. If you are outside the United States and are interested in learning more about Lilly programs in your country, please contact your local Lilly affiliate for more information.

Lilly also offers other programs such as their Lilly Camp Care Package program, which provides diabetes educational kits, inspirational speakers, insulin, and other supplies to camps for children with diabetes. Lilly also offers college resources after partnering with The College Diabetes Network. CDN realizes that campus life and independence can be hard enough without diabetes. They created a community for young adults living with diabetes through its national network of campus-based chapters and their resources available on their website.

5. Ask Siri for Your Glucose Reading

If you are using a Dexcom CGM, you can take advantage of Siri and ask her any time of the day, “What is my blood sugar?” and she will take the reading from your Dexcom and say it out loud. This has become incredibly useful when I’m driving or don’t have the time to unlock my phone and go to the Dexcom app.

6. Happy Bob App

This app takes mundane diabetes data and turns it into an engaging and positive experience for the user. You can switch between Happy Bob and Snarky Bob to get a different dose of entertainment. Both of which will help ease the stress of this disease and leave you with a smile!

7. Dexcom Overlay

Did you know that Dexcom offers free over-patches to help reinforce the adhesive? There are plenty of great companies out there that offer this as well but be sure to take advantage of this free offer and see how it works for you and/or your child. You can submit a request using this form.

8. Preboarding Before a Flight

As people living with diabetes, we are allowed to preboard all flights. This is helpful to get your luggage in a safe space and make sure you have time to access any supplies or snacks before the plane gets crowded and it’s more difficult to move around. This will help set you up for a comfortable and relaxing flight. Read here for more information on air travel and what you need to know.

9. Sugarmate App

Sugarmate is a companion app for those using Dexcom G5/G6 and boasts many great features such as apple watch integration, will call you if your CGM goes low, and is ignored, even if it is in the Do Not Disturb mode. The newest feature if you own a car with CarPlay and connect your phone, your blood sugar will automatically display on your screen.

Make sure to take advantage of these above diabetes hacks to make living life with diabetes a little easier. Many of the above tips can help change your mindset, improve your mood, and give you a little motivation to keep on thriving.

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

FDA Approves Lyumjev – A New Rapid-Acting Mealtime Insulin

This content originally appeared on diaTribe. Republished with permission.

By Frida Velcani

Lyumjev reduces blood glucose spikes and can be taken at the beginning of a meal, or even 20 minutes into the meal; available through Lilly’s insulin affordability program

A new rapid-acting mealtime insulin has been approved by the FDA to reduce high blood sugar after meals and keep blood glucose levels in-range. The insulin is rapid-acting, meaning that it is absorbed into the bloodstream and the body more quickly. This approval provides another important mealtime insulin option for adults with type 1 or type 2 diabetes. Lilly’s Lyumjev was approved in Japan and Europe in March 2020, and the company is working to make Lyumjev available to people in the United States as quickly as possible.

Lyumjev will be offered at the same price as Humalog. Lilly will also offer Lyumjev through its newly launched Insulin Value Program, which makes the therapy available at $35 per month for people who are uninsured or have commercial insurance. The $35 cap applies regardless of the number of insulin doses required.

This approval was granted based on the results from the 2019 phase 3 PRONTO-T1D and PRONTO-T2D trials. The data showed that, compared to Humalog, Lyumjev reduced blood glucose spikes (hyperglycemia) one hour and two hours after a meal in people with type 1 and type 2 diabetes. The drug did not affect A1C reduction. In people with type 1 diabetes, Lyumjev reduced hypoglycemia four hours after meals, whereas in people with type 2 diabetes, the insulin slightly increased hypoglycemia both one to two hours and two to four hours after a meal.

Lyumjev can be taken at the beginning of a meal or 20 minutes after starting it. This flexibility is due to the faster onset and offset of the insulin. That said, it is still strongly recommended that whenever possible, people should take Lyumjev before the start of the meal.  Lyumjev by Lilly joins Fiasp by Novo Nordisk as the two faster acting insulins available giving people with diabetes more flexibility in mealtime insulin dosing.

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

What to Do If You Need Insulin Right Now

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

What to Do If You Have No Insulin at All

Go to the emergency room. Under US law (The Emergency Medical Treatment and Active Labor Act), the emergency room cannot turn you down in a life-threatening emergency if you do not have insurance or the ability to pay.

If Emergency Room staff is telling you they cannot treat you, stay put. Be clear that you are in a life-threatening emergency because you have type 1 diabetes (T1D) but do not have insulin. Do not leave. Please note that urgent care centers are not required to abide by the same laws.

Once you are stabilized and before you leave the hospital, hospital staff is required to meet with you to make sure you understand that you are leaving the hospital of your own accord. At this time, let the hospital staff person know about any financial situation you are in. Some hospitals are aligned with charities that can help you pay. Other hospitals offer payment plans based on your situation. No matter your financial situation, know that your life is the most important thing.

What to Do If You Have Some Insulin, But Are About to Run Out

Utilize Kevin’s Law

If you have an existing prescription at your pharmacy, but have not been able to get ahold of your healthcare provider to renew the prescription, you may be able to take advantage of Kevin’s Law. Kevin’s Law was named for a man with T1D who passed away after not being able to access his insulin prescription over the New Year’s holiday. Under the law, pharmacists are able to provide an emergency refill of insulin in certain states, without the authorization of a physician to renew the prescription. Rules around the law vary from state to state and not all states have the law in place. Kevin’s Law only applies to those who have an existing prescription and, depending on where you live, your insurance may or may not cover the refill. Learn more about Kevin’s Law, including whether or not your state has it, here. Please note, your pharmacist may not know the law by name, or know that the law exists. If you are in a state with Kevin’s Law and working with a pharmacist who is unaware, stay put and ask to speak to someone else in the pharmacy.

Ask Your Physician for Samples

While this is not a long-term access option, your care provider may be able to provide you with a few vials/pens for free, and bringing your HCP into the access conversation means that they can help direct you to other options that might be available to you, like local community health centers with insulin available.

Utilize Patient Assistance Programs – Standard out of Pocket Cost $0

  • If you take Lilly insulin (Humalog, Basaglar) call the Lilly Diabetes Solutions Call Center Helpline at 1-833-808-1234
    for personalized assistance. You may be eligible for free insulin through LillyCares.
  • If you take Novo Nordisk insulin (Fiasp, NovoLog, NovoRapid, Levemir, Tresiba) and demonstrate immediate need or risk of rationing, you can receive a free, one-time, immediate supply of up to three vials or two packs of pens by calling 844-NOVO4ME (844-668-6463) or by visiting NovoCare.com
  • If you take Sanofi insulin (Admelog, Lantus, Toujeo): the Patient Connection Program provides Sanofi insulins to those who qualify, which is limited to those with no private insurance and who do not qualify for federal insurance programs and who are at or below 250% of the federal poverty level – with a few exceptions.

Utilize CoPay Cards – Standard out of Pocket Cost $35 – $99 per Month

Copay cards that reduce the out-of-pocket cost you pay at the pharmacy exist for most types of insulin. Some copay cards can be emailed to you within 24 hours. Currently, copay programs exist for:

  • Lilly, capping copays at $35 per month for those with no insurance or with commercial insurance
  • Novo Nordisk, capping copays at $99 for those with no insurance or with commercial insurance
  • Sanofi, capping copays at $99 for those without prescription medication insurance
  • Mannkind, capping copays at $15 for some of those with commercial insurance

Unfortunately, copay cards are typically not available for those insured through Medicaid or Medicare. Use the tool from the Partnership for Prescription Assistance to search in one place for discount programs and copay cards you qualify for here. Please be aware that you will need to search by brand name (i.e. Humalog, Novolog), not just “insulin.”

Get R & NPH Human Insulins – Standard out of Pocket Cost $25-$40 per Vial

R (Regular) and N (NPH) human insulins are available over-the-counter in 49 states and cost much less ($25-$40 per vial at Walmart) than analog insulins such Novolog, Humalog, Lantus, or Basaglar. They also work differently than analog insulins – they start working and peak at different times – but in an emergency situation can be a resource. Speak with the pharmacist or your healthcare provider if possible before changing your regimen and keep a very close eye on your blood sugar levels while using R & N insulin.

Research Available Biosimilar (Generic) Insulins

The biosimilar insulin market is changing rapidly as the FDA adopts new regulatory pathways to more efficiently approve interchangeable insulins that may be available for a lower price. Ask your healthcare provider for the most up-to-date options for you. A few options available are:

  • A generic version of Humalog — Insulin Lispro — is available at pharmacies in the U.S. for $137.35 per vial and $265.20 for a package of five KwikPens (50% the price of Humalog.) If you have a prescription for Humalog, you do not need an additional prescription for Lispro; your pharmacist will be able to substitute the cheaper option. Insulin Lispro is not currently covered by insurance.
  • Authorized generic versions of NovoLog and NovoLog Mix at 50% list price are stocked at the wholesaler level. People can order them at the pharmacy and they’ll be available for pick up in 1-3 business days

If you have enough insulin to last you a few days, but need to figure out where to get a more reliable, consistent supply, visit our Get Insulin page to find further resources.

Source: diabetesdaily.com

Why Glucagon Is a Must for Sick Days

This content originally appeared on Beyond Type 1. Republished with permission.

By Jordan Dakin

Common Knowledge

Becoming sick when you have type 1 diabetes can easily complicate things. When you have the flu or a serious bacterial infection, your blood sugar levels can quickly become harder to manage, as they typically trend higher because of your body’s automatic, hormonal response to being sick. Because of this, you might find yourself needing more insulin than usual and needing to check for ketones more often to prevent diabetic ketoacidosis (DKA). Having a plan for sick day management when you have type 1 diabetes is crucial.

It’s important to be mindful of the possibility of high blood sugar when you’re sick. But it is also important to realize that sick day lows are a definite possibility as well! Especially if you’re taking more insulin than normal to combat highs when sick, you have to be mindful of resulting lows. You also run the risk of encountering a severe low if you are either unable to keep food down or lack an appetite when you’re sick, which are common realities when you have a cold or flu.

Enter Glucagon

Whatever the reason for a low, keeping glucagon handy to combat severe bouts of hypoglycemia on a sick day is definitely a must. Severe hypoglycemia is a dangerous complication of type 1 that can result in seizure, loss of consciousness, or death, and there is peace of mind in having a safety net to prevent any one of those outcomes. Glucagon is the first line treatment for severe hypoglycemia because it is the main counter-regulatory hormone to insulin. Parents and caretakers of those with type 1 can especially benefit by having an immediate safeguard against the dangers realities of a severe low.

The standard of care has been to keep a glucagon emergency kit handy. Historically, these emergency kits came equipped with an injectable form of glucagon, that requires mixing powder and liquid with a syringe by whoever is administering the shot. While this can definitely be an effective form of glucagon, having to mix the shot prior has made the procedure complicated and intimidating for some.

Next Level Options

Luckily for those of us affected by type 1 diabetes (T1D), glucagon has been approved in two new forms over the last year: nasal glucagon and pre-mixed steady state.

Baqsimi is the first and only nasal, non-injectable form of glucagon, offering a slight variation on what most people with diabetes are used to. It is administered like a nasal spray, but does not require inhalation, so even if a patient is unconscious (a frequent cause of severe hypoglycemia), anyone can administer Baqsimi and it will work.

Gvoke is the first liquid stable form of glucagon, meaning though it is an injection, it comes ready to use and requires no mixing on the part of whoever is administering the shot. Gvoke also comes in two forms: a pre-filled syringe (called Gvoke PFS) that is available to patients now and an auto-injector pen (the Gvoke HypoPen) that has yet to become officially available.

Neither Gvoke nor Baqsimi require refrigeration, and both have an impressive shelf life of up to two years if kept at room temperature. Another added benefit of these next generation iterations of glucagon is that these tools can likely prevent an ambulance trip to the hospital, saving time and resources. (Editor’s Note: This is especially important during the current COVID-19 pandemic, as it is not advised to visit hospitals unless absolutely necessary.)

How to Get Glucagon

Lilly currently offers a Baqsimi coupon patients can use to get up to two devices for as little as $25.

Through the end of April 2020, Xeris is offering a Gvoke co-pay card with which some patients can pay as little as $0 with eligible insurance to get their Gvoke PFS. Patients can also opt to request their prescription through the website and have Gvoke PFS delivered by PillPack at no additional cost.

Keeping glucagon handy is the best defense against unexpected lows when you’re not feeling well. Being sick might come with some uncertainties and cause some worry, but you can rest easier knowing you’re prepared and equipped with the necessary tools to take on whatever comes your way.

For step by step instructions on how to use each type of emergency glucagon, click here.

Source: diabetesdaily.com

How to Make an Emergency Preparedness Plan

The reality of living in a time of a global pandemic, such as COVID-19, is slowly starting to sink in for millions of Americans. Without any preventive antibodies, vaccine, or cure, it is extremely scary when the closest thing we can do to protect ourselves is to wash our hands, avoid sick people, and remain socially distant at all times. With society all but shut down, here’s our guide to creating an emergency preparedness plan if you get sick and/or need to quarantine in place for a long period of time.

What and How Much to Stock Up on to Shelter-In-Place

With shelter-in-place mandates in all but a handful of states, it’s important to know what you’ll need for (ideally) several weeks without leaving home. People with diabetes are more susceptible to having severe complications from COVID-19, so even though grocery shopping and going to the pharmacy is permitted under a shelter-in-place order, it’s not necessarily recommended. Even though the food supply-chain will not break down, it’s best to not be running to the grocery store any more often than you absolutely need to, so try and stock up on at least two weeks’ worth of shelf-stable food, water, and toiletries. In a pinch, apps like Instacart and Amazon Fresh offer online grocery orders, so if you’re running low on some staples but don’t want to leave home, these are a great option to have.

Shelf-stable foods:

  • Dried beans
  • Rice
  • Lentils
  • Flour
  • Pasta
  • Canned and frozen vegetables
  • Canned soups
  • Peanut butter
  • Canned and frozen fruits
  • Canned meats and seafoods

In a March interview with NPR, Dr. Peter Jacobson, a University of Michigan professor of health law and policy, advises a stockpile of at least 90 days for medical supplies:

“People should not be caught short of having enough heart medications, diabetic medications, or any potentially life-saving medication that they need on a routine, daily or weekly or monthly basis,” he said.

Sometimes this can be as easy as signing up for your pharmacy’s mail-order option or talking to your pharmacist and asking if they can fill your routine medications for 90 days instead of 30.

Contacts to Have on Hand

Now is an excellent time to gather all of your important phone numbers for doctors and family members should you need to get in contact with them quickly (or if you fall ill and your spouse needs to contact someone quickly). Important numbers to gather and have in a communal space (like pinned up on the refrigerator):

  • Endocrinologist
  • Primary Care Physician (PCP)
  • Your Employer
  • Immediate Family Members
  • Trustworthy Neighbor
  • Local hospital (where your insurance is accepted!)
  • Your Pharmacy/Pharmacist
  • Water Company
  • Power Company
  • Internet Provider
  • Children’s School or Daycare

Have a Plan B If You Need to Evacuate

Have a plan in place if you’ll need to evacuate your home or city. Reach out to your support network of family members or close friends should you need to self-isolate due to COVID-19 exposure, or if you feel your city is becoming unsafe and you need to get away. Make sure you prepare a packing list, have a to-go bag ready, and prepare your home if you need to leave quickly. Conditions can change quickly, so it’s important you know where you can go, how to get there, and what to bring if and when you need to leave.

Important things to pack in a to-go bag:

  • All medications, insulin, and diabetes supplies
  • Cold and flu medicines
  • Low supplies
  • Toiletries and extra towels
  • Clothing/pajamas/exercise clothes and extra socks and shoes
  • First aid kit
  • Copies of important documents, such as prescriptions and ID
  • Chargers for CGM, cell-phone, etc.
  • Vitamins and self-care essentials
  • Books and important mementos

What Do I Do in the Case of…?

It’s a scary time to be quarantined in your home, away from many friends and family. It’s even scarier when you have diabetes. Here are some common conundrums and resources to help you:

  • I Suspect I Have COVID-19: Read up on COVID-19 , and if you suspect you’ve been exposed to the virus, self-isolate immediately and call your physician to describe your symptoms. They will guide you as to what your next steps should be.
  • I Have a Bad Low and I’m Home Alone: If you’re home alone and are battling a bad low, call 911 immediately. If you can access your glucagon, get that while you’re on the phone with an emergency dispatcher. It’s best to know how to inject glucagon before you ever need to know. Learn how to do so here.
  • I’m Sad and Scared During This Time: If you are having trouble managing the emotional toll during this time, check out our top ways to protect your mental health. You can also take advantage of telehealth, and schedule some time with a counselor to talk about your feelings during this hard time.
  • I’m in DKA: If your blood sugar has been persistently high, you have ketones, and you think you may be developing diabetic ketoacidosis (DKA), it’s time to either go to your local emergency department, or call 911 (if you are unable to drive). Be sure to act quickly, as time is of the essence when it comes to extremely high blood glucose levels. Medical professionals will be able to re-hydrate you, better regulate your glucose levels, and monitor you, keeping you safer than you will be at home.

Whether you come down with coronavirus, you are quarantined, or you are self-isolating, you may be unable to venture out to pick up your prescriptions. You may be able to get your medication delivered directly to you. Here’s how:

  • Reach out to big chain drug stores. Both CVS and Walgreens are currently offering free home delivery of prescription drugs.
  • Call your regular pharmacy. Many smaller pharmacies will usually deliver medications for free.
  • Try a mail-order pharmacy. They often offer great discounts (sometimes as much as 90-day supplies for the co-payment of 60 days) as well as free shipping. Find out if your insurance company will cover a mail-order option.
  •  If you need a new prescription, but either can’t get to your doctor’s office, nor can you take advantage of telehealth, consider using HeyDoctor, GoodRx’s telehealth service. HeyDoctor visits cost a flat fee of $20, regardless of your insurance (and even without insurance). They’re currently offering free COVID-19 screening consults.
  • Check out new programs directly from insulin manufacturers. Eli Lilly , Novo Nordisk, and Insulet have recently set up new affordability programs.
  • I Lost My Job: This global pandemic has quickly turned into an economic crisis, with millions of Americans losing their jobs and having their work hours cut, in short order. In the US, losing a job can often mean also losing your health insurance, which is terrifying for someone living with diabetes. Check out our guide to finding affordable health care if you find yourself recently unemployed due to the COVID-19 crisis.

We’re living in extraordinary times, but having an emergency preparedness plan in place can help you manage circumstances in these extreme conditions. What are some ways in which you’ve planned for the worst (but hoped for the best?). What has helped you the most? Share this post and comment below; we love hearing your stories.

Source: diabetesdaily.com

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