Successful self-management is hard work for those living with diabetes. If adherence to recommended care is an issue, the elephant in the room may be expenses related to diabetes. From 2012-2017, the American Diabetes Association (ADA) studied the economic burden of diabetes in the U.S. and reported, among other findings, the estimated medical costs (adjusted for general inflation) associated with diabetes:
· Increased by 26% from $188 billion to $237.3 billion.
· Individuals with diabetes were reported to spend on average $9,601.00 in excess expenditures for medical expenses compared to those without diabetes.
· Medications to control blood glucose increased by 45% in the same time period.1
The rising cost of insulin has captured the attention of the nation. Diabetes organizations and health care groups are calling on policymakers to take action to address making insulin more affordable. The 2018 ADA Insulin Affordability Survey provides valuable insight into the impact rising insulin costs and related practices have on the individual.2 When you are at an appointment, asking the patient if they are having any difficulty affording diabetes medications may allow for exploration of ways to help lower out-of-pocket expenses for them.
Understanding and navigating insurance and prescription benefits can be confusing. Individuals are dealing with obtaining needed supplies and medications while balancing their diabetes care, work and school along with numerous other demands. Patients and families often find themselves at the mercy of insurance companies, health care systems, pharmacies and durable medical equipment (DME) companies. Diabetes self-management education and support programs (DSME/S) may provide information for understanding coverage and insurance terms. Diabetes centers fortunate to have billing specialists can provide invaluable assistance and support to patients.
Consider providing patients a guide for talking with their insurance company and a log for keeping track of phone calls. Some questions may include:
1. What medications and supplies are on formulary and what items are preferred? (Explain to patients if there is concern about any costs, the health care provider may be able to change the medication to one with better coverage or that is less expensive.)
2. Is there a preferred pharmacy? (Patients should find out if their plan has a pharmacy benefit and, if so, what diabetes items can be obtained from the pharmacy.)
3. Is there a requirement to use a DME for supplies, and, if so, what are their choices?
4. Is there better pricing from a 90-day supply versus a 30-day supply?
We should not assume patients and families are aware of the questions to ask.
Another potential way to save money is by advising individuals to check manufacturer websites for any online savings cards, vouchers and patient assistance programs. Encourage individuals to routinely ask their provider, diabetes care and education specialist and/or pharmacist if any coupons, vouchers or savings cards are available for their medications and supplies. Although potential resources are somewhat limited, you may share some available that may provide savings to patients.
Resources for potential cost savings
Diabetes technology such as continuous glucose monitors (CGM) and insulin pumps can offer opportunities for improving diabetes care; however, it can be costly. In addition, it is equally as important to have realistic expectations of the benefits, costs and amount of attention involved in using the device. Understanding of the initial and ongoing monthly costs is an essential part of the decision-making with regard to therapy. Knowing if the insurance plan requires devices and supplies to be obtained through a DME, the manufacturer or pharmacy can prevent frustration and unexpected costs. Individuals who have a high deductible plan may benefit financially from strategically timing the purchase of expensive diabetes supplies in relation to their annual deductible. Encourage price comparison of DMEs and pharmacies if there are options.
Research has shown quality DSME/S is associated with improvement in diabetes self-management, patient satisfaction and glucose outcomes.3-4 As of 2016, 46 states and the District of Columbia had legislation mandating coverage for diabetes education.5 Reimbursement for DSME/S is available from the Centers for Medicare & Medicaid Services (CMS) and many private payers. Despite this, the percentage of those receiving diabetes self-management education (DSME) within their first year of being diagnosed is only 6.8% for those with private insurance6 and approximately 5% for Medicare recipients.7 Diabetes care providers should emphasize to patients that quality, evidence-based DSME/S is a fundamental part of the treatment plan. In fact, DSME/S is considered such an essential component of diabetes care that medical treatment without it is considered inadequate.8
The Juvenile Diabetes Research Foundation (JDRF) and ADA may have educational events that are free to the public. Other organizations may offer low-cost diabetes educational conferences or scholarships to attend, such as:
• Friends for Life, offered through Children with Diabetes (CWD), for type 1 diabetes. Youth and their families can apply to program scholarships: https://childrenwithdiabetes.submittable.com
• Taking Control of Your Diabetes has low-cost educational conference and exhibit fairs for those with type 1 and type 2 diabetes and their families: https://tcoyd.org/tcoyd-conference-health-fair
• Local and state health departments and community centers may offer DSME/S for adults with diabetes at no cost to the patient
Furthermore, phone calls with certified diabete care and education specialist (CDCES), if available, can provide education over the phone as a way to address immediate needs and reinforce DSME/S. Licensed clinical social workers, particularly those who work with diabetes patients routinely, may be able to connect families with resources to alleviate financial burden.
As it relates to health, purchasing gym memberships can be expensive and, in fact, is not necessary. Creative and low-cost ideas for exercise may include using an exercise app to track activity, setting an exercise goal and a realistic plan, joining a community walking group, taking advantage of free
community classes, or participating in diabetes fundraising walks or other physical activities sponsored by such organizations as ADA and JDRF. Share ways to save on food costs with your patients, such as:
· Plan meals. Start with trying to do one to two per week. Scan cookbooks.
· Always have a shopping list.
· Do not go to the supermarket on an empty stomach.
· Plan some meatless meals with other sources of protein.
· Inventory your pantry and use up what you have before buying more of the same types of foods.
· Avoid processed and prepared foods.
· Utilize store loyalty programs.
· Supermarket apps often have useful tools, such as meal recipes and shopping lists.
· Visit discount stores.
· Try growing your own herbs.
· Buy store brands but still compare prices (for example, if there is a sale and coupons for name-brand items).
· Opt for frozen vegetables versus fresh produce.
Providing patients and families with a list of reputable diabetes magazines and websites may encourage them to learn more about diabetes self-management. Both options can provide resources such as recipes, cost savings ideas, inspiration and creative tips for improving health. Provider offices should be able to obtain consumer magazine samples to give their patients an idea of which ones may be helpful. In addition, encourage patients to browse the diabetes section in their local library for diabetes health information. Some diabetes groups and organizations offer free diabetes shopping tours as a way of providing hands-on nutrition education. Encourage your high school students to explore the College Diabetes Network for a list of potential sources for scholarships for students in high schools and college (https://collegediabetesnetwork.org/content/scholarships-1).
For most living with diabetes, navigating the landscape of diabetes daily self-management, insurance coverage of medications and supplies, and the financial burdens of a chronic disease can be challenging. The community that cares for patients with diabetes is fortunate to have a plethora of organizations, resources, health care teams and diabetes consumer advocates dedicated to improving health outcomes. As diabetes care professionals, we must empower our patients to “fight the good fight,” which hopefully will result in cost reduction along the way.
Access additional resources and practical information to enhance the care and treatment of your diabetes patients.
About our experts