Financial Assistance for Diabetes Treatment

Diabetics find themselves in an increasingly uncomfortable position these days: If the disease doesn’t get them, the cost for treating it will.

The average diabetic spends $16,750 a year on medical care, or about $10,000 a year more than people without diabetes. The cost of diabetes medications, which account for most of that total, rose 52.8% between 2014 and 2016, compared to an 18.8% cost increase for all other drugs. In 2017, diabetics spent $15 billion on insulin; $3.7 billion on supplies and $15.8 billion on other anti-diabetes agents.

Type 1 diabetics, who can’t live without insulin, watched the price of the most popular form of the drug skyrocket from $20 per vial in 1996 to $275 per vial in 2018, an increase of 1,275%.

The amount of insulin diabetics use varies, but most need about two vials ($550) a month. One vial holds about one-third of one ounce of insulin.

“You end paying just about the same price for an ounce of insulin that you do for an ounce of gold,” Tim Harrison, owner of Harrison’s Pharmacy in Orlando, FL said. “It’s ridiculous.”

The skyrocketing cost for insulin was red-hot enough that in 2019 there were Congressional hearings about it and requests that drug companies explain why they still have patents and are raising the price on drugs that have been around for 50 years.

As a result, Eli Lilly, makers of the very popular Humalog 100 insulin, announced it will sell a generic version of the medication for about half the $275 per vial cost of Humalog. No details were released about when the cheaper version would be available.

Every Type 1 diabetic must take insulin and some – about 25% according to a Yale University study – ration the amount they use because of the cost. That can have severe health consequences, including damage to eyes, kidneys, heart and nerves.

“It’s been my experience that diabetics have the highest expenses per year of any of my customers because of complications,” Harrison said. “You would think the insurance companies would give them a break on supplies just to keep them out of the hospital, but they don’t!”

What to Do If You Can’t Afford Insulin

So, what do you do if you can’t afford to be a diabetic? Well, there is help, just not a lot of it. Here are the most encouraging suggestions.

• Ask your doctor for help. If you are rationing your insulin, or worse, have stopped taking it altogether, tell your doctor and ask if there are sample vials available. Hopefully, that will tide you over while you research other options.
• Do research on prescription drug sites. There are several reliable online sites like GoodRX, SingleCare, Blink Health and FamilyWize that offer discounts on some insulins.
• Look for a drug savings card. Drug companies do have coupons or saving cards that can reduce the cost significantly. Most are available online as well as places like NeedyMeds and the Partnership for Prescription Assistance. However, you can’t use them if you have government drug coverage like Medicare, Medicaid, VA, etc.
• Visit patient assistance programs like Lilly Cares Foundation Patient Assistance Program. This is a nonprofit organization that provides free medications made by Eli Lilly and Company. All the drug companies have patient assistance programs.

Those, however, are only short-term solutions. At the moment, the only long-term solution to dealing with the cost of diabetes supplies is to hope you qualify for one the government-backed forms of insurance. Here is a breakdown of what you would get.

How the Affordable Care Act Impacts Diabetics

The most notable impact that the Affordable Care Act (ACA) has had on diabetics is that they actually get insurance and pay the same rate as everyone else. In the bad old days, insurance companies could deny coverage or increase premiums just because you have diabetes. They also could limit coverage on basic needs like insulin, syringes, tubing, blood testing strips, etc., to the point where a diabetic couldn’t afford the out-of-pocket expense for supplies.

The ACA ended that. All insurance companies must treat diabetics the same as anyone else.

The other plus for diabetics stemming from the ACA is that it opened the door for expanded Medicaid coverage among low-income and uninsured adults who didn’t have an affordable option for health insurance.

While the ACA doesn’t allow for weeding out consumers with pre-existing conditions, it doesn’t offer much in the way of help in paying the tab for diabetes supplies. Depending on which level of insurance you choose, you could be paying as much as the first $5,000 for your insulin and other diabetic supplies before the ACA insurance picks up anything.

Diabetes and Medicaid

Medicaid has been a problem solver for low-income, disabled and elderly diabetics coping with the cost of insulin and supplies.

When Medicaid coverage expanded eligibility in 29 states and Washington D.C., there was an immediate impact on diabetics. Prescriptions filled for insulin and other diabetes medications rose 40% in states that expanded Medicaid eligibility in 2014 and 2015, according to a study by Dr. Rebecca Myerson, an assistant professor of pharmaceutical and health economics at the University of Southern California.

Myerson’s study also showed that prescriptions filled for new medications – Type 2 diabetes treatments like Trulicity, Victoza, Farxiga and extended release Glucophage – increased by 39%.

States that didn’t allow Medicaid expansion, saw no notable increase in diabetes prescriptions filled.

“Given the high costs of insulin for patients who pay out of pocket, expanding access to Medicaid can make a big difference,” Dr. Myerson told Debt.org. “Unfortunately, many states with the highest prevalence of diabetes have not expanded access to Medicaid among low-income adults.”

In other words, geography could be a big factor in a diabetics’ ability to get insulin. If you’re living in a state that doesn’t have expanded Medicaid, and you don’t have insurance coverage, which always is a problem among low-income families, you are out of luck.

Diabetes and Medicare

Medicare is an invaluable lifeline for diabetics 65 years and older. It generally covers the diagnosis and treatments needed to control diabetes. It is especially valuable for people whose level of exercise drops and weight increases as they get older. Those are two of the tell-tale signs of Type 2 diabetes.

If you have Medicare Part B, it helps pay for:

• Supplies such as glucose monitors, test strips and lancets
• Insulin pumps and the insulins used in them
• Diabetes screening tests
• Self-management training
• Flu and pneumonia shots
• Foot exams and treatment
• Therapeutic shoes or inserts for people who need special footwear
• Eye exams for glaucoma
• Counseling for obese people trying to lose weight
• Medical nutrition therapy services

People with Medicare Part D receive help paying for:

• Insulin not used in an insulin pump
• Supplies such as syringes and needles
• Diabetes medications
• Alcohol swabs, gauze and inhaled insulin devices

Assistance for Those Without Health Insurance

If you have diabetes, but don’t have insurance the best suggestion available is: FIND A WAY TO GET INSURANCE!

It is possible for a diabetic to survive without insurance, just not advisable. You could do things like:

• Change insulin from effective, but expensive Humalog or Novolog to cheaper, but far less effective ones like Novolin N or Novolin R
• Ask your doctor for a free sample
• Ask a friend to donate a vial or two
• Attempt to ration your insulin supply
• Allow your income to crumble so low that you qualify for Medicaid assistance

At best, those would all be short-term – very short-term! – solutions to the permanent problem of managing your blood sugar levels in a responsible way.

Patient Assistance Programs

All the major drug companies, including the three biggest insulin producers in the U.S. – Novo Nordisk, Lilly and Sanofi – have a patient assistance program (PAP) that offer free or low-cost drugs to people unable to pay.

Each company’s program has its own eligibility and application requirements, but the major one is financial. You must be able to prove that you can’t afford the medication.

Each drug company has its own table for qualifications, but they are similar and generally based on some formula that includes the federal poverty level, which in 2019 was $12,490 for an individual. That number goes up $4,420 for every other individual in a family household.

For example, in 2019, Lilly’s household income limits were $36,420 for individuals and $75,300 for a family of four. Novo Nordisk’s range is $37,470 for a single person and $77,250 for a family of four. Sanofi was at $31,223 for an individual and $64,347 for a family of four.

It should be noted that you can apply to the PAP programs for as many drug companies as you want, however, patients who already receive assistance from programs like Medicare, Medicaid, VA or have private prescription coverage are not eligible.

Check each company’s website for specific details on eligibility.