If you have diabetes, you understand how complex it is to manage the disease. Every day is filled with thoughts and efforts to stay healthy from the time you wake up in the morning to the moment you drift to sleep at night, and even in the middle of the night. There are so many tools and technologies available to help ease the burden. But there is one aspect of diabetes management that never seems to improve: the cost.
People with diabetes pay more for health care. Based on a 2017 study , individuals with diabetes paid more than double what they would without diabetes. Interestingly, these expenses can be reduced significantly. Of the $237 billion spent on diabetes medical costs in 2017, only 1.6% or $3.8 billion was spent on testing supplies. The remaining $233.2 billion was spent on medication, hospital care, outpatient care and more—many of which could be reduced by preventing complications from diabetes. Many of these complications result from frequent high blood sugar. The $3.8 billion spent on supplies for managing blood sugar are important dollars. If every individual with diabetes was able to prioritize testing supplies and use them to better manage blood sugar, the costs of major procedures could be reduced significantly.
Here are three ways people should NOT attempt to reduce the costs of diabetes:
- Testing blood sugar less often to use fewer test strips
- Decreasing medication doses to make it last longer
- Reusing supplies that are intended for single-use.
While these are the areas where corners are most often cut, saving money today can lead to financial and physical costs years later. So, where can people save money safely?
There is hope.
3 Cost-Saving Tips for People with Diabetes
Through our years of experience, we have come up with several money-saving tips for people with diabetes that will not interfere with long-term health. In fact, these suggestions are designed to improve long-term health because they allow you to properly manage your diabetes.
Tip 1: A medical provider’s preferred brand isn’t necessarily “best.”
A doctor or insurance provider says we need a specific medication or product. Instead of researching we just go along with what is recommended regardless of cost. While your medical provider is focused on what is best for maintaining your health, they may not be thinking about your wallet. This often leads to paying too much.
Things to consider:
Meters and test strips
- Your medical provider may have given you a free meter, but how much do the testing strips, lancets, and control solution for that meter cost? Look at the long-term costs associated with your meter and make sure you’re not paying too much.
- Consider buying supplies directly from suppliers, like Diathrive. If you are paying more than $12 per month out of pocket for testing supplies there is a good chance you could pay less by cutting out insurance and pharmacy altogether.
- With new, fancy devices and meters coming out, it can be tempting to go for the newest, flashiest technology. But often, the basic models are just as effective. Find what works best for you.
- Medications and syringes
- If you use insulin, find out what brand(s) your insurance will cover. If yours is not covered, ask your doctor to prescribe a biosimilar that is.
- Have you been prescribed a brand-name medication, like Glumetza or Glucophage? Ask your pharmacist if the generic (metformin) will cost less.
- Pen needles: There are universal options that will fit most insulin pens. You don’t have to use a specific brand of pen needles.
- Shop online for syringes, or find out if your pharmacy carries a lower-cost option.
Tip 2: Understand your insurance plan options.
Shopping for insurance can be a nightmare. Even if you have employer-subsidized insurance, you probably have options to choose from. With pages and pages of technical documentation, it’s difficult to understand what is covered. Knowing what to look for can help you get the best coverage for your needs.
Things to consider:
Forecast your diabetes supply needs
- How often do you check your blood sugar each day? How much insulin do you use? What other supplies are you going to need? What about pen needles and lancets? Calculate everything. Keep it all in a spreadsheet. Once you have assessed your daily, monthly and annual needs you can find out what is covered and estimate your out of pocket expenses.
High deductible vs. low deductible plans
- High deductible plans cost less up front in premiums. But, generally, they won’t cover the cost of medications and supplies until you have reached your deductible. Evaluate the monthly premium savings vs. your monthly out-of-pocket expenses to see if the upfront savings exceed the monthly costs.
- Low deductible plans cost more money up front in premiums. But, generally, they have lower monthly copays for your diabetes supplies and better pharmacy benefits. Additionally, low deductible plans will give you better preventative medical coverage. Evaluate the monthly premium costs compared to the savings from better coverage and copays. Does the plan actually save you money? Keep in mind, monthly copays for testing supplies may still be more expensive than buying them direct.
Pharmacy benefit vs. durable medical equipment
- Many plans now have a separate deductible for durable medical equipment (DME) which is the category that some diabetes supplies fall into, such as insulin pumps, CGM, and sometimes regular testing supplies. Ask your insurance provider if you have a separate DME deductible and whether your supplies are covered under a pharmacy benefit or DME. Some medical billing codes to ask about are E0607 (glucometer), A4253 (test strips), A4256 (control solution), A4258 (lancing device), and A4259 (lancets). If you want to get your supplies via mail order, ask them if they cover those same codes with the KL modifier.
- Many times even when you have hit your deductibles you are still responsible for a copay that can be as high as 50% of the product’s cost. When you ask about coverage don’t just ask about your deductibles. Ask about copayments required even after you have met the applicable deductibles.
- Cafeteria plans and health savings accounts
- There are several pre-tax medical savings options available. You may have these provided to you through your employer. If not, you can also set up many of these accounts on your own.
- If you go with a high deductible plan you may be eligible for a health savings account (HSA)  which allows you to contribute money, pre-tax, on a monthly basis for future medical needs. This money never expires but can only be used for qualified medical procedures.
- Cafeteria plans, much like HSAs are contributed to, pre-tax, on a monthly basis. These have an annual cap on how much money can be contributed and the money expires after a year. While the tax savings are great, the use-it-or-lose-it aspect can counteract the savings if you don’t use all the money. Cafeteria plans are available regardless of the type of insurance you have.
Be willing to do the math when comparing insurance plans. Evaluate everything: deductibles, copays, medications, supplies, retail costs, etc.
Tip 3: Research discounts and assistance programs.
Many of the big pharmaceutical brands today have options to help significantly reduce out of pocket costs. For example, major insulin providers, including Sanofi, Eli Lilly, and Novo Nordisk have assistance programs for people with lower household incomes and people without insurance. Each program differs slightly, but all are worth investigating. There are also copay and discount cards available for many of them. Click here to download our guide to getting insulin at little to no cost.
There are enough pains associated with having diabetes. Overpaying shouldn’t have to be one of them. Follow these tips to find cost-effective ways to get the supplies you need and check your blood sugar as often as you need to within your budget.
- American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care 2018;41:917–928 http://care.diabetesjournals.org/content/diacare/41/5/917.full.pdf
- Health Savings Account (HSA). https://www.healthcare.gov/glossary/health-savings-account-hsa/
Originally written and published at Diabetes Daily in August 2018: https://www.diabetesdaily.com/blog/managing-the-costs-of-diabetes-587308/