Carol Phillips has a problem -- a big one, but a common one. She is grappling with the cost of diabetes. At the end of May, her COBRA benefits from a former employer will run out, and she will join the ranks of more than 43 million Americans without health insurance. Because she was recently diagnosed with type 2 diabetes, it will be hard for her to afford a new policy.
"I have called a couple of places and inquired," she tells WebMD. "Either I am non-insurable, or the premiums that are quoted are ridiculous."
Phillips is too young for Medicare, and as a self-employed consultant in the travel industry, she makes too much annually to qualify for Medicaid. Nevertheless, her out-of-pocket diabetes costs will take a bite out of her income. "It's going to be very scary," she says.
Since her diagnosis in January, she says she has been able to get her blood sugar under control with the diabetes drug Avandamet and major lifestyle modification. "I'm a changed individual in terms of what I do and what I consume," she says. She exercises daily and has already lost 25 pounds.
She says she hopes to reduce her costs by getting off diabetes medication altogether, and managing her blood sugar by diet and exercise alone. For people who are diagnosed early in the course of the disease, that is sometimes possible.
Cost of Diabetes: Strategies for Saving Money
Even if she must stay on medication, Phillips is cutting her cost of diabetes by taking a combination diabetes drug. Many people with type 2 diabetes take more than one medicine. "Two or three is not uncommon," says Paul Jellinger, MD, president of the American College of Endocrinology.
If someone with insurance were to take the two drugs individually, they would have to pay a co-payment for each one, doubling their cost. Those paying full retail prices out of pocket could benefit even more from a combination drug. For example, at one pharmacy, 60 tablets of Avandamet sell for $62, while 60 tablets each of the brand-name versions of metformin and rosiglitazone together cost $166.
Considering generic drugs can cut your cost of diabetes care, sometimes significantly. Retail prices for generics are generally lower. Also, when a generic version of a drug becomes available, sometimes health plans will charge a higher co-pay for the name-brand version or may stop covering it altogether. The diabetes drugs available as generics are:
"Wherever possible, go generic," James Gavin, MD, chairman of the National Diabetes Education Program, tells WebMD.
The cost of medications isn't the only cost involved in diabetes care, however. Phillips expects to pay $80 a month for test strips when her insurance runs out. She says she has seen test strips on eBay go for much less, and she says she would be willing to give that a try. "As long as it's a sealed, unexpired box, I'd buy it."
Gavin doesn't explicitly encourage buying on eBay, but he says people should bargain hunt and comparison shop like they would for anything else.
Diabetes Costs: Paying for the Insulin Pump
Diabetes is the sixth leading cause of death in the United States and is estimated to cost the nation $132 billion annually. Given the numbers, 46 states have mandated that insurers must cover not only diabetes medicines, but also supplies and equipment.
Some states have even written provisions into their laws that require insurers to pay for insulin pumps.
Many people who take insulin would love to try using a pump, but they are very expensive, costing as much as $6,000, plus monthly supplies. To get coverage often means jumping through a lot of hoops.
"Pumps are not for everybody, and they're not an easy fix," Martin Abrahamson, MD, acting chief medical officer of the Joslin Diabetes Center at Harvard University, tells WebMD.
"At Joslin, we have a very rigorous approach towards selecting people for pumps," he says. "To qualify for a pump you have to be a highly motivated individual. You have to be checking your finger-stick sugars a minimum of four times a day, preferably closer to seven. You have to understand how to count carbohydrates and have a very, very sophisticated knowledge of nutrition, and of course know how a pump works."
But after all that, "We have never really had a problem with insurance once we've approved somebody to be on a pump."
Thirty-two state governments now have programs to help people who don't qualify for Medicaid coverage of prescription drugs. The income caps vary widely, from $35,000 a year for singles in New York to $17,000 a year for singles in Missouri. Most programs are for seniors and Medicare beneficiaries, though a few, like Maine's drug discount, have no age limit.
How these state programs will mesh with the new Medicare prescription drug benefits, set to take effect in 2006, has not been ironed out yet, says Juliette Cubanski, a senior policy analyst at the Kaiser Family Foundation.
Currently, 29 states also have "high-risk pools" that provide insurance to people whose existing illnesses make buying a private health plan too expensive.
Assistance from drug companies is another possibility for those who are too young to benefit from programs geared toward seniors.
Pfizer runs a discount program called "Pfizer Pfriends," which is open to anyone without drug coverage. GlaxoSmithKline's "Bridges to Access" program hands out free medication to people who qualify. The income cap is $25,000 a year for singles, or 250% of the federal poverty limit for families, and the enrollment process has to be handled by a third party.
You can search for these and other discounts at Partners for Prescription Assistance, www.pparx.org, a web site set up by drug companies, insurers, and patient advocacy groups to help people find discounts available to them.
"The programs are worth exploring," Cubanski tells WebMD. "They're good for people who are taking drugs that are made by these companies, who don't have any other source of drug coverage."
A drawback to these kinds of programs, she says, is that only brand-name drugs are involved. "If the potential exists for a consumer to switch from a brand name drug to a generic drug, they might not necessarily get that information," Cubanski says.
Good Control = Good Care
In a 2004 study, published in the journal Diabetes Care, University of Michigan researchers found that 11% of diabetes patients surveyed nationwide had skipped doses of their diabetes medicines because of cost. In a related study, published in the journal Medical Care, the researchers found that people with diabetes who skipped doses of their medication had worse control of their blood sugar.
If you can't pay to fill a prescription, you can't pay, but if you habitually skip doses to eke more out of it, "You're going to end up costing yourself more," Gavin says.
Not having good control of your blood sugar raises your risk for diabetes complications, and the cost of treating them can be many times over what you might spend on your medicines.
What's more, the worse your control is, the more drugs you may eventually have to take. That's because in uncontrolled type 2 diabetes, the longer it goes on, the more ability to produce insulin you may lose. "It's easier to keep control once you're in control than it is to get control when you're out of control," Gavin says.