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Dr. Bill's Commentaries

Paying for diabetes care during times of financial hardship   (April 19, 2009)

A writer for the Associated Press recently described the plight of some folks with diabetes who have had to scrimp on their diabetes care due to the recession, stopping medications or cutting back on testing and doctor's visits because of lack of money. It's sad, to be sure, and there are no easy answers for folks to cope with an expensive disease (the typical monthly bill to treat diabetes runs $350 to $900, according to the article). Some of the solutions that are described in the article include:

* asking for free samples. Always a good idea; call your physician's office and see if they might have whatever you are presently taking. Ask all your doctors for samples every time you are in any of their offices. Some physicians distribute samples liberally, and the drug companies don't seem to mind.

* getting generic medications whenever they are available. Examples include metformin instead of brand-name Glucophage, and glyburide instead of brand-name DiaBeta. But newer diabetes drugs don't have generic equivalents available.

* switching from expensive diabetes pills to cheaper insulin. A great idea; sooner or later, type 2 diabetes will require insulin therapy, and there are many good arguments for "early insulinization" -- and apparently cost is one of them.

* using free clinics instead of usual physicians' offices.

Some other ideas that weren't mentioned:

*there are many hints to save a few pennies: reuse the lancets for fingersticking, reuse the syringes for insulin, don't use alcohol on the skin, test less often if the blood sugar levels are stable, don't eat out as often, etc., etc. Ask your diabetes team about these ideas.

* be sure your doctor knows of your financial problem. Sometimes a swap to a cheaper medication will work just as well as the more expensive medication. The swap might be to a generic version, or to a different compound altogether that does the same general thing (control blood sugar or blood pressure or whatever).

* if you have any health insurance, doublecheck and triplecheck if it might cover medications.

* comparison shop for prices: the prices charged by different pharmacies for the same medications are frequently different.

* ask your doctor to word the prescription so the pharmacy can give you their best deal: if you buy only one pill, the cost per pill will be different than if you buy 100 since the pharmacy has the same per-prescription charge to tack on; your doctor can write a prescription that says "Dispense #100 or 3 months supply or 1 month's supply". That way, if there's a better deal for a larger amount (and if you can afford it) you can probably get a price break on a per-pill basis. And no matter what the prescription's limit is, if the pharmacist says he/she can give you a better deal by purchasing a different amount than what's specified on the prescription, ask the pharmacist to call your doctor's office and request authority for the different amount! (Please note: in many managed-care pharmacy plans, there are strict limits on how many pills can be purchased at one time, frequently one month or three months' supply; however, in a case where there is no health insurance, the decision on how many to buy at once is up to the physician, and the patient's pocketbook.)

* if you smoke, stop. The money you'll save will help pay the pharmacy bills, and will protect your health.

* pill-splitting. See David Mendosa's article about this.

* find out if your drug's manufacturer has financial assistance available. The rules vary from company to company, but your doctor can get forms from the drug company (he/she can ask the drug reps or call the phone number in the PDR) and you fill them out; the doc will sign a prescription and somewhere on the form you complete.

* investigate patient assistance programs, such as the following:

* The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Many will get them free or nearly free.

* provides information about patient assistance programs which provide no cost prescription medications to eligible participants.

* Rx Outreach is a patient assistance program developed by Express Scripts Specialty Distribution Services, Inc. The program provides qualified low-income individuals and families with access to generic versions of brand name medications.

* for children with diabetes, Supplies for CWD Foundation (SCWDF) is a branch of the Children with Diabetes Foundation, a non-profit 501(c)(3) organization.

* compare ideas with others at on-line discussion forums such as

* finally, complain to your Congressperson. Send copies of the bills, and a letter signed by your doctor, and add your voice to the many many others who have protested the high price of living with chronic disease.

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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