A diabetes diagnosis not only requires a close relationship with your healthcare provider, but with your health insurance company too. Your insurance can have a strong impact on how you care for your diabetes. We discussed the relationship between costly insurance and managing your diabetes with expert Mark Harmel, MPH, CDE, and clinical research coordinator at the USC Westside Center for Diabetes. We were also joined by Jewels Doskicz as our moderator.
Q. What is the latest diabetes drug or device that is higher out-of-pocket, but worth paying for?
A. Mark: My favorites are Tresiba for people with type 1 diabetes and Jardiance and Victoza for heart disease reduction.
Jewels: It will be Medtronic MiniMed's 670G. I can't wait to give it a try, but the cost won't even apply to our deductible.
• My Dexcom. I'm lucky to have access. Still very expensive out-of-pocket. Wish it were more accessible for all socioeconomic groups.
• Any device that makes management smoother and more "real" is worth it.
Q. Insurance companies dictate the brands they will cover and limit access to other options. How has this practice affected you?
A. Mark: I was on the prior-authorization beat in our office for a while and it drove me crazy. Important to fight though.
Jewels: I've had to unhappily switch our insulin and glucometer brands. I've also disputed (and won) on the amount of necessary diabetes supplies.
• I've had to switch insulins and appeal test strips. A pain, but I have persevered through.
• Had to go from Humalog to Novolog.
Q. What is a good diabetes switch versus a bad switch? Explain.
A. Mark: How many type 2s out there are not on metformin? It is cheap, effective, and considered first-line treatment, but only 60 percent [of them are] using [it].
Jewels: Forced changes can be bad switches. Healthcare providers prescribe certain drugs, products, and services for a reason.
• Diabetes should be beyond good and evil, but one that is better is one that works!
• A good switch is one that makes diabetes management easier. A bad switch is a medication or device that doesn't work for your body or lifestyle. We are all different!
• A bad switch increases your cost without providing any return for the money spent. A good switch is becoming aware of the truth.
Q. What steps can you take to get what you want from your health insurance company?
A. Mark: Have you called, or asked your provider to help you with coverage?
Jewels: Call, dispute, inquire. Why are your needs being rejected by the insurance company? Ask them how to take the next steps.
• Provide good documentation and have data to submit to your insurer.
• Don't accept their first response
• In my case, I start with my healthcare provider. My doctors are all contracted with the health management organization, so if they justify, it carries lots of weight.
Q. Sticker shock at the pharmacy can be frustrating. How can you find out whether there is a cheaper or generic alternative?
A. Mark: Neighborhood pharmacies are more likely to help you with pricing. Ask your pharmacist for low-cost options.
Jewels: Plans that have us meet our deductible prior to paying any pharmacy or durable medical equipment expenses crush people financially in the new year. Pharmacists are incredible resources—ask for a patient consult.
• My insurance company lets me know if my specific prescription is cheaper based on other insurance users’ data.
• At my pharmacy, I ask. They want to keep me as a customer.
Q. Have you used a patient assistance program or drug savings card? Share your experience.
A. Mark: Pharmacy companies are all pushing savings cards for their new drugs. Prescription savings cards may increase prices overall, but help individuals.
Jewels: I have used a patient assistance program for an arthritis drug. It was slick and seamless. I’ve never used it for diabetes needs.
• I have. They worked well and saved me some money off my co-pay until my insurance company stopped accepting them.
• I have never used an assistance program, but I sure would if I qualified!
Q. What else do you do to save on diabetes drugs and supplies?
A. Mark: There is good study on stretching Dexcom sensors.
Jewels: I try to stay on a timetable as much as possible after my deductible is met. I get on automatic shipping for the rest of the year.
• I used to wait until I was nearly out to reorder, but that backfired more often because it took three weeks for billing.
• Mail order can help.
Q. What are your tips, tricks, and hacks when you need to stretch out the use of your medicines? How can you do it safely?
A. Mark: Here is how to get more strips on a budget.
Jewels: Compare pricing at your local pharmacies. I find coupons and savings by knowing where it’s most affordable.
• I reuse pump reservoirs, but not infusion sets.
• I feel perfectly safe using CGM sensors past one week.
• I draw up just over 20 percent more of my son’s required insulin for three days in order to reduce waste.
Thank you to all of the members of the diabetes community who joined our chat, and a special thank you to Mark Harmel and Jewels Doskicz.
You can join this chat by commenting below, or one of our future chats every Tuesday at 9:00 p.m. ET by following @DiabeticConnect and using #DCDE.