Personal Economics of Diabetes Care

With the recent disastrous turn in the markets (and expected prolonged recession ahead), many of us will see a big increase in the number of patients who are simply unable to afford their medications. This week alone I have already seen several people under the strain of the last few months of steep gas prices and not being able to buy their Lantus insulin. Needless to say their blood sugars were a nightmare…

And the medications are only a part of the issue. Insurance companies have a rotten reputation already in regards to covering supplies like testing strips which cost and arm and a leg. I bought a meter and test strips for my Aunt who lives out of the country so it was purchased even without any benefit of insurance—those strips are wickedly expensive, costing about $1 PER STRIP. By the time you get to syringes and alcohol wipes, although they tend to be cheaper, it still stings. And woe be unto you if you happen to be using an insulin pen instead! With convenience comes an extra cost, that is for sure. A few years ago some of this was not as big an issue because clinics regularly stocked samples of medications brought in by drug reps. I could wander into the closet and bring out a bag full of insulin pens, and throw in some blood pressure medications to boot. Not anymore. The recent crack-down of what some saw as inappropriate influence by drug companies has now led to a dearth of free samples in many clinics, especially university-based medical centers. Thus more empty hands to show our patients (not to mention fewer free pens, notepads and lunches for everybody. I think medical students and broke interns around the country went into mourning with this change).

So it got me thinking about how we will be able to deal with the rising numbers of folks unable to afford their medical care. If we could all manage to set up free clinics (as I hope to in the near future) and maintain our own income to feed our families and pay off med school loans, I am sure many of us would take the opportunity. But that is not the case, so where do we go from here? The first easiest answer is to tap into the hospital or community resources in place, which is the initial step many of us take. Our university hospital has an office for financial assistance and they have connections and forms of every kind in an effort to obtain medications and services at reduced cost for individuals demonstrating need. Most patients take appropriate advantage of this service and it works out very well.

A few are a bit more wary, some may say proud, and do not want to go that route. In this case I (and the patient) generally start canvassing the companies’ websites and contact them directly about low-cost programs for their medications. Merck had a well-publicized program but many others do as well, and if not a program per se they often have medication vouchers available for even a few month’s worth at low cost or free. Any little bit helps.

And of course last but not least, we can switch medications to the cheapest generic version out there. Some medication is better than none in most patients, even if the formulation is not perfect. I have patients that switched from the current mercedes of injectable insulin regimens (Lantus or Levemir/Novolog or Lantus or Levemir/Humalog) to the good old NPH/regular version. Is the coverage as consistent? Not really. There are definitely more peaks and valleys in the NPH/Regular insulin road. Does it work in bringing blood sugars down? Of course, in the right doses. And it’s a heck of a lot better than sugars running upwards of 300 when off all insulin. As for the cost, there really is no contest here. Unless you get your long acting/fast acting insulin’s pretty much for free, the generic NPH and regular insulins come out on top in terms of cost. Some will argue about the relative cost effectiveness over the long term (a study in England did look at that in regard to NPH versus Glargine) but these days you will be hard-pressed to make that argument to someone bringing in $1000/month and faced with buying Lantus at $50/vial versus NPH at $20/vial on top of paying bills, feeding their families and yes, buying gas.

So we will do our best to help our patients cut corners where they can and still get appropriate medical care. By hook or crook, we’ll find a way. And when we come out of this financial mess we will all buy insulin pumps to celebrate (kidding).