By offering resources such as free samples and generic alternatives, pharmacists can help patients lower costs.
According to the American Diabetes Association, individuals with diabetes have medical costs of almost $17,000 per year. Of these costs, about $9600 are related to diabetes. Individuals with diabetes, on average, spend more than double the amount of those who do not have diabetes.1 Findings of a study published in October 2022 in the Annals of Internal Medicine on data from the CDC’s 2021 National Health Interview Survey showed that over 1 year, 16.5% of patients who use insulin—or 1.3 million Americans—skipped insulin doses, injected less insulin than needed, or delayed purchasing insulin—all due to cost.2
A lack of adherence to a diabetes treatment plan can cause devastating consequences, but pharmacists can help patients save money on diabetes care. Read on for resources and tips pharmacists can share with patients.
Medicare Open Enrollment. Open enrollment for Medicare coverage in 2023 runs through December 7, 2022.3 Some good news for Medicare recipients: Starting in 2023, patients with Medicare will pay no more than $35 per month for insulin, regardless of deductible.4
Encourage patients to take time during the open enrollment period to ensure their medications will be covered, and to make coverage changes if necessary.
BenefitsCheckUp. This website is part of the National Council on Aging.5 Patients can enter their zip code to access various benefits, such as Medicaid, Medicare Extra Help, also known as the Part D Low-Income Subsidy free one-on-one insurance counseling, and many other programs.
NeedyMeds is a nonprofit organization that helps patients find ways to pay for various aspects of health care, such as prescription drugs and medical clinic visits, and offers diagnosis-based assistance.6
Partnership for Prescription Assistance. Patients can access the Medicine Assistance Tool, created by the Pharmaceutical Research and Manufacturers of America, to access public and private assistance programs to help pay for medications.7
RxAssist. This website allows patients to access various patient assistance programs and co-pay assistance resources.8
Reach out directly to drug companies. Patients can often save hundreds of dollars on diabetes medication, including insulin, by accessing manufacturer coupons or by calling the pharmaceutical manufacturer to inquire about various assistance programs.
Ask health care providers for free samples. This can be especially helpful with insulin and with other diabetes medications that are not available as a generic. Patients can ask their primary care provider or endocrinologist whether samples are available.
Look for generic opportunities. Pharmacists can help patients look over their profile—not just for diabetes medications, but for all other medicines, for any cost-saving alternatives. For example, a patient may become an expert at saving money on diabetes medication, but could still be paying a high co-pay for a brand-name cholesterol drug when a similar, lower-cost generic could be substituted. In these cases, pharmacists can offer to contact the health care provider to request a medication change.
Look into continuous glucose monitoring. Rather than focusing on finger sticking, pharmacists can help patients determine whether continuous glucose monitoring (CGM) is an option. Pharmacists can also request a prescription from the health care provider and access savings (for example, FreeStyle Libre offers a free 2-week trial of its sensor). Pharmacists can help patients learn how to apply the sensor, set up the mobile app, and explain how to use it. If the price of a CGM system is comparable to that of blood glucose monitors, patients may find it well worth having a 24/7 view of their blood glucose levels without the need for frequent finger sticking and associated supplies.
In addition to helping patients find ways to save money, pharmacists can counsel patients on dietary and exercise changes and refer patients to a certified diabetes care and education specialist (CDCES) or a registered dietitian. Pharmacists can also remind patients about preventive care: Is the patient seeing a podiatrist, an ophthalmologist, and a dentist regularly? Keeping up with all these visits can help prevent complications, saving money in the long run.
Pharmacists can also always remind patients of the importance of adherence, encouraging them to reach out for help if they are having trouble affording their medications, rather than skipping or rationing medicine.
Cost Saving Tips
From Ryan Frickel, PharmD, senior product manager of clinical quality at Arrive Health
“When a patient is speaking with their provider or pharmacist, there are a number of important details that they should confirm to ensure they are being prescribed the lowest-cost treatment. Although many are fairly simple, like proactively asking if there are any lower-cost options and confirming that the medications are covered under their insurance, a few things could increase the price dramatically. For example, confirming that the pharmacy—regardless of whether it is a mail-order or retail pharmacy—is in network is essential to keeping the cost low. Additionally, confirming that the medications are tier 1 on the insurance plan is important.
“Lastly, many health plans will significantly discount higher quantities of medications; checking if there is a 90-day supply might be a way to reduce the overall treatment cost. In most cases, checking patient coverage and costs can be done through real-time benefit check software, integrated into provider workflows. This technology enables care teams to discuss the cost and affordable care options with patients prior to checking out at the pharmacy counter.”
References
1. The cost of diabetes. American Diabetes Association. Accessed November 14, 2022. https://diabetes.org/about-us/statistics/costdiabetes
2. Briskin A. Insulin: no more rationing. The diaTribe Foundation. October 24, 2022. Accessed November 14, 2022. https://diatribe.org/insulin-no-more-rationing
3. Sainz N. New law to cap insulin at $35. The diaTribe Foundation. Updated August 29, 2022. Accessed November 14, 2022. https://diatribe.org/new-law-caps-insulin-at-35
4. Explore your Medicare coverage options. Medicare.gov. Accessed November 14, 2022. https://www.medicare.gov/plancompare/#/?year=2023&lang=en
5. National Council on Aging. BenefitsCheckup. Accessed November 14, 2022. https://benefitscheckup.org/
6. NeedyMeds. Accessed November 14, 2022. https://www.needymeds.org/
7. Pharmaceutical Research and Manufacturers of America (PhRMA). Medicine assistance tool. Accessed November 14, 2022. https://medicineassistancetool.org/
8. RxAssist. Accessed November 14, 2022. https://www.rxassist.org/
Written by Karen Berger for Drug Topics Journal, Volume 166, Issue 12.
