Tagged: cost of diabetes

Diabetes & Taxes

90376_1582Death, taxes… diabetes. We’re all certain that until there is a cure, we’ve definitely got diabetes and have to pay our taxes (at least in the United States). Don’t we already bleed enough?

When you have a very expensive chronic illness (hint: diabetes is a very expensive chronic illness), it pays to be prepared when it comes to doing your taxes and squeezing every dime out of your medical deduction. You need to begin the hunt for your expenses - and the receipts for those expenses.

Topic 502 of the IRS is all about Medical and Dental Expenses. We all need to know about this topic. Here’s the deal if you itemize your expenses on your 1040:

For years beginning after December 31, 2012, you may deduct only the amount of your total medical expenses that exceed 10% of your adjusted gross income or 7.5% if you or your spouse is 65 or older. The 7.5% limitation is a temporary exemption starting January 1, 2021 to December 31, 2020 for individuals age 65 and older and their spouses.

It Pays To Itemize

It pays to itemize. Seriously. Plain and simple: we spend a lot of our diabetes care, but we don’t think about all of the items. (And a lot of the time, we don’t keep the receipts…)

I’m telling you this: start now. Even if you didn’t keep the receipts from last year, start collecting. If you’re high tech, scan them in somewhere. Take a picture of your receipts and put them in a file on your computer. Heck, get a folder and put it next to your keys and put any receipts that can be included as medical/dental expenses into it. Find a system that works for you. But start now.

Ground Rules

I AM NOT A TAX PROFESSIONAL. Oh, please. I have a BA degree and a MSc. degree, neither of which is in accounting. You know (hopefully) by now how much I do not like math. I use a bolus calculator for a reason. I have wonderful friends who are CPAs. Do not look to me for tax advice. Do not look to me as the shining pillar of how to do taxes. I am many things, but I am not a tax professional nor am I perfect. (I am The Perfect D, but…)

I’m not giving you the entire list of what are considered acceptable deductible medical expenses. If you want the whole list, you can get it from the IRS website.

Here are the ground rules for what you can deduct:

  • You can only include the medical expenses you paid during the year and you can only use the expenses once on the return.
  • If you got reimbursed for any medical expenses, you must reduce the expense by the amount you were reimbursed.

For instance: You paid a doctor $120 for an appointment in May of 2014, sent the receipt into your insurance, and they sent you a check for $100 in December of 2014. You can then only claim $20 for this 2014 expense on your taxes, because you paid only $20 to see the doctor. 

What You Can Deduct If You Have Diabetes

Deductible diabetes medical expenses may include (but are not limited) to:

Your payments to your healthcare team: physicians, CDEs, nutritionists, dietitians, psychiatrists, psychologists, endocrinologists, nephrologists, podiatrists, cardiologists, physical therapists, chiropractors, and “non-traditional medical practitioners”, including acupuncture for smoking cessation, and massage therapists when used for a medical condition.

Your prescriptions/insulin. Anything that you have a prescription for, you can list as a medical expense. And… even if you don’t have a prescription for insulin, it’s still a medical expense that is covered. That includes your pump and all supplies. Your insulin pens and syringes and cartridges. If it helps you get the drug into your body, it’s a medical expense that can be deducted.

Your meter and blood glucose testing supplies. (These are diagnostic devices and therefore, covered. Same goes for your CGM and sensors. Ketone test strips (urine or blood).

291573_5192Your medical supplies. Yeah, you’re thinking, of course. But medical supplies include: alcohol swabs, IV Prep 3000, Band-Aids, etc.

Your eyeglasses or contact lenses. If you have contact lenses, you can deduct the cost of the enzyme cleaners and daily cleaning solutions. Don’t forget to include your eye exam, even if it was a refraction/non-dilated exam. That’s included.

Dental treatments at the dentist’s office, including cleanings and fillings. (You cannot expense floss, toothbrushes, or toothpaste.)

Your guide dog expenses, including grooming and food and vet fees. 

Your lab fees. Your ambulance fees or ER fees or hospital stay. All of it is covered. They’ll send you receipts. You’ll weep at seeing how much they charge.

Your lodging for medical care (up to $50 per person per night) (meals not included), if:

  1. The lodging is primarily for and essential to medical care.
  2. The medical care is provided by a doctor in a licensed hospital or in a medical care facility related to, or the equivalent of, a licensed hospital.
  3. The lodging is not lavish or extravagant under the circumstances.
  4. There is no significant element of personal pleasure, recreation, or vacation in the travel away from home.

Your cost of special dietary considerations (i.e. celiac disease - and you must click on that link and read this post from one of my favorite bloggers) or costs for participation in a weight-loss program after an obesity diagnosis) when prescribed by a doctor. Don’t try to deduct health club dues. Nope.

Your admission/registration costs AND travel expenses for a chronically ill person or spouse or a parent of a chronically ill kid to attend a medical conference to learn about new medical treatments. (You can’t deduct meals or lodging while attending the conference.) Hello? Friends for Life? AADE or ADA? Ahem. Deductible medical expenses. Holla. 

Your Electronic Health Records cost to keep all your data in one place. Also known as a “medical information plan” or a “personal electronic health record.”

1442111_98999959Your transportation costs to and from medical appointments/hospitals/medical centers. Don’t forget tolls, parking, gas, oil… Straight from the IRS:

Payments for transportation primarily for and essential to medical care that qualify as medical expenses, such as payments of the actual fare for a taxi, bus, train, ambulance, or for medical transportation by personal car, the amount of your actual out-of-pocket expenses such as for gas and oil, or the amount of the standard mileage rate for medical expenses, plus the cost of tolls and parking fees.

Some of your health insurance premiums. I’m not going to get into this one, as it’s a minefield of what you can and cannot deduct. You need to look at the IRS website on this particular subset.

What You Can’t Deduct

One of the things that I wish could be covered is hypoglycemia recovery supplies (i.e. glucose tabs, juice, etc.). I’m doing everything that I can to keep that cost to a minimum, but really… we all probably spend far too much on that, and it’s not reimbursable. (Not unless you have a prescription written by your doctor for “juice”…)

You can’t deduct the cost of the cell phone plans and minutes calling your insurance company to argue over what is covered and what isn’t.

You can’t medically deduct the cost of your Internet service plan for the time you spend getting peer to peer support online from the DOC.

You can’t deduct the over-the-counter salves and moisturizers to keep our pretty diabetic feet from cracking or drying out.

Hopefully I’ve triggered something in your brain that says: “I can deduct that?! Booya!” Start preparing now for the 2014 tax season. (I’m quite aware that U.S. taxes are not due until April 15th, but don’t wait until the 15th to think about all the items that you can add together for your medical expense deductions… you’ll get overwhelmed and you’ll inevitably miss something.)

Happy deduction hunting! 

 

 

 

How Much Do Diabetes Supplies/Medications Cost in The U.S.?

batch of dollarsWhile everyone’s diabetes treatment plan, medications, and technology may be different, there is one thing we can all agree on: diabetes is expensive. In two previous posts at The Perfect D, I gave some sense of what the bare minimum of care for a U.S. adult with Type 1 diabetes would be and also financial resources and programs to help with the financial burden of living with diabetes.

However, this post is about how much it could cost an adult with Type 1 diabetes if they used the technology and medications that are currently out on the market (and thought of as “the latest and greatest”) and paid out of pocket with no insurance. Research on this topic has shown me that: 1) prices can fluctuate wildly, so it pays to shop around and 2) there is a very big gap (financially, medically, and technologically) between the bare minimum and “surviving” and actually utilizing the tools and latest technology that is out there.

So, the hypothetical person for this exercise is a Type 1 adult in the United States who weighs 60kg, just like the other calculation post I did.

Ground Rules

  • These prices are accurate on the websites I have referenced for December 1, 2014. They may change, they may add shipping, they may not offer the services, technology, or drugs on their website after this is posted. These prices are not a guarantee. They are to be used as a reference.
  • The listing of prices/websites on this post does not mean that I endorse the company or product or service.
  • I have not listed all the products available on the market for people with Type 1 diabetes. I have listed major ones to give you an idea of major manufacturers’ costs for the products that are available for general public viewing.
  • I did not call any companies and ask for pricing. Why? Because I believe that we, the diabetes community, should be able to really know how much something costs without having to go through hoops and customer service/sales representatives. Device prices should be listed on a company’s website, knowing that insurance pricing will be different. (We should be able to know how much a drug would cost without insurance, too.)
  • Some of the items are only dispensed with a prescription.
  • Yes, I know that some people with Type 1 do not use an insulin pump. In fact, only 30% of Type 1s use a pump for insulin delivery. Some are happy and do well with MDIs/pen needles. The cost of pen needles are comparable to using a syringe, so you can refer to this post if you want to do your own calculations. As I say, my blog, my words…
  • I used averages. That means that some pump therapies may cost more or less than the average.

Insulin

mediumIf you take a total of 30 units per day (hey, adjust for more or less, this is a hypothetical Type 1 adult weighing 60kg), you will take about 900 units per month. You might be able to get by on one vial a month, but this doesn’t factor in correction boluses that might need to be raged to bring down a high blood sugar or a heavy carb meal. So…. two vials per month.  If you’re on a pump, it’s two vials of fast acting. (Don’t forget that you’ll need that back up prescription for long-acting insulin if your pump malfunctions…)

Fast-acting:

Apidra vial 10ml = $177.59

Humalog vial 10ml = $217.45

Novolog vial 10ml = $210.49

Average cost per month (insulin pump): $403.68

Average cost per year (insulin pump): $4,844.16

Average cost per month (MDI): $201.84

Average cost per year (MDI): $2,422.08

Basal/long-acting:

If you aren’t on an insulin pump, T1s must use a long-acting insulin in conjunction with their fast acting. This hypothetical (hopefully not hypoglycemic) T1 would use one vial of fast-acting and one vial of long-acting insulin per month.

Lantus vial 10ml = $284.39

Levemir vial 10ml = $216.69

Average cost per month (MDI): $250.54

Average cost per year (MDI): $3,006.48

(So, for those of you keeping a tally for comparison,  the total cost per year for insulin using a pump is $4,844.16 and for MDI, it’s $5,428.56.)

Insulin Pumps

800px-Early_insulin_pump

This is an early version of an insulin pump. You’d never get a button error with this. Dials!

You know that some of these prices may not be the price you actually pay if you have no insurance. You call the manufacturer and explain that you will be paying out of pocket and ask what the “cash pay price” would be and if they have a financing program. (Some companies offer this; others do not.) But these prices are what’s shown on websites where you can purchase them….so ta-da.)

Most pumps are under warranty for four years. Some have upgrade programs. Others have a “trade your old pump from another company and we’ll give you a discount…) Do your homework before committing to a pump. Please. Some will let you test drive. Others have a return in 30 days policy.

Minimed Paradigm Real-Time Revel 723 Pump = $5655.99

t:Slim Insulin Pump = $5720.00

Omnipod = $800 for the PDM, which is the brains of the pod. The pods are extra. ($337.00 per 10 pod box and 12 boxes needed annually) = $4844.00

Animas Ping = $4977.29

Accu-Chek Spirit Pump = $4,751.07

(I would have added the Asante Snap, but there are no places online to get an actual price. I got estimates from blogs and news outlets that say $700ish, but without a definitive click, I can’t in good faith include it.)

Cartridges

Got pumps? Then you need cartridges. Can’t have one without the other (except if you’re talking the Omnipod, because the pods act as the cartridge and the insertion set.). Cartridges (or reservoirs, if you are Medtronic) are needed to hold that expensive insulin you purchased.

Omnipod = $0.00 because the pod acts as cartridge and insertion set. See below.

T:Slim Insulin Pump Cartridge - 3ml - Box of 10- 10/bx = $46.19

Animas 2ml Cartridge 1200 Pump - 10 Bx = $45.79

Accu-Chek Disetronic Spirit 3.15mL Plastic Cartridge System - Box of 5 = $24.30

Medtronic

  • Minimed Paradigm Reservoir 1.8ml - 10 Bx  = $38.00
  • Minimed Paradigm Reservoir 3ml - 10 Bx = $36.39
  • Insertion device for your Medtronic infusion sets = $26.20
  • Serter devices for your Medtronic sensors = $25.00/$14.70 (depending on the type of sensor you use)

Some people change their cartridges once per week, while others change every three days. So, you could use 4 per month or 10 per month.

Average Total Cost per month: $41.39

Average Total cost per year (9 boxes): $372.51

Average Total cost per year (12 boxes): $496.68

Insertion Sets

800px-Infusion_set_3Those pumps and cartridges aren’t enough to get the insulin into your body. You need insertion sets (again, unless you use Omnipod, which are tubeless and incorporate the cannula directly into the pod).

Most people change their insertion set every 3 days. (You should. I don’t judge. Some people change it more frequently, due to inflammatory reactions or the dreaded occlusion.) So, you’ll go through one box per month… if not more.

Most people have a preference of the type of insertion type/tubing length they use. 90º or 30/45º angles, short tubing or long tubing, 9 or 6 mm cannula, metal or plastic… so I’m giving you a few choices. And again, it pays to shop around. Sometimes the manufacturer of the pump is not the cheapest place to get supplies (which confuses me to no end…).

Reference: Omnipod pods (10/box)= $337.00

Inset Infusion Set 23″ 9mm (10/box) = $95.77

Cleo 90 Infusion Set 24″ (60cm)/6mm 10/bx = $112.99

Comfort Infusion Set - Can be used with t:slim, Animas (Box of 10) = $105.99

Accu-Chek Disetronic Rapid D Infusion Sets - 6mm Cannula and 24″ (60cm) Tubing - 15/bx = $94.39

Medtronic

Quick-set 9mm Cannula / 43″ Tubing (10/box)  = $136.70

mio 9mm Cannula / 32″ Tubing CLEAR (10/box) = $151.00

Silhouette 17mm Cannula / 43″ Tubing (10/box) /cannula only = $121.19/$117.30

Sure-T 29g 10mm Needle / 32″ Tubing (10/box) = $94.60

Average Total Cost per month: $101.60

Average Total cost per year : $1219.20

Continuous Glucose Monitor (CGM) & Supplies

Dexcom

Dexcom Platinum G4 Sensors (4/pk) = $349.00

Dexcom Platinum G4 Transmitter = $599.00

Dexcom Platinum G4 Receiver = $599.00

(Remember that you need all three of these items to get your Dexcom to work properly. Start up can be expensive. In addition, the new Dexcom transmitter warranty is only good for 6 months and you will most likely need to purchase two each year.)

Initial/Replacement Cost of Transmitter & Receiver:$1797.00

Cost per month for sensors: $349.00

Total cost per year for sensors: $4188.00

Total Annual Dexcom cost: $5985.00 

Dexcom Share Cradle w/ Free Service = $299.00

(This is an add-on device that caregivers/loved ones can use to view the graph/numbers on the receiver in another room.)

Medtronic

The Medtronic insulin pumps use integrated technology on their Revel and 530G to show the continuous glucose monitor graphs/numbers, so you don’t need a “receiver” if you are using these pumps. You can purchase a receiver to use the Sof-Sensor sensors, but… why? (And I couldn’t find a place to purchase with a price on a stand-alone Medtronic receiver.) The sensors cost are per month, as the Enlites last longer than the Sof-sensors.

Enlite® Sensor (5 pack) - used with the Medtronic 530G pump only = $473.00

Total cost per month: $473.00

Total cost per year: $5676.00

Sof-sensor® Glucose Sensors (10 pack) = $439.00

Total cost per month: $439.00

Total cost per year: $5268.00

mySentry Outpost (this allows you to see data from the Medtronic pump/sensor in another room) = $500.00

Blood Glucose Monitors/Test Strips

1154350_32525829According to the ADA, for Type 1s, self-monitoring of blood glucose (SMBG) is key to diabetes management. They recommend 6 – 8 times per day as a minimum of blood glucose testing. When you read the Standard of Care document, they state:

“…prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normal glycemic, and prior to critical tasks such as driving.”

8x/day minimum = 240 strips per month minimum, so 250 (because that’s easy to purchase in boxes of 50). So, that’s what we are going with, although I know that some people with diabetes use more - and less - than that. We are not going with the bare minimum.

Here’s where it pays to shop around…

Wal-Mart is NOT always the least expensive when it comes to purchasing blood glucose monitors and blood glucose test strips - not by a long shot. Of course, prices always vary given the day, the website, the weather…. you get the drift. SHOP AROUND. (Click the link to be forwarded directly to the website that had the price listed.)

And don’t forget that there are certain meter companies that have “special savings programs“, even for those who have insurance!

Accu-Chek

Accu-Chek Aviva Plus Glucose Meter Kit = $9.97 or FREE.

(Remember, if you use the subscription based Accu-Chek To Program, you get a Aviva Plus Meter for free with your first shipment.)

Accu-Chek Aviva PLUS Test Strips - 50ct = $30.29

Cost per month without Accu-Chek To program: $151.45

Cot per year without Accu-Chek To program: $1817.40

Cost per month with Accu-Chek To Program + regular purchase: $131.77

Cost per year with Accu-Chek To Program + regular purchase: $1581.24

(Remember, if you use the subscription based Accu-Chek To Program, you can purchase 50ct Accu-Check Aviva Plus Test strips for $20.00 and 100ct. for $40.00 per month.)

Accu-Chek Nano Glucose Meter = $5.07 of FREE

(Remember, if you use the subscription based Accu-Chek To Program, you get a Aviva Nano for free with your first shipment.)

Accu-Chek Smartview Test Strips - 50ct = $27.77

(Remember, if you use the subscription based Accu-Chek To Program, you can purchase 50ct Accu-Check Aviva Smartview Test strips for $20.00 and 100ct. for $40.00 per month.)

Cost per month without Accu-Chek To program: $138.85

Cot per year without Accu-Chek To program: $1666.20

Cost per month with Accu-Chek To Program + regular purchase: $123.31

Cost per year with Accu-Chek To Program + regular purchase: $1479.72

Abbott FreeStyle

FreeStyle Lite Glucose Meter/ FreeStyle Freedom Lite Glucose Meter = $10.09

Abbott FreeStyle Lite Test Strips - 50 ct. = $46.99

Total cost per month: $234.95

Total cost per year: $2819.40

Bayer

Free Bayer Contour Next Meter  - shipped by Bayer to you. $0.00

Free bayer Contour Next USB Meter - shipped by Bayer to you. $0.00

Contour Next Link Blood Glucose Meter = $89.00

Wireless communication to Medtronic devices enables fast and easy bolus dosing and continuous glucose monitoring calibration
• Built-in USB cable has pass-through feature to allows for easy downloading to Medtronic’s convenient online CareLink® Personal software

(Bayer Contour Next Test Strips (box of 50 strips on Medtronic’s website) = $52.00 BUT THIS IS WHY YOU SHOP AROUND…)

Bayer Contour Next Test Strips - 50ct = $19.09

Total cost per month: $99.95

Total cost per year: $1199.40

LifeScan OneTouch

OneTouch Ultra 2 Glucose Meter Kit = $19.88

OneTouch Ultra Mini Glucose Meter Kit = $17.63

One Touch Ultra Blue Glucose Test Strips - 50 ct. = $74.99

Total cost per month: $374.95

Total cost per year: $4499.40

OneTouch Verio IQ Glucose Meter Kit = $29.99

OneTouch Verio Sync System Kit =  $29.99

OneTouch Verio IQ Gold Test Strips - 50ct = $90.89

Total cost per month: $454.45

Total cost per year: $5453.40

But We Aren’t Done Yet

If you’re on an intensive management plan, then you’re strongly encouraged to have a glucagon kit available in case you have a severe hypoglycemic reaction. This item isn’t cheap.

Glucagon Kit = $213.69

220623_1002Some people with diabetes on intensive management plans (those who are on pumps, microbolusing with flex pens, and/or CGMs are considered intensive management therapies) often see an endocrinologist and other specialists. You might need to include these in your team:

  • Endocrinologist/CDE
  • Cardiologist
  • Podiatrist
  • Nephrologist
  • Neurologist
  • Ophthalmologist/Retinal Specialist
  • Orthopedic specialist/surgeons

These specialist costs are higher than just seeing a regular general practitioner. Some by hundreds of dollars. The tests that may be prescribed can cost thousands of dollars out of pocket (say the word “nuclear stress test” and shudder when they tell you what it costs).

For reference, I see a retinal specialist for a dilated eye exam follow up every six months: $335.00 without insurance. My annual cardiologist visit is $430.00 without insurance for the (literally) five minutes I talk with him, including the pleasantries. One orthopedic surgeon office visit was $295 while the second opinion office visit with another surgeon was $180. As with everything else, shopping around if you have no insurance, especially when it’s diabetes related, is necessary. 

Then there are the additional medications that might be needed: statins, blood pressure medications, medications for neuropathy, kidney disease, etc. These are too numerous to mention (and quantify), but you know that these are additional costs. Most people with diabetes wouldn’t be taking these medications if they didn’t have diabetes.

In a previous post, I mentioned the costs for treating mild hypoglycemia, for lancets and alcohol swabs, for the little things that all add up. The purchase of a juice/glucose-heavy item at a convenience store because you are low is a cost, but rarely factored in. Parking at hospitals for appointments. Tolls. Wear and tear on a vehicle as you travel to see various physicians to stay healthy. Batteries for the gear that isn’t rechargeable.

So, if you are truly calculating the costs of the latest supplies, technology, and treatments, there are items that you don’t even think about… the small ticket items that leech money from your pockets. They can add hundreds of dollars to the existing cost.

Let’s do some math.

If I am a T1 adult with no insurance who uses Humalog in a new Animas pump and a new CGM Dexcom, checking my blood glucose with a One Touch Verio IQ meter, it could be:

$23,348.47

If you have already purchased a pump and a Dexcom, the out of pocket costs would be:

$16,574.18

If I am a T1 adult with no insurance who uses Apidra in a new Omnipod and a new CGM Dexcom, checking my blood glucose with an Accu-Check Nano meter, it could be:

$14,439.80

If you have already purchased a pump and a Dexcom, the out of pocket costs would be:

$11,842.80

If I am a T1 adult with no insurance who uses Novolog in a new Medtronic (not 530G) pump and Sof-Sensor CGM, checking my blood glucose with a Bayer Next meter, it could be:

$16,917.27

(The price would be greater with the 530G pump and the Enlite CGM sensors.)

If you have already purchased a Medtronic pump with CGM integration, the out of pocket costs would be:

$11,261.28

That’s not counting the physicians (multiple visits), the labs, the other tests that you might need, the glucagon, the back up long-acting insulin, the small items, etc.

That’s just for the technology, supplies, and insulin analog.

Are You Getting What I’m Saying Here?

994448_53508805Without insurance, it is unlikely that you have thousands of dollars under a mattress for this type of intensive management. Even with insurance, many of these items can be cost-prohibitive, with deductibles to be met each year and percentages paid out each month to durable medical equipment companies and pharmacies.

This is not meant to shame medical device manufacturers and pharmaceutical companies. I’ve said before that they are not charities; they’re businesses and they can choose to set their prices and work with insurance companies for discounting.

Who loses in this scenario are those who want the technology but do not have an insurance company adept at bargaining or adept at meeting customer (that’s the subscriber) needs. Or those who don’t have insurance at all and fall into the gap of making too much to qualify for assistance programs but not enough to pay out of pocket for these items.

When someone asks a person with diabetes if it’s a hard disease to live with, they’re often asking about the physical aspects of the disease. Very few people outside of the community understand the financial burden many families face if they want what is the BEST technology and treatment for the person with diabetes.

Until there is a cure (be it biological or otherwise), this is the financial cost of living well with diabetes. Insurance companies can blunt some of the cost through their collective bargaining agreements, but we are still paying through premiums and deductibles and, in some scenarios, an inability to choose the medications or technology that they want, because of contracts.

There is no grand “THE END” to this post. For many people with diabetes, this is the reckoning that we do in our heads, wondering if we spend less now, will we pay more later? The answer is almost always… yes, but if we cannot even afford what the best treatments for diabetes on the market, how can we live long enough to get to that “later“?

I have no solutions. This is more of an academic exercise to see if what the statistics touted by the government on how much a person with diabetes pays for care was correct. It’s not.

People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes. - NIH

 

We pay much more if we want excellent care. What can be done? Beyond a cure? I don’t know. Do you?

 

Need Help With U.S. Diabetes Supplies and Medications?

159942_2191For anyone who has diabetes, the cost of staying alive is expensive.

This is a current list of currently available programs, co-pay cards, organizations and manufacturers that may help, and the requirements to participate in the programs.

Why did I create this?

Every other “diabetes financial assistance/resource” page that I would visit would give you a link to supposed help - but you had to dig deep to find out if there were exclusions or restrictions. Some of the resource pages had links that no longer exist. Others had a single page that said: “We no longer offer a program.” (And I’m talking major diabetes organizations and manufacturers… they’re not keeping their own pages up to date…)

This page will give you the restrictions/exclusions I’ve found and the contact information and site to get yourself started if you qualify. (And in some cases, all of us will qualify!)

These links are up to date and I will be adding additional resources as they are made available. (If you have links or resources, please list them in the comment section and if they’re legitimate, I’ll add them.)

Right now, you’ll see a glaring absence of blood glucose monitoring supplies. Every link I researched ended with a dead end. Roche/Accu-Chek does offer a free Aviva or Nano meter on their site, but there are no programs currently offered for free/discounted strips. If this changes, I’ll let you know. (And not five minutes after posting this, Megan helped our community by giving us our first program for test strips/meters. That’s what community is all about!)

Hope this helps you.

Share it if you please - no one should be “sick” with diabetes from a lack of medication or supplies - let’s help each other by getting the word out. 

Diabetes Medications & Needles

Eli Lilly

Eli Lilly offers Humalog, Humalin, and Humalog Mix under the Lilly Cares program.

  • You must be a U.S. resident.
  • You must not have prescription coverage.
  • You must meet the household guidelines:

Household Income Guidelines:

  • The total number of people in the household includes yourself and each of your dependents.
  • Total yearly income includes incomes from all earners in your household before taxes and deductions.
  • To qualify, your total yearly income cannot exceed the values listed below.

 

Number of People in Your Home 1 2 3 4 5 6 7 8
Total Yearly Income
(48 Contiguous States and DC)
$36,000 $48,000 $60,000 $72,000 $84,000 $96,000 $109,000 $121,000
Alaska $44,000 $59,000 $75,000 $90,000 $105,000 $120,000 $136,000 $151,000
Hawaii $41,000 $55,000 $69,000 $83,000 $97,000 $111,000 $125,000 $139,000

 

For additional information about Lilly Cares, call at 1-800-545-6962.

*A 120-day supply of medicine will be shipped to your health care provider’s office. Prescription refills will be available during your 1-year enrollment period.

GlaxoSmithKline

Avandia may be available at a reduced cost or for free. Unfortunately, the qualifications are not listed. You must call 1-866-GSK-FOR-U (1-866-475-3678).

NovoNordisk

Novo Nordisk Patient Assistance Program (PAP) provides free medicine (to those who qualify), including: Levemir, Novolog, Novolog Mix 70/30, Novolin, GlucaGen Hypo Kit, Victoza, and disposable needles for FlexPens and Victoza.

The application for Novo Nordisk’s medication assistance program is downloadable here. 

  • There are several limitations to this program. Review the application for all the restrictions.
  • You must be a U.S. citizen.
  • Patients must have a household income less than 200% of federal poverty level.

You can get more information by calling the Novo Nordisk Patient Assistance Program toll free at 866-310-7549.

If approved, a free 120-day supply of medicine will be sent to the prescribing health care providers’ office to be picked up at the patient’s convenience. Novo Nordisk will automatically contact the health care provider 90 days later to approve the medication reorder.

Merck Helps

Merck offers a prescription assistance program for Januvia.

  • You do not have to be a US citizen. Legal residents of the United States, including US Territories, are also eligible.
  • Your prescription for a Merck medicine from a health care provider licensed in the United States.*
  • You do not have insurance or other coverage for your prescription medicine. Some examples of other insurance coverage include private insurance, HMOs, Medicaid, Medicare, state pharmacy assistance programs, veterans assistance, or any other social service agency support.
  • You may qualify for the program if you have a household income of $46,680 or less for individuals, $62,920 or less for couples, or $95,400 or less for a family of 4.

The application for this program must be downloaded, filled out, and brought to your medical provider. Click here for the Merck Helps application.  (It is also available in Spanish.)

If you don’t meet the criteria, you can also try and use the “Januvia copay assistance coupon”. 

Januvia’s coupon is for “as little as $5 per prescription” for up to 12 months. Here’s the information on the restrictions and what you’d need to do. 

Pfizer

If you use Glucotrol, Pfizer offers a discount card for individuals who have NO prescription coverage. You’ll need to call 866-706-2400 to apply. 

  • You must be prescribed a Pfizer medicine available at a savings.
  • Have no prescription coverage.
  • Live in the United States, Puerto Rico, or the U.S. Virgin Islands

They also offer free medication for uninsured individuals through some clinics and hospitals. You can see if there is one located near you by entering your zip code at this website. 

Sanofi- Apidra

Those who take Apidra can use the Apidra® No Co-Pay Savings Program with their Apidra® prescription payments. Activate your card by checking this box and you can get No Co-Pay* on Apidra®. If you’re registering someone under the age of 18, please call 855-242-6938.

  • The card is not valid for prescriptions purchased under Medicaid, Medicare, or similar federal, state, or other government funded benefit programs.
  • Only patients who reside in the United States or Puerto Rico can participate in this program.
  • All commercially insured patients are eligible, even those with insurance that places Apidra® on the 3rd tier.
  • Cash-paying patients are also eligible for a benefit of up to $100 off per prescription.

Sanofi - Lantus

Sanofi offers a discount card for those who use Lantus SoloStar - pay no more than $25 for up to 3 prescriptions. (Maximum $100 benefit off of each prescription, for up to $300 for three prescriptions.)

  • The card is not valid for prescriptions purchased under Medicaid, Medicare, or similar federal, state, or other government funded benefit programs.
  • Only patients who reside in the United States or Puerto Rico can participate in this program.
  • All commercially insured patients are eligible.

Patient Access Network Foundation

The Patient Access Network (PAN) Foundation, an independent, national 501 (c)(3) organization dedicated to providing underinsured patients with co-payment assistance through more than 60 disease-specific programs that give them access to the treatments they need.

Diabetic Foot Ulcers

Eligibility Criteria

  •  Patient should be insured and insurance must cover the medication for which patient seeks assistance.
  •  The medication must treat the disease directly.
  •  Patient must reside and receive treatment in the United States.
  •  Patient’s income must fall below 400% of the Federal Poverty Level. (Here’s the handy chart showing you what that is based on how many people are in your household.)

Diabetic Macular Edema

Eligibility Criteria

  •  Patient should be insured and insurance must cover the medication for which patient seeks assistance.
  •  The medication must fight the disease directly.
  •  Patient must reside and receive treatment in the United States.
  •  Patient’s income must fall below 500% of the Federal Poverty Level. (You can use the chart and do the calculations for 500%. For instance, if you are a household of one, you qualify if you earn less than $48,350 gross income annually. For a household of three, you qualify if the household earns less than $98,950.)

Kidney Transplant Immunosuppressants 

Eligibility Criteria

  •  Patient should be insured and insurance must cover the medication for which patient seeks assistance.
  •  The medication must fight the disease directly.
  •  Patient must reside and receive treatment in the United States.
  •  Patient’s income must fall below 500% of the Federal Poverty Level. (You can use the chart and do the calculations for 500%. For instance, if you are a household of one, you qualify if you earn less than $48,350 gross income annually. For a household of three, you qualify if the household earns less than $98,950.)

Solid Organ Transplant Immunosuppressant Therapy

This will cover pancreas transplants and kidney-pancreas transplants.

Eligibility Criteria

  •  Patient should be insured and insurance must cover the medication for which patient seeks assistance.
  •  The medication must treat the disease directly.
  •  Patient must reside and receive treatment in the United States.
  •  Patient’s income must fall below 400% of the Federal Poverty Level. (Here’s the handy chart showing you what that is based on how many people are in your household.)

Retinal Vein Occlusion (RVO)

From the Patient Access Network Foundation website:

Central and branch retinal vein occulusions (RVO) happen when the vein at the back of the eye is blocked. This blockage causes pressure build and some of the small blood vessels in the eye may burst and cause fluid to leak into the retina. If untreated the vessels may be able to repair themselves and bypass the blockage but there may be permanent damage to the retina resulting in vision loss. 

Eligibility Criteria

  •  Patient should be insured and insurance must cover the medication for which patient seeks assistance.
  •  The medication must fight the disease directly.
  •  Patient must reside and receive treatment in the United States.
  •  Patient’s income must fall below 500% of the Federal Poverty Level. (You can use the chart and do the calculations for 500%. For instance, if you are a household of one, you qualify if you earn less than $48,350 gross income annually. For a household of three, you qualify if the household earns less than $98,950.)

 

Healthwell Foundation

For children under eighteen years of age

HealthWell Pediatric Assistance Fund® assists children 18 years old or younger living with a chronic or life-altering condition that their families are struggling to treat due to cost. They provide financial assistance to families so their children can start or continue critical medical treatments, including diabetes.

Families must meet HealthWell’s standard income and insurance eligibility criteria to qualify for a grant. Grants are awarded on a case by case basis. To apply for a grant, call 1-800-675-8416 anytime Monday through Friday, 9:00 a.m. to 5:00 p.m. (ET).

  • You must have some form of health insurance (major medical or prescription drug) that covers part of the cost of your medication.
  • Families with incomes up to 400 percent of the Federal Poverty Level may qualify. HealthWell also considers the cost of living in a particular city or state.
  • If you appear to be eligible for assistance through the Pediatric Assistance Fund, additional information and documentation is required for review and consideration prior to grant approval. Once all information has been received and reviewed by the committee, grant determinations will be made.
  • You will be asked to provide the Foundation with the patient’s diagnosis, which must be verified by a physician, nurse practitioner, or physician assistant’s signature. The patient must receive treatment in the United States.

Immunosuppressive Treatment for Solid Organ Transplant Recipients

HealthWell will pay for the following medications for immunosuppressive therapy:

Astagraf XL, Cellcept, Gengraf, Hecoria, Imuran, Myfortic, Neoral, Nulojix, Prograf, Rapamune, Sandimmune, and Zortress.

  • You must have some form of health insurance (major medical or prescription drug) that covers part of the cost of your medication.
  • Families with incomes up to 400 percent of the Federal Poverty Level may qualify. HealthWell also considers the cost of living in a particular city or state.

You can apply online for this medication grant here.  or call 800-675-8416. Agents are available Monday–Friday 9am–5pm EST.

Insulin Pumps

Medtronic MiniMed

The Medtronic Financial Assistance Program offers help to those who:

  • Use an insulin pump and/or continuous glucose monitoring
  • Meet specific income guidelines
  • Have an insurance company that allows for additional assistance

It also provides temporary coverage for specific situations:

  • Unemployment within the last 12 months
  • Gap in insurance coverage because of a pre-existing condition
  • Multiple pumpers in one household
  • Permanent disability

You’ll need to call Medtronic 1-800-646-4633 and select option 4 to get specific information.

Other pump companies offer self-funding payment programs. You should call them individually to find out the particulars. (The plans may change based on what you are looking for…)

*** If you have information regarding insulin pump programs, please contact me via email at theperfectd [at] gmail.com - you’ll be helping us all out!***

Equipment

Charles Ray III Diabetes Association

The CR3 Diabetes Association, Inc. is a 501(c)3 non-profit organization. 

According to the website, the organization is currently accepting applications for insulin pumps, blood glucose meters, and blood glucose test strips. You must review the following criteria:

  • You are uninsured
  • You are under insured (which means that your yearly deductible is unattainable)
  • Household income is less than $60,000
  • Your physician has recommended insulin pump therapy for you

They will only accept online applications on their website. The link to the online application is here.

Supplies for CWD Foundation (For children aged 18 years and younger)

Supplies for CWD Foundation (SCWDF) is a branch of the Children with Diabetes Foundation, a non-profit 501(c)(3) organization, providing short-term (up to three months) diabetes supplies for children with type 1 diabetes who are in emergency situations. (An emergency situation may be defined as: loss of health insurance, loss of a parent’s job, or a local disaster, combined with the family having no other resources with which to purchase diabetes supplies.)

Diabetes supplies is defined as any of the following: blood glucose meter, blood glucose test strips, insulin, insulin pump supplies, blood or urine ketone strips, lancets, syringes, and glucose tablets.

Download and fill out this application after reviewing all the requirements on the website.

Blood Glucose Meters/Test Strips

Freestyle Promise Program - $15 copays and a free Abbott Freestyle meter.

  • Co-pay assistance is not valid for prescriptions reimbursed under Medicare, Medicaid, or similar federal or state programs or in Massachusetts.
  • Eligible patients are responsible for the first $15 of co-pay under their insurance coverage, and can receive up to a maximum of $50 in co-pay savings. Uninsured patients are also eligible for savings in most situations.

Contour Choice Program - For ContourNext test strips. Eligible patients pay the first $15 in co-pays each month. Insured patients can receive savings of up to $35 per month of co-pays using the Contour Choice Card.

Not valid for patients with prescription benefits covered by federal and/or state government programs (e.g. Medicare, Medicaid.)

Clinical Trials

Do not forget about participating in clinical trials, some of which provide monetary compensation in addition to supplies and medications at no cost. (Some also provide physician/medical visits!)

Please seriously consider participating in these trials - in some, you can get access to pumps or medications that would not be available to you due to cost - or FDA approval. And… you can help others (and yourself) through clinical trials.

Click here for a list of clinical trials for diabetes that are recruiting  (general, which include both Type 1, Type 2, LADA, MODY, and gestational).

 

 

Any other sites/supplies/organizations/medication programs that might be helpful to others? Help us!

DAM: Diabetes By The Numbers

WDD-logo-date-EN-2048pxToday is World Diabetes Day. We don’t party with funny hats and beer with limes in them, or funny hats and green beer, or funny hats and…O.K., so we may party today with funny hats. (In fact, I’m headed to the Diabetes Mine Innovation Summit in Palo Alto, CA right now. There will be some well-deserved celebration with other people with diabetes tonight.) But diabetes is no party.

I’m going to give you some numbers, because numbers are solid and tangible and can be referenced to something. (Feelings and opinions make for lousy quadratic equations.)

 

 

  • There are more than 371 million people in the world with diabetes.
  • My blood glucose has been as low as 28 and as high as 778. (Got a thing for numbers ending in 8, my body.)
  • 79 million people in the United States have “pre-diabetes”, meaning they are at risk for developing Type 2 diabetes without making lifestyle changes.
  • In 2012, the direct medical cost in the U.S. for diabetes was $176 billion. (Yes, with a B. Billion.)
  • I’ve checked my blood sugar approximately 44,530 times.
  • Diabetes is the 7th leading cause of death in the United States.
  • A single vial of Humalog insulin is $148 without insurance at my local pharmacy.
  • People with diabetes spend an average of $13,700 per year on medical expenses; about $7,900 of that is attributed directly to diabetes care.
  • The risk for stroke and heart disease is 2 to 4 times higher among people with diabetes.
  • There are more than 3 million Americans with Type 1 diabetes - 85% of them are adults.
  • Diabetes is the number one cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the United States.
  • 4.8 million deaths in 2012 (the last time global mortality data was compiled) were caused by diabetes.
  • 80 people each day are diagnosed with Type 1 diabetes in the United States.
  • Those with type 1 diabetes are living around 11 to 14 years less, on average, at the age of 20 to 24 years than those in the general population; this figure drops to 5 to 7 years less at age 65 to 69.
  • I’m 43.

What’s the point of World Diabetes Day?

The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its member associations. It engages millions of people worldwide in diabetes advocacy and awareness. World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat that diabetes now poses. World Diabetes Day became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. 

Why today? It’s the birthday of Frederick Banting who came up with the idea leading to the discovery of insulin in 1922. So, because of him (and Charles Best), I’m alive today.

And that’s a good enough reason to put on a funny hat and celebrate. 

(Thanks to IDF, the U.S. Government, ADA, and JDRF for these statistics.)

5 Thoughts About the DTS 9.9 Meeting

If you want the (mostly) objective summation of what happened at the Diabetes Technology Society’s meeting on September 9th in Bethesda, MD regarding blood glucose monitoring accuracy, you can go to the Strip Safely blog post that I wrote.

If you want to read my top five completely subjective thoughts on the DTS meeting, read on…

1. I want to move to Norway.Flag_of_Norway

They’ve already got the process/system in place over there that doesn’t allow inaccurate meters and strips onto the market. It’s basically what DTS has proposed to do here in the U.S. and it works brilliantly over there because the government believes in the program (called SKUP) and it’s mandatory. I don’t believe that the same thing will happen in the U.S. without it being mandated by Congress, which will take a while.

Dr. Grete Monsen of Norway gave an amazing presentation and gave a lot of advocates in the room a glimmer of hope.

(I’m kidding about moving to Norway. I love their sweaters, but I’m not big on the cold weather.)

2. They’re going to have to build a bigger boat.

Yes, a Jaws reference. Why? Because diabetes advocates have teeth.

A post-market testing program is going to need a lot of people involved and a lot of funding to go with it. The room was filled with representatives from industry, clinicians, government, and patient advocates. It wasn’t a ballroom, but there was a lot of dancing around issues that must be addressed. Most of it is regulatory and governmental and financial, but Dr. David Klonoff, the president of the Diabetes Technology Society said that they will be building a roster for a steering committee to start… and it must include patient advocates. When he first mentioned the steering committee, patient advocates were not included. Someone quickly reminded him of us and we were added during his final comments.

3. Dr. Gary Puckrein is my new hero.

Sitting at the end of the esteemed panel of clinical and patient representatives who all gave their views on the need for glucose monitoring accuracy, he waited patiently as others gave their views. I’m sure that he had his talking points and was ready to add his approval to the collective voice when Dr. Elizabeth Koller began reading her prepared statement….about how for her “patient population” (i.e. Medicare and CMS), accuracy really doesn’t matter and that the tools currently available are just fine.

(Look. I’m paraphrasing, because I began to see red and stream poured from my ears. With such dispassion, she essentially told all of us that we were wasting our time sitting here, because as long as the FDA approves a meter, it’s fair game for Medicare and they’ll choose what millions of people will use. Sort of a “nanny-nanny-boo-boo - suck it up and we don’t care because we’ll do what we want and what’s cheapest” attitude.)

Dr. Puckrein was called upon to speak and instead of launching into his prepared statement, he turned to her and (again, I’m paraphrasing) told her that what she was saying was scary and that if this is how Medicare and CMS was going to play…

“We are going to come after you like dogs.”

My hero. I want that man in our corner and thankfully, he is.

4. The FDA needs a good public relations firm.

I have to tip my hat to the FDA representatives at the meeting. They’re like Timex watches - they take a licking and keep on ticking. Diabetes advocates asked over and over about enforcement and what it would take to remove an inaccurate meter and strips from the market. They never wavered in their vagueness. We expect that. What we didn’t expect was the admission that they don’t do a very good job of explaining what they can and cannot talk about in terms of enforcement. I’d love to see a PR firm get their hands dirty and revamp the forward-facing portion of the “What we do” part of the FDA’s device division website, giving all of us a better idea of what steps they can and cannot take… so that we don’t have to repeated ask and get repeatedly shut down. It was frustrating to all of us - advocates and the FDA alike.

Boots5. We have a long road ahead. Get your boots on.

So, you may be asking… what’s next? Didn’t you get what you wanted? Aren’t we going to get better accuracy from our strips?

Answer…. Not without enforcement and making it mandatory. And funding.

It’s one thing to have a proposal. It’s another thing to make it happen.

Funding, whether through Congress or private philanthropic organizations, has to happen. This is not a “let’s get this on Kickstarter” project… this is a Dr. Evil putting his pinky up to his mouth amount of money… And it needs to continue to be funded.

Support from the government is essential and not just the “we think this is a great idea” lip service. Once the program is up and running, the data given to them has to be acted upon, especially if it is determined that some meters and strips aren’t meeting standards (Hint: some already aren’t…). Without enforcement and “if you show us the data, we’ll act on it”, this becomes another pie in the sky project. The only benefit is for those who can afford to pick and choose their meters and supplies without suffering financial setbacks because their insurance company won’t pay for the accurate ones. That’s unacceptable.

We have a long way to go…. and we will all be right there, because we want industry and government to see the faces of those that accuracy and diabetes impacts.

Every meeting. Every discussion. Every time. 

Disclosure: The Diabetes Hands Foundation compensated my travel and lodging to attend the Diabetes Technology Meeting on September 9, 2013. My thoughts and feedback are my own and are not representative of the DHF or the Diabetes Advocates program.