Saving on the Cost of Diabetes Care (cont.)
"At Joslin, we have a very rigorous approach towards selecting people for pumps," he says. "To qualify for a pump you have to be a highly motivated individual. You have to be checking your finger-stick sugars a minimum of four times a day, preferably closer to seven. You have to understand how to count carbohydrates and have a very, very sophisticated knowledge of nutrition, and of course know how a pump works."
But after all that, "We have never really had a problem with insurance once we've approved somebody to be on a pump."
Thirty-two state governments now have programs to help people who don't qualify for Medicaid coverage of prescription drugs. The income caps vary widely, from $35,000 a year for singles in New York to $17,000 a year for singles in Missouri. Most programs are for seniors and Medicare beneficiaries, though a few, like Maine's drug discount, have no age limit.
How these state programs will mesh with the new Medicare prescription drug benefits, set to take effect in 2006, has not been ironed out yet, says Juliette Cubanski, a senior policy analyst at the Kaiser Family Foundation.
Currently, 29 states also have "high-risk pools" that provide insurance to people whose existing illnesses make buying a private health plan too expensive.
Assistance from drug companies is another possibility for those who are too young to benefit from programs geared toward seniors.
Pfizer runs a discount program called "Pfizer Pfriends," which is open to anyone without drug coverage. GlaxoSmithKline's "Bridges to Access" program hands out free medication to people who qualify. The income cap is $25,000 a year for singles, or 250% of the federal poverty limit for families, and the enrollment process has to be handled by a third party.
You can search for these and other discounts at Partners for Prescription Assistance, www.pparx.org, a web site set up by drug companies, insurers, and patient advocacy groups to help people find discounts available to them.
"The programs are worth exploring," Cubanski tells WebMD. "They're good for people who are taking drugs that are made by these companies, who don't have any other source of drug coverage."
A drawback to these kinds of programs, she says, is that only brand-name drugs are involved. "If the potential exists for a consumer to switch from a brand name drug to a generic drug, they might not necessarily get that information," Cubanski says.
Good Control = Good Care
In a 2004 study, published in the journal Diabetes Care, University of Michigan researchers found that 11% of diabetes patients surveyed nationwide had skipped doses of their diabetes medicines because of cost. In a related study, published in the journal Medical Care, the researchers found that people with diabetes who skipped doses of their medication had worse control of their blood sugar.
If you can't pay to fill a prescription, you can't pay, but if you habitually skip doses to eke more out of it, "You're going to end up costing yourself more," Gavin says.
Not having good control of your blood sugar raises your risk for diabetes complications, and the cost of treating them can be many times over what you might spend on your medicines.
What's more, the worse your control is, the more drugs you may eventually have to take. That's because in uncontrolled type 2 diabetes, the longer it goes on, the more ability to produce insulin you may lose. "It's easier to keep control once you're in control than it is to get control when you're out of control," Gavin says.
Published April 14, 2005
SOURCES: Carol Phillips. James Gavin, MD, director, National Diabetes Education Program; president, Morehouse School of Medicine. Paul Jellinger, MD, president, American College of Endocrinology; professor, University of Miami School of Medicine. Martin Abrahamson, MD, acting chief medical officer, Joslin Diabetes Center. Juliette Cubanski, senior policy analyst, Kaiser Family Foundation. Diabetes Care, March 2003, February 2004, January 2005. American Diabetes Association. FDA. CDC. State Coverage Initiatives. The National Conference of State Legislatures. AARP. National Academies, Institute of Medicine. National Institute of Diabetes and Digestive and Kidney Diseases. News release, University of Michigan Health System, February 2004. Medical Care, February 2004.
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Last Editorial Review: 4/18/2005 7:43:17 PM