Financial Barriers for Diabetes Patients

For unknown reasons the last few years, doctors seem only interested in how fast they can work you through the system. As long as they receive money and co-pay for your appointment, they are not interested in whether you, the patient, can afford the medications they prescribe, and many are not aware that some patients are having financial burdens.

The author of this article lists many of the financial barriers to care:

• Often this is what doctors call “non-adherence” symptoms, meaning that patients may stretch out the use of their test strips or take medications inconsistently to save money.
• Often, simply prescribing a less expensive medication may overcome some barriers.
• Other barriers can include:
  • 1. Testing frequency
  • 2. Transportation availability
  • 3. Medical supply costs
  • 4. Copay costs
  • 5. Housing and utility bills
  • 6. Stress
  • 7. Depression
  • 8. Missed work days

Supposedly, doctors are trained to ask questions, but many doctors assume they know the answers, but with financial barriers, they may have no clue. I hope that I can provide some resources that will help you meet your goals.

One strategy is to switch to a less expensive medication, such as changing to NPH or regular insulins from the analog insulins or combined therapy, such as 70/30 insulin. Metformin, sulfonylureas, and pioglitazone are economical drugs that can help reduce your costs. Vouchers or savings programs may also be used.

Testing supplies, if they do not align with what the insurance company is paying for, can be an additional and often insidious cost. Many patients often do not realize that their co pays change because of formulary changes. You just know that when you went to the pharmacy last month, it was covered, and now it is not. Being willing to tell your doctor about what is holding you back or keeping you from moving forward is critical.

In this case, it is valuable to tell your doctor how often you test, to help the doctor find out whether buying test strips, lancets, and other supplies is a problem. Learning whether the your blood glucose meter and test strips are covered by insurance can help open up a dialogue about how often you need to be testing based on the medication you are taking. This provides an opportunity to change medication on the basis of your needs to reach your goals.

Using prescription programs, such as NeedyMeds.org, GoodRx.com, and state-sponsored prescription savings programs also can be helpful. The paperwork is a little burdensome and may require an investment of time and energy, but if your doctor uses a team-based approach to care and has a staff member who can help you with the paperwork, the pay-off is quite significant.

Coupons and vouchers have their limitations but also play a role, particularly when looking at comorbid conditions and symptom reduction.

Polypharmacy is another area where co pays can become burdensome. Putting medications in combination or changing to a formulary alternative that may reduce the number of times the you have to take a medication may also help you, the patient, reduce the financial burden. Walmart, Costco, and others carry store brands of meters and test strips, which can also be more economical.

Utility support, such as the Low Income Home Energy Assistance Program (LIHEAP) and the Universal Service Fund (USF), can be very helpful. The Medical-Legal Partnership is a resource to help with advocacy and legal issues, landlord/tenant relationships, and work absences.

Food pantries are a great source of healthy foods. The Coalition Against Hunger is a national resource that supplies food pantries and fresh produce programs. Community hospitals and local agribusiness programs may also offer produce boxes during peak seasons, and supermarket surplus is often available at certain times of the year.

Diabetes is a journey. Do not be afraid of not having the answers. We can always find those. We just need to make sure we are building trust and moving in the right direction.