Type 1Diabetes + No Insurance? How Little Can You Pay To Live?

Money

You are an adult with T1 diabetes living in the United States. You have no health insurance – or worse, health insurance with such a high deductible that everything you need is out of your own pocket. This is today’s reality for so many people.

Want to know how much having diabetes and paying out of pocket will cost? How little you can pay? Read on…

Ground Rules

This is the bare minimum standard of care, which means I’m not trying to NOT use test strips or avoid tests or health care visits.

When I say “bare minimum”, it means that there are no insulin pumps, no continuous glucose monitors, no conveniences, no latest on the market medications, and forget the latest insulin analogues. The insulin you’ll be using is the same formulation that I started with in 1983 – Regular and NPH (except you get recombinant DNA and I got a mix of beef and pork). 

You should take this as a “If I am to follow what the ADA says I need to do at the very least, this is how much it would cost me for my diabetes.”

This does NOT take into consideration if you have to see additional health care professionals or have additional tests if it’s been determined that you have complications.

I am using the American Diabetes Association’s Standards of Care 2014 as the guiding document.

Most of the items listed can be purchased at Wal-Mart. Why Wal-Mart? Because ReliOn items, sold at Wal-Mart, are the cheapest on the market. I can’t vouch for their accuracy, efficacy, or their overall comfort and convenience. With the exception of the ReliOn glucose tabs that I purchased in an emergency once, I’ve never used these items. But here goes…

Insulin

PR-052_1280x580The least expensive insulin that you can purchase in the United States is at Wal-Mart. Remember that these particular insulins are not the latest or fastest insulins on the market. You will need to work with your health care professional to create your dosage plan, because if you are switching from different insulins (Humalog, Novalog, or Apridra for fast-acting or Lantus, Levemir for slower-acting/basal insulins) your dosage, timing, and when these drugs peak will be completely different.

The ReliOn brand insulin is manufactured by NovoNordisk, just so you know.

That being said, once your have your dosage, let’s pretend calculate:

If 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. As there are 1,000 units per vial, you’ll need at a minimum 2 vials per month.

  • $24.88 ReliOn®/Novolin® Human Insulin N
  • $24.88 ReliOn®/Novolin® Human Insulin R
  • $24.88 ReliOn®/Novolin® Human Insulin 70/30

Total cost per month: $49.76 

Total cost per year: $597.12

Syringes

PR-038_1280x580You have insulin, but you need the vehicle to get the insulin into you: syringes.

  • $12.58 ReliOn Insulin Syringes (100 syringes in each box)

If you use the ReliOn insulin, you’ll most likely take two shots per day (minimum, remember?), so that’s 60 syringes per month. You can only buy them a box at a time.

Total cost per month: $12.58

Total cost per year: $100.64 (8 boxes, for 720 syringes each year, hoping that every single one works properly)

Blood Glucose Monitoring

You need 1 meter. Here you go:

Total cost (let’s just call it per year, OK?): $16.24

Now, this is where it begins to get tricky. You need strips and lancets.

According 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.”

That is waaayyyy more than 6 times per day, but I’m going with the bare minimum.

So,  6x/day = 180 strips per month. Wal-Mart sells their ReliOn strips in counts of 50, so you’ll need 4 boxes per month.

Total cost per month: $36.00

Total cost per year: $432.00

Now, you have to have a lancing device to get that blood.

Total cost per year: $5.84 

0007874202646_180X180.jpg-5678a538e37caabcaab7cedf6058410c726dc3e5-optim-180x180You are supposed to use a new, sterile lancet for each blood glucose check. (Ahem.) Following the guidelines, it would be 6 new lancets each day for a total of 180 lancets per month. Buy the bigger box and you’ll save a penny per lancet.

Total cost per month: $5.84

Total cost per year: $64.24 ( you only have to buy 11 boxes if you buy the larger box each month). 

Miscellaneous Supplies:

You hope that you’ll never be sick, under stress, or have a blood glucose over 240 mg/dl, because then you could possibly have ketones. But you need to have the ketone strips on hand, just in case. These do expire, so at a minimum, you’ll need one vial of these per year.

Total Cost per year: $6.64

If you are following the guidelines, you’ll need to use an alcohol swab for every time you use a syringe or a lancet.

  • $3.74 ReliOn Alcohol Swabs, 400ct

You’ll use a whopping 2,920 of these each year. Minimum.

Total Cost per year: $29.92

Hypoglycemia? According to Diabetes Care:

Individuals with type 1 diabetes average 43 symptomatic episodes annually; insulin-treated individuals… As for severe hypoglycemic episodes, patients with type 1 diabetes experience up to two episodes annually…The risk increases with a history of hypoglycemia and an increased number of years of insulin treatment.

So, figure on one hypo per week. (You and I both know there are more, but again, we’re bare boning this.)

Hypoglycemia treatment options? Well, you could use glucose tabs or gels; they are the most effective in treating hypoglycemia. Still need something, so you can purchase juice or candy that can treat hypoglycemic reactions for less, but won’t be as effective or as portable or convenient.

  • $3.98 50 ct. ReliOn Glucose Tablets (with an average of 4 tablets for each episode, but you may have to buy something on the fly so this cost may be higher)

Total cost per month (average): $3.98

Total cost per year (average): $47.76 (not counting extra items purchased if you don’t care the glucose tabs with you at all times)

 Lab Tests/Vaccines

Standard of Care states:

Type 1s should have their A1C tested twice per year if you are under 7.0% and quarterly if not meeting goals. The least expensive option is… yes, you guessed it: Wal-Mart.

  • $8.98 ReliOn A1c Test – must mail test to lab to get results.

Total Cost per year: $17.96 – $35.92

Influenza vaccine annually (remember, this is Standard of Care recommendations) You can try and get a free one at a health fair or county health department

Total Cost per year: free to $25.00, depending on where you go without insurance.

Now, often you’ll have to see a health care provider to get this test, but there are some places that you can walk in and get this done without insurance or a prescription. I chose Any Lab Test Now for pricing (obviously this can vary around the country).

Fasting lipid panel annually, regardless of history. If you’re on a statin, then more frequently.

Total Cost per year: $49.00 (minimum) 

Microalbumin test to measure albumin excretion (levels will determine your kidney function)

Total Cost per year: $49.00 (minimum)

Health Care Visits

797188_84253664One visit (minimum) to a health care provider to do physical exams, etc. If there is any evidence of complications or comorbidity, additional visits may be requested.

Total cost per year for a single non-specialist: $95 to $215 (depending on location, according to this 2014 article)

One visit (minimum) for a dilated comprehensive eye exam. (This cost referenced is for a standard eye exam. It may be more based on dilation.) Remember if the health care provider finds evidence of retinopathy, additional visits, treatment, and tests will be needed.

Total cost per year for an eye exam: $50 to $114 (depending on location, according to this website)

 

$1561.36

This is the bare minimum cost annually without insurance (or out of pocket if you have horrible insurance options, not counting the amount you are paying for premiums), if you are not eligible to use free services or patient assistance programs.

Remember The Ground Rules

This amount assumes you are not using an insulin pump, a CGM, any brand name products besides ReliOn, the latest analogues or medications, or using any resources that may cost extra. You are essentially using the same technology that I started with over 30 years ago when I became Type 1, except the blood glucose testing is less expensive and results are faster.

That amount assumes that you are eating a healthy diet (oh, wait… it costs more to eat healthy, so factor that in…).

That amount assumes you are without ANY complications from diabetes or have ANY comorbidities.

That amount assumes you do not take a statin or an ACE inhibitor (recommended by ADA for many patients).

That amount assumes you do not take ANY other medications – or gosh, need a Glucagon Low Blood Sugar Emergency Kit.

That amount assumes you do not have periodontal disease, heart disease, depression, hypothyroidism (which is the most common autoimmune disorder associated with T1 – up to 30% of us have it), kidney disease, neuropathy, frozen shoulder or trigger fingers, foot issues…

That amount assumes you will not be admitted to the ER, the hospital, need specialists (nephrologists, podiatrists, orthopedists, ophthalmologists, cardiologists, gastroenterologists) or have to take time off of work due to diabetes.

If you do need assistance, there are resources available for U.S. individuals with diabetes that meet certain criteria.  

Are you getting what I’m saying here?

607166_81443036If those assumptions are wrong (and most of the time, they are) there are additional thousands of dollars to be spent out of pocket. You can’t get those services at Wal-Mart prices.

This is not a blueprint for how to manage your diabetes.

This is showing you the cheapest, but often substandard treatments, for diabetes. How many people with diabetes must make decisions that impact our life due to the cost of living with this disease? TOO MANY.

I haven’t even started on the emotional cost. The psychological cost. The cost on families, coworkers, employers, friends…

It’s not how little we can pay…

I’ve figured that out: $1561.36 per year, give or take thousands of dollars.

It’s about how much we can’t afford to lose, which is much, much more. 

 

 

Two Minute Diabetes Advocacy: #Vote4DM

If you have two minutes, you can make a difference for people with diabetes (even if YOU don’t have it). Got a Twitter handle? Have we got a deal for you…708615_95129272

It’s an exciting time of year! It’s football voting season. Congress seats will be up for grabs and we want to remind those currently in power that they can’t forget the millions of people with diabetes and their friends vote. And we want them to know what’s important.

You want your voice heard in Congress?

Then tell them to #Vote4DM.

There are three bills that are currently in play up on Capitol Hill:

S539/HR1074 – National Diabetes Clinical Care Commission Act

Did you know that there are 37 federal agencies that play some role in the prevention and treatment of diabetes?  (Have you ever worked with 37 people in one group? Try 37 agencies!!!) These agencies aren’t always working together, resulting in miscommunication (or lack of communication), reinventing the wheel, and wasting of resources.

The National Diabetes Clinical Care Commission Act will coordinate diabetes efforts. The Commission will include federal agency representatives, patients and health care providers, and will use existing funds at no extra cost to taxpayers to do its work.

S945/HR1274 – Access to Quality Diabetes Education Acts

This bill will increase access to diabetes self-management training (DSMT) by designating credentialed diabetes educators as certified providers for purposes of outpatient DSMT services under Medicare Part B. It’s “budget neutral“, meaning that the cost of the outpatient services will be offset by the savings provided with the program.

 S. 2689/HR5644 – Medicare CGM Access Act of 2014

Medicare does not currently cover CGM devices, leaving people over 65 with type 1 diabetes (T1D) without coverage for continuous glucose monitors. Did you know that right now, costs for a hypoglycemia inpatient admission average $17,564 per visit!?

Passage of the bill will facilitate Medicare coverage of CGMs, and help pave the way for the next generation of CGM-related technologies, such as artificial pancreas (AP) systems.

unnamed-3Here’s what you can do.

Participate in the two Tweet-Ins for #Vote4DM: a 24 hour Tweet-In beginning on 10/22 (Wednesday) at 8pm EST and then another 24 hour Tweet-In beginning on 10/29 at 8pm EST. (If you can’t make these times, you can still tweet these messages out. It’s just important that you tweet them!)

StripSafely‘s made it so incredibly easy for you to use the power of Twitter for good.

Let’s get a 100% #VOTE4DM from our Congressional representatives and vote diabetes out of office.

1. Find your representative in Congress easily by clicking on this link and entering your zip code. (Remember that name or keep that page open for your reference.)

2. Go to the StripSafely Twitter page and let the blitz begin. (Look! A football reference!)

  • You will send three Tweets per person on the list: One for each of the bills currently on the Hill.
  • We are either asking them to cosponsor the bill or thanking them for cosponsoring the bill.

Now:

  •  Tweet the Senate and House leadership and the Diabetes Caucus leadership, regardless of what state you live in.
  •  Tweet your state senator(s) and district representative. 

3. Share the StripSafely Twitter page with anyone who has diabetes or cares about someone with diabetes. (That means share with everyone you know.) Ask them to tweet. 

And that’s it. Mark the date and time in your calendar and help us raise awareness for these non-partisan bills that will help people with diabetes. Share this info with people via Facebook, Twitter, and emails. We would love to shake the Twitter tree and get Congress to see that we won’t be quiet anymore about keeping us safe!

 

#DOCAsksFDA Needs You

FDACalling all PWDs! Calling all PWDs! Pick up the bat phone!

 

O.K., really, just need you to take a quick survey to help the entire diabetes community. 

On November 3, the FDA will host an unprecedented discussion between the diabetes community and senior agency leadership (both drugs and devices). 

The event will be live webcast from 1 – 4 pm.

How much of a big deal is this?

Big. Super mega colossal big. 

The event will include a panel of patients (T1 and T2), as well as representatives from ADA, JDRF, and diaTribe.

Each of us live with challenges due to our diabetes every day. Take a few moments to share your thoughts on what’s important when it comes to living with diabetes.

The survey, posted over at Diatribe, is short. The results will go DIRECTLY to the peeps over at FDA and will influence the dialog that will happen on November 3rd. Diatribe is asking those with diabetes (Type 1, Type 2, MODY, LADA, etc.) to help gather all of our thoughts.

We need to show the FDA that patients care about these issues, that patients have valuable input to share, and that the treatment options we have are still not good enough. 

As soon as the link to register for the live event is posted, I’ll get you the details. In the meantime, the survey awaits your input.

Help the FDA understand what we want for our future.

They’re listening.

Let’s tell them.

Glucagon

glucagon-extinguisherThe red box.

I’ve shown it to coworkers. To family. To friends. I open the box up, show them the contents, and go through a complicated pantomime of what they would need to do. (Marcel Marceau is rolling in his grave. Silently, of course.) I had one staff meeting where my team played Rock Paper Scissors for who would use the red box. Make no mistake – it was the loser who got to administer it on me.

The red box is my glucagon kit and in all my years of T1, it has been used twice on me, and I was awake each time (although it was close). If you are having a severe hypoglycemic episode and can’t ingest glucose (because you’re unconscious or throwing up or can’t get another gram of glucose into you by mouth), it’s what’s going to help you.

It’s an insurance policy. The kits do expire and they’re aren’t cheap, even with a prescription, but it’s worth having – if you have someone with you who knows what the hell to do with it. It’s not a “take it and jab it into her butt and there you go” sort of deal. While you are incapacitated (and let’s be honest… if your blood sugar is 25, you’re not exactly spouting off the Declaration Proclamation verbatim, although you may think you are), the individual you trusted to use this kit must follow a set of directions that involves a few steps. It’s not like someone is going to rifle through your things and say…

“Hey, look! A glucagon emergency kit! Let me sit down and read the directions and get comfortable with this concept and figure out what to do…wow, there are a lot of steps… before I plunge a needle into your…”

If they don’t know what it is, what it’s for, what they need to do, it’s going to sit there.

So, here’s my challenge for you today.

If you have a glucagon kit, talk about it with the people who you love and hang out with you. If you have someone you work with that you trust, talk with him/her. I know that some people don’t want to disclose diabetes at work, but the last thing you want is to pass out and not have anyone understand why.)

  1. Show them where it resides (in your backpack, in the refrigerator, in your bedside drawer).
  2. Explain what it will do for you and what it won’t do.
  3. Tell them that you will do everything to avoid ever having to use this, but if it does need to be used, that you trust them to do whatever it takes to keep you alive – and it will keep you alive.
  4. Pull out the kit, go over the instructions, and answer any questions that they might have about it.
  5. Thank them. This is so important. Thank them for caring enough to help you if you can’t help yourself. It’s just as scary for them as it is for you when you are crazy low and/or unconscious.

 

I have an Eli Lilly Glucagon Emergency Kit for Low Blood Sugar. And you know what Eli Lilly did?

They made an app for the iPad and iPhone, giving you easy visuals to share and show – and prepare in case something does happen.

This is the website where you can get more info and click to download the app. I put it on my iPhone and it’s very easy to use:

www.lillyglucagon.com

app-screenshots

Until there are easier ways to administer glucagon (and there will be, because I believe that what is currently in clinical trials will become FDA approved – administered nasally versus intramuscular injection? Oh, yes.), it’s important that we give ourselves and those who are around us the tools and resources to help. (That nasal glucagon link? They are still recruiting, so you can help us all out if you are near a trial center.)

Now, what if you don’t have a glucagon kit?

Get one. Ask your doctor for a prescription and get one from your pharmacy. (Note: check the expiration date on the kit while you are standing at the pharmacy window. Do not accept a kit that has less than a year left to use it. Unlike some other supplies, this one will become less potent after the expiration date and because it’s expensive, don’t waste your money on a kit with just a few months left.)

As I said before, they are expensive and it’s one of the few things about my diabetes management in which I want to let expire.

Why do I tell you this?

I had a severe hypo a few weeks ago. Severe enough that I needed John to help me, because I could not longer use my legs to get more glucose. I was scared.

And after the disastrous event, both of us admitted that the red box was about a minute away from being used. If I hadn’t forced (and kept down) another juice box, it would have been a reality. I am thankful that I took the time to show John how it should be used and trust his judgement. I want everyone to be thankful. And everyone to have a red box – and never use it.

PIP PIP! I’m Not So Cheerio Right (Write) Now…

Remember how I wrote earlier this week that my finger was detriggered?

Um. About that.

If I am correct (and I’ll find out on Monday, so please place your bets now), I have developed a PIP joint flexion contracture in that finger. My finger will not fully extend, so when I give someone a high five, it’s more like a high four and a half. And the joint is locking and clicking.

What does this mean for me? Again… place your bets. I am hoping that I am going to lose the one I’m making with myself, because it would involve another surgery.

So, without narcotics (which I took to write this post and get things done around the house), I’m unable to complete the every day tasks I was doing before the surgery. I have so much to do and so much to write about that this is one.big.bummer. (And I abhor narcotics, so I’m not the happiest of campers right now.)

I often tell people that it’s not the big complications that make daily life with diabetes tough; it’s the little things. This is a little thing in the grand scheme of it all, but right now, it’s coloring everything I attempt to do. My blood sugars are “fine” for a PWD who is under stress, but I’m looking for some resolution.

So, that’s why the posts have been non-existent. Hopefully, Monday, I’ll have an idea and can move forward.