The Role Of Pharmacy Benefit Managers
Prices are also driven up through the use of pharmacy benefit managers . PBMs are companies that create and manage the lists of prescription medications that insurance companies cover. These lists are called formularies.
PBMs give priority to prescription manufacturers that offer large rebates. Manufacturers that offer large rebates are placed on more formularies and are favored by insurance companies.
More expensive prescriptions can offer larger rebates because their starting costs are so high. This has driven the price of insulin up dramatically.
Financial Help For Diabetes Care
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Diabetes management is expensive. According to the American Diabetes Association , the average cost of health care for a person with diabetes is $16,752 a yearmore than twice the cost of health care for a person without diabetes.1
Many people who have diabetes need help paying for their care. You can find help through private or government health insurance, local programs, patient support groups, and medicine-assistance programs. You can also find ways to save money on diabetes medicines and supplies.
Free Medications For Diabetes
If you do not have insurance, ask your pharmacy to check the free medication list for options. Metformin, a popular first line therapy for type 2 diabetes, is often on the free medication list. Some of the older, yet still effective diabetes medications are also on the free or low-cost list at the pharmacy. Community free clinics also have a pharmacy and may be able to provide basic medications.
You can also ask your healthcare provider for medication or insulin samples during an in-office visit. They may have access to free samples or be able to contact the sales representative to request more. This can help in a pinch, but unfortunately its not a sustainable long-term solution.
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Find Free Insulin From Pharmaceutical Companies
There are three major insulin producers. Low income patients, those on Medicare, and the uninsured can get free insulin as noted below. There are also monthly subscription plans that charge a fixed rate per month, patient assistance programs, and other resources. Learn about .
Eli Lilly provides free or affordable assistance to low to moderate income families, the uninsured, people in high deductible plans, some patients with a disability and others who may be struggling. The Lilly Diabetes Solution Center will allow anyone in need of information to get insulin for free. Customer service representatives will review all of the insulin assistance programs that may be available to the patient.
There are community clinics which offer free insulin for type 1 diabetic patients as well as other health care services. Point of Sale savings and discounts are offered too. There is other forms of financial aid, and help is available in multiple languages too, including Spanish. The main phone number is 808-1234.
Low cost or free insulin can also be obtained from the patient assistance program known as Lilly Cares. It will focus assistance on patients without health insurance, those in Medicare Part D, and where insurance will not pay for any insulin or medications. There are other requirements as well in order to get insulin such as Humalog. Read more on .
How To Save On Insulin With Or Without Insurance Coverage
Cutting down or rationing insulin has dire consequences for all type 1 as well as type 2 diabetics dependent on insulin. Working in a busy practice alongside an endocrinologist with predominantly type 1 diabetic patients, Ive seen the team behind our doctors working hard to keep insulin affordable for patients. Here is what Ive learned from the best.
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Community Health Centers And Pharmacies
Community Health Centers provide low cost diabetes care. These centers and their pharmacies are part of the federal 340B program. The 340B program requires drug manufacturers to sell certain medications, including many insulin products, at a reduced cost which is passed onto patients. In order to purchase your insulin products at these reduced costs, you must be a patient of the CHC and fill your insulin prescriptions at a pharmacy located within the CHC or at a pharmacy that is partnering with the CHC. For information on how to become a CHC patient in Utah, please go to or .
Lilly Cares Patient Assistance Program For Diabetic Medicare Beneficiaries
Eli Lilly and Companys program covers the insulins Humalog, Humulin, and Basaglar.
To qualify, you must:
- Be a United States citizen or permanent resident
- Not be eligible for or enrolled in Medicaid or VA benefits
- Have spent more than $1,100 on Part D medications in the past calendar year
- Have been prescribed insulin covered by the program
- Meet certain financial criteria
If you are approved, Eli Lilly will ship one to four months of insulin to your doctors office. The company will also include a refill form with this shipment, and you must fill it out and return it before you need another refill. Eligibility for the program lasts for 12 months, but you can reapply if you continue to need assistance.
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Need Help Paying For Your Insulin Know Your Options
About 32 million people10.5 percent of the U.S. populationhave diabetes, according to the Centers for Disease Control and Prevention National Diabetes Statistics Report. Meanwhile, 88 million people 18 years or older34.5 percent of the adult U.S. populationhave prediabetes.
To manage this chronic condition, 7.4 million Americans use insulin.
The COVID-19 pandemic has led to overarching uncertainty nationwide. Now more than ever, people need assurance they can access and afford essential medications for conditions such as diabetes. Fortunately, living a long, healthy life with diabetes is possible with the proper treatment, diet, exercise and prescription programs like that of Lilly.
Insulin For My Type 1 Diabetic Mom
Heathers mom has lived with diabetes her entire life. But recently, her insurance company began charging her over $2,000 for a 90-day supply of insulin. When Heathers mom began rationing her insulin because of financial struggles, Heather knew she had to find a way to help. She launched an online fundraiser and was able to raise over $3,600 for her mom.
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Look For Inexpensive Branded Drugs
There are some lower-cost options now available for people who want to or have to stick with a branded insulin.
Sanofi, for example, now has a program for people who buy their own insurance or get it through their employer that eliminates or sharply reduces copays for five of its branded drugs: Adlyxin, Apidra, Lantus, Soliqua 100/33, and Toujeo. For people without insurance, it sets a $99 limit per month for four of its drugs: Admelog, Apidra, Lantus, and Toujeo, says Nicholas Kressmann, spokesperson for Sanofi.
Eli Lilly has set a similar cap$95 per monthfor Humalog, Humalog Mix 75/25, KwikPen, and Humalog Junior KwikPen. The discounted price should be automatically available when you fill your prescription, says Eli Lilly spokesperson Kueterman. People without insurance can use a discount card to get the same low price , says Kueterman.
Last month, Novo Nordisk announced it would offer a months supply of any of its branded insulins, including Fiasp, Levemir, Novolin, Novolog, Novolog Mix 70/30, and Tresiba for $99 for anyone with or without insurance, says Ken Inchausti, spokesperson for Novo Nordisk.
Seek Assistance From Your Doctor To Get Insulin Without Insurance
Discuss your financial situation, and not having insurance with your doctor thoroughly.
Upon doing this, your doctor may consider enrolling you in some of their discount programs or consider changing your prescription to a generic or other low-cost alternative medication/formula which can still be effective.
Your doctor may also write you a prescription for a larger quantity of insulin, which can help reduce your overall cost.
This discussion can also help you get free samples of vials or pens available at the doctors office. This might offer a short-term solution until you find other means to cover your insulin costs or look to explore other methods.
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Consider An Older Version Of Insulin
Insulin is a naturally occurring hormone, and for decades, insulin used by humans was derived from pigs or cattle. Today, insulin is cultivated in a lab, with the most common type called human analog. It’s designed to be more quickly and consistently metabolized by the body, and consequently, it’s more expensive.
But an older type of insulin, simply called “human insulin,” is still sold today, and may work for some people, says Novo Nordisk’s Inchausti. He says half a million people rely on the companys Novo Nordisk Human Insulin, which is available for about $25 per vial at Walmart or CVS pharmacies. Eli Lillys, called Humalin, cost $148 per vial. Your insurance may cover some or all of that cost.
Help With Your Diabetes Prescription And Insulin Costs
All people with T1D should have affordable access to insulin. While sharing the resources below that can help with costs, JDRF is also fighting for changes from manufacturers, health plans, employers, and the government to make insulin more affordable. Learn more here.
Prescription costs for drugs to treat type 1 diabetes can make up a large percentage of what you pay each year for healthcare. There are a few ways you can lower your prescription and insulin costs: through state and nonprofit programs diabetes patient assistance programs offered by pharmaceutical companies medication discount cards and prescription alternatives such as biosimilar insulin.
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Novo Nordisk Opens Free Insulin Program To People Who Lost Insurance Due To Covid
Like Sanofi and Lilly, Novo Nordisk also offers no-cost insulin to qualified beneficiaries. Novo Nordisk covers the insulins Fiasp, Levemir, Novolog, Novolin, Tresiba, and Xultophy.
To qualify for this program, you must:
- Be a United States citizen or permanent resident
- Have a household income of less than 400 percent of the federal poverty level
- Not have or qualify for private prescription drug coverage, VA benefits, or Medicaid unless you have spent more than $1,000 on prescription drugs in the past year and have been denied Medicare Extra Help
If you meet all eligibility requirements, Novo Nordisk will send a 120-day supply of insulin to your doctors office along with a refill form. When you need a refill, your doctor can submit this form to you.
Visit the for more information and to see if you qualify.
Nership For Prescription Assistance
Applying for hundreds of PAPs can be time-consuming. But the Partnership for Prescription Assistance may help you save time. You can apply for hundreds of private and public assistance programs at once through PPA, rather than applying to each individual company. PPA is designed to assist people who dont have any prescription drug coverage. You may not qualify for any plans if you have pharmacy or prescription insurance.
For example, if you search a popular insulin like Lantus, youll find two options: Lantus and Lantus. If you choose the Lantus pen, youll find information on a program funded by Sanofi, creators of Lantus. The RxAssist listing tells you a variety of details about the program, including financial structure, requirements, and contact information.
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I Have Medicare Medicaid Or Veterans Affairs Benefits
Eligibility requirements for many Patient Assistance Programs currently do not allow people with government insurance to enroll. However, some people may qualify for resources under the I am uninsured section below, especially if you are on Medicare Part D. Call your medications manufacturer to determine whether you can qualify for their programs.
Novo Nordisk’s My$99Insulin Cash Card Program provides 3000-3800 units of Novo Nordisk analog insulin for $99 for up to 12 months. Note: all people are eligible for this program.
There may be additional eligibility requirements for those covered under Medicare Part D however, this savings program is one of the few that includes government insurance beneficiaries.
Through Lilly’s Patient Assistance Programs , LillyCares, people who are covered under Medicare Part D, have spent $1,100 on prescription medications this calendar year, and meet the income and other eligibility requirements.
Limited-income seniors can search for help with medicines, health care, rent, and other needs at Benefits Check Up.
Pharmaceutical Company Patient Assistance Programs
You may be able to get help with the costs of insulin and medication through drug assistance programs from pharmaceutical companies, known as patient assistance programs . Each program has its own eligibility requirements for people with type 1 diabetes, so its important to check those details. Here are a few programs offering assistance for diabetes medications:
You can also find a program by searching on the medication name here.
If you need assistance with your pump supplies or CGM, directly contact the manufacturer via their customer service number.
- Medtronic: 1-800-646-4633
- Abbott Diabetes Care: 1-855-632-8658
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What Health Insurance Plans Cover People With Diabetes
Health insurance helps pay for medical care, including the cost of diabetes care. Your health insurance options are
- private health insurance, which includes group and individual health insurance
- government health insurance, such as Medicare, Medicaid, the Childrens Health Insurance Program , TRICARE, and veterans health care programs
Under current law, health insurance companies cant refuse to cover you or charge you more just because you have a pre-existing conditionthat is, a health problem you had before the date that new health coverage starts.
Changes to insurance rules happen often and may affect your health insurance choices. Learn more or get help with your health insurance questions through
- HealthCare.gov , the federal marketplace, 1-800-318-2596, TTY: 1-855-889-4325
- copayments and deductibles
- health care providersdo your providers participate in the plan, or will you have to change providers or pay more to see your current providers because they are out of network?
Ask for a Summary of Benefits and Coverage, which explains the plan in plain language, including free preventive services. This summary may include a coverage example for managing diabetes.
A Blast From The Past: Considerations With Lower
The high price of insulin has been a hot topic in the news this past year as people on limited budgets have sometimes been forced to ration insulin, ending in serious or even dire outcomes. If you have trouble affording insulin and have not qualified for a PAP, you might consider switching to an older, more affordable insulin formulation. These older insulins, called human insulin, are available at Walmart for around $25 a vial.
Human insulin was used safely and effectively for many years, but works differently than newer analog insulins. Be aware that some people have ended up in the hospital because they expected the older insulin available at Walmart to act in a similar way to the newer analog insulin they had been using prior. Before changing your insulin, ask your healthcare provider if it is clinically appropriate for you to make the switch.
Older insulin is still better than no insulin, so partner with your healthcare provider to guide you on the appropriate dose, how to mix the insulins, when to take them, and how to adjust your diet, to transition safely.
Saving on diabetes costs can take time and patience, but being a savvy consumer can save you money and help you better manage your diabetes. With the resources above, you can continue to research options, ask questions, and find assistance to reduce your diabetes costs.
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Blood Glucose Meters And Test Strips
As discussed in the prescription section above, try using the brand that is preferred by your individual insurance plan and any preferred mail order or medical supply distributor to potentially save on copays.
If you have a high deductible or no insurance, paying cash for glucose testing supplies will likely be necessary. The good news is that you do not need a prescription for these items. Fast, accurate, and simple-to-use blood glucose meters are now more affordable for people paying out of pocket. Meters and test strips from AgaMatrix have ranked in the top tier for accuracy by the Diabetes Technology Society and can be shipped directly to your home at an affordable price.
Many pharmacies also offer store-brand meters that are easy and affordable, and are typically found on a shelf near the pharmacy counter. Retailers like CVS, Target, and Kroger offer store-brand meters that have ranked highly in independent tests for both accuracy and affordability, and often have sales for a free meter or percentage off test strips to save even more money.
Get Help Paying For Insulin
Insulin is expensive. If you are a type 1 diabetic like I am, you might spend over $500 a month for your insulin and supplies. Thankfully, I have insurance I hope you do, too. Either way, you might need to get help paying for insulin and other diabetes medications.
Thankfully, there are many avenues that diabetics could take to pay lower prices and even get help with co-pays.
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