According to the Centers for Disease Control and Prevention, diabetes is the most expensive chronic condition in the US. Most of these costs are associated with complications related to diabetes, which can be reduced when diabetes is managed and medications are administered. However, with inflation and rising costs, diabetes and financial planning can be complicated. To help, we've put together the following tips on maximizing savings without sacrificing effective diabetes management.
The Financial Impact of Living With Diabetes
The American Diabetes Association (ADA) publishes the Economic Costs of Diabetes every five years, providing a comprehensive analysis of the financial burden of living with diabetes in the United States. The most recent report (2022) found that the total annual cost of diabetes in 2022 was $412.9 billion, including $306.6 billion in direct medical costs and $106.3 billion in indirect costs.
Direct medical costs included diabetes medication and management, as well as long-term complications such as kidney disease, heart disease, retinopathy, and other diabetes-related complications. Indirect costs included reduced work productivity, unemployment, and absenteeism.
According to public health data, the medical costs for people living with diabetes have increased 35% over the past 10 years. With unparalleled increases in yearly salaries, this has become increasingly devastating for people with diabetes and their families. Some other alarming statistics that were brought to light by the Economic Costs of Diabetes 2022 report include:
- After adjusting for inflation, the direct medical cost of diabetes increased by 7% between 2017 and 2022.
- The inflation-adjusted cost of insulin increased 24% from 2017 to 2022.
- Spending on insulin tripled in the past 10 years—increasing from $8 billion in 2012 to $22.3 billion in 2022.
- Black Americans with diabetes pay the most in direct health care expenditures.
- On average, people with diagnosed diabetes have medical expenditures 2.6 times higher than would be expected without diabetes.
You can read the full report, "Economic Costs of Diabetes in the U.S. in 2022" from ADA here.
7 Tips for Financial Planning and Diabetes Management
Unfortunately, managing diabetes is not a choice; it's a part of life. If diabetes is left untreated, it can lead to serious health outcomes, other chronic diseases, and even death. Therefore, although the overall financial burden of diabetes management continues to grow in the U.S., you can do a few things to help with financial planning and out-of-pocket costs.
1. Ask Your Doctor About Generic Options for Medications
Many people are unaware that generic medications can be just as effective as brand-name drugs but at a fraction of the cost. Generic brands must meet the same rigorous FDA standards as brand-name medications, including quality, safety, and effectiveness. Therefore, common diabetes medications like Metformin have widely available generic versions. Insulin is also starting to have more biosimilar (generic-like) alternatives, but it's important that you discuss this with your doctor ahead of time and ensure that your insurance provider will cover the changes.
If applicable, asking your doctor to switch you to a generic or biosimilar version of your diabetes medication can significantly reduce your prescription costs. You'll still want to regularly review your treatment plan with your healthcare provider to ensure you get the best care value, but lowering any out-of-pocket pharmacy costs can be a game changer for financial planning associated with diabetes.
2. Research Pharmaceutical Co-Pay Savings Programs
Many pharmaceutical companies recognize the financial burden of diabetes and may provide co-pay savings programs to help ease their patients' costs. These programs are helpful for people with private health insurance, as they can drastically reduce co-pays on essential medications like insulin, GLP-1 receptor agonists (such as Ozempic or Trulicity), and even blood glucose monitoring supplies.
Many pharmaceutical companies offer these savings cards online, and patients can often present them at their pharmacy when filling a prescription. Researching and enrolling in these programs annually is a good idea, as terms and availability can change. Depending on your income, you may also qualify for programs that offer significant discounts, even if you have insurance.
3. Look Into Patient Assistance Programs
Patient assistance programs (PAPs) can be a financial lifeline for those who don't qualify for co-pay savings programs, lack insurance, or are underinsured. These programs, typically run by pharmaceutical companies or nonprofit organizations, help provide free or low-cost medications to individuals in financial need.
Qualifying for a PAP usually requires meeting income eligibility criteria and providing proof of financial hardship, such as recent tax returns or pay stubs. Some programs also cater to uninsured patients or those ineligible for government assistance programs like Medicaid. PAPs can provide individuals with significant financial relief from the high costs of medications, which helps people in low-income situations access insulin or other diabetes drugs necessary to stay healthy.
4. Contact Insulin Manufacturers
Insulin has become one of the most controversial diabetes-related expenses due to its rapidly rising costs. Insulin manufacturers like Lilly and Novo Nordisk have developed various programs to help reduce patient costs. These include savings programs, rebates, and even emergency access programs that offer free or reduced-price insulin in times of crisis.
For example, Lilly’s Insulin Value Program allows eligible patients to pay a flat monthly fee ($35) for insulin regardless of the amount they need. Contacting insulin manufacturers directly can also help you access limited-time promotional programs or trial offers, which can reduce your overall insulin expenses. Additionally, manufacturers often work with pharmacies and clinics to distribute discounted insulin to underinsured or uninsured patients.
5. Review Your Options Regarding Diabetes and Health Insurance
Health insurance is one of the most important financial tools for managing diabetes, but not all plans are created equal. If you're spending too much on medications, devices, or doctor visits, it may be time to re-evaluate your insurance options. Some health plans offer better coverage for diabetes-related expenses, such as lower co-pays on medications, access to endocrinologists, or coverage for continuous glucose monitors (CGMs) and insulin pumps.
So, if possible, during your insurance’s open enrollment period, consider switching to a plan that has more comprehensive diabetes coverage. It's also essential to check if your plan covers newer medications, like GLP-1 drugs, and if it offers any wellness programs that can help you manage your diabetes more effectively at a lower cost. If you're uninsured, consider options like Medicaid or the Marketplace to find a plan that works for you.
6. Get Involved with the American Diabetes Association (ADA)
The American Diabetes Association is a valuable resource for individuals living with diabetes. By getting involved, you can stay updated on new programs that can help reduce costs, such as government initiatives to cap insulin prices or expand access to affordable care. You can also take a proactive stance on advocacy to help drive change in your community.
The ADA also provides information on free educational resources, legal assistance for diabetes-related discrimination, and opportunities to participate in clinical trials that could give you access to cutting-edge diabetes treatments at reduced or no cost.
7. Make Lifestyle Adaptations to Help Reduce Reliance on Medications
Individuals with type 2 diabetes can also help improve diabetes management through diet and exercise. While it does still cost money to buy healthy food, doing so may help you achieve more stable blood sugar levels over time. Ongoing care and weight loss may even help some individuals reverse diabetes or reach a state of "diabetes remission," where they no longer need to take insulin or diabetes medicine. However, this degree of diabetes care takes time and may not work for everyone. There's still a lot of research that's required to understand how to "reverse" a diabetes diagnosis.
The introduction of GLP-1 drugs may also help adults with diabetes reduce their need for frequent medication, but not everyone has access to them. Certain insurance providers may not provide coverage for care costs associated with GLP-1 drugs, so even if your doctor prescribes them the out-of-pocket costs are usually too high for long-term use. Luckily, thanks to advancing research, more health plans are offering coverage for these drugs for people with type 2 diabetes.
To help you simplify diabetes management and reduce the risk of complications, consider using diabetes management products from Byram Healthcare. We also provide diabetes support and educational resources for comprehensive care. Contact us today to learn more.
