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When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay...
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When Patients Cant Afford Diabetes:
Helping People with Limited Resources Judy Hauswald, RN, BSN, CDE
Diabetes Program Coordinator
Objectives
1. Identify one option for affordable blood glucose testing
supplies.
2. Explain how to use Patient Assistance Programs to obtain
free or lower cost diabetes medications.
3. Explain who is eligible and how to use pharmaceutical
discount/copay cards.
4. State the importance of identifying patient food insecurity
and where to find local food assistance.
Title
Healthcare Barriers
Poverty/Insurance statistics
Resources for:
Diabetes supplies
Diabetes medication
Diabetes Education (DSMT)
The role of Community Health Centers
Food insecurity and resources
Outline
Title
Financial : poverty, insufficient insurance
Low level of education
Low health literacy
Language other than English
Cultural differences re: health/wellness/disease
Lack of transportation
Healthcare Barriers
Poverty Statistics
✤ % Population in Poverty, Total, 2015
✤ Iowa: 12.43%
✤ O’Brien County: 11.88%
✤ Lyon County: 10.51%
✤ Osceola County: 10.17%
✤ Sioux County: 7.39%
✤ Plymouth County: 5.73%
Source: US Census data, 2015
Insurance Statistics
✤ 7% of people living in Iowa are uninsured.
✤ 8% of people in the US are uninsured.
✤ 9% of people in Sioux County are uninsured
(higher than Iowa and US stats)
✤ Source: University of Wisconsin Population Health Institute. County Health
Rankings 2017
Diabetes is an expensive disease to manage
Expensive meds
Expensive supplies
Expensive Diabetes Education
Expensive lab
Expensive doctor appointments
Patients who are uninsured and/or are living below the
poverty level often struggle to afford all these costs.
So, how can we help?
Blood glucose testing resources
✤ Meter companies don’t offer Patient Assistance
Programs
✤ Possible short-term solution:
✤ Use a free starter kit with 10 strips (One Touch,
Accuchek, Bayer Contour, Freestyle Lite, etc)
✤ Brand name strips are too expensive to buy
without insurance
WalMart Relion Prime
✤ No starter kit – have to buy
each piece separately
✤ Relion Prime meter, 25 strips,
lancet device & 100 lancets =
$22.00 TOTAL
✤ Strips come in
25 ct. = $5
50 ct. =$9
100 ct. = $18
Prodigy Autocode
Starter Kit (no strips) =
$12
50 Strips = $10
EasyTouch lancet
device = $2
100 Lancets = $1.49
TOTAL = $25.49
Insurance coverage for supplies
✤ In 2017:
✤ BCBS Iowa – One Touch brand
✤ Iowa Medicaid – Freestyle brand, Unilet lancets,
Glucagen HypoKit, BD syringes and pen needles
✤ Medicare – no preferred brand, covered 100%
(with Part B and Medicare supplement)
Create a special “diabetes fund”
✤ Contact local service organizations for an annual
donation (Lions Club, Kiwanis Club, Rotary Club,
Community Chest in Storm Lake, etc.)
✤ Use for:
✤ partial payment of supplies, meds
✤ not meant to be long-term solution
✤ Avoid using for DSMT – refer to Hospital Financial
Assistance program instead
Title
Online program started by person with T1 diabetes
Provides One Drop meter and 50-300 strips/month
Personalized coaching with CDEs
Cost: $15 - $40/month, including supplies and DSMT
Must upload meter to website (to prevent stockpiling)
One Drop online program
Title
App and coaching available in Spanish
Good for:
uninsured patients
Medicare patients frustrated by strip limits
patients not attending DSMT
www.onedrop.today
One Drop online program
Title
App and coaching available in Spanish
Good for:
uninsured patients
Medicare patients frustrated by strip limits
patients not attending DSMT
www.onedrop.today
One Drop online program
Medicare test strip limits
✤ Diet-controlled & oral diabetes meds:
✤ 100 strips and lancets every 3 months
✤ 1 lancet device every 6 months
✤ Insulin:
✤ 100 strips and lancets every month
✤ 1 lancet device every 6 months
✤ Can get >100 strips/month, but patient must
provide pharmacy with BG records showing
increased use
Contacting insurance re: meds/strip coverage
✤ Call or use online options
✤ Need to determine what meds/strips are “preferred”
or “on formulary”
✤ Tier 1: generic meds – least expensive
✤ Tier 2: “preferred” brand name – lowest co-pay for
newer meds
✤ Tier 3 & 4: non-preferred brand name – most
expensive copays
Title
free app
can search insurance
coverage for specific
meds
Search by:
general location
(use Sioux City IA or
Sioux Falls SD)
type of insurance
Formulary App
Patient Assistance Programs (PAP) ✤ All pharmaceutical companies offer these
✤ Free meds for one year
✤ Meds usually mailed to provider
✤ Income-based
✤ Used for:
✤ Low income patients with or without insurance
✤ Medicare Part D patients in the Gap (“donut-
hole”)
Patient Assistance Programs (PAP) ✤ Medicaid and VA patients are not eligible
✤ Most require US Citizen or Legal Permanent
Resident status
✤ Merck PAP only requires US Resident
✤ Patients without SSN may apply
✤ Covers Januvia, Janumet and other Merck meds
Patient Assistance Programs (PAP))
✤ Oral Meds
✤ www.azandmeapp.com
(Onglyza, Farxiga, Bydureon)
✤ www.lillycares.com
(Tradjenta, Jardiance)
✤ www.janssenprescriptionassistance.com
(Invokana)
✤ www.merckhelps.com
(Januvia)
✤ Takeda PAP – Helping At Hand
(Nesina, Oseni, Kazano)
✤ Insulins/GLP1 injectables
✤ www.lillycares.com
(Humalog products, Basaglar,
Trulicity, Glucagon)
✤ Sanofi Patient Connection
(Lantus, Apidra, Toujeo, Soliqua)
✤ Novonordisk PAP
(Novolog products, Tresiba, Victoza,
Glucagen HypoKit)
✤ www.gskforyou.com
(Tanzeum)
Discount and Co-pay Cards
✤ Usually for newer drugs
✤ Get cards from drug reps
✤ Can’t use for Medicare and Medicaid patients
✤ Commercial insurance - often $0 - $25 co-pay for 1-2
years
✤ Some allow a cash discount for self-pay/uninsured
Free Sample Cards
✤ Eli Lilly Free Sample Voucher
✤ One free vial, cartridge or 5 pack insulin pens
✤ Limit: one/patient
✤ Trulicity Free One Month Supply Offer (then $25
copay)
✤ Toujeo Solostar Free One Month Supply Offer (then
$10 copay)
Zero Co-pay cards
✤ Can only be used with commercial insurance
✤ Farxiga, Xigduo XR
✤ Apidra vials or pens (must be on formulary)
✤ Soliqua – basal insulin and GLP1
✤ Invokana
✤ Jardiance/Glyxambi
Low cost generic diabetes pills
✤ $4 for 30 days or $10 for 90 days (WalMart,
HyVee, etc)
✤ Metformin and Metformin ER 500mg (not 1000mg)
✤ Glyburide, Glipizide, Glimepiride (micronized
Glyburide)
✤ Pioglitizone is generic, but still very expensive
(15mg = $105 for 30 days)
Least expensive insulins
✤ WalMart Relion Novolin R, Novolin N, Novolin 70/30
✤ $24/vial (no pens)
✤ Insulin regimens
✤ 70/30 30 min before breakfast and supper
✤ N&R 30 min before breakfast and supper
✤ N&R 30 min before breakfast, R 30 min before supper, N @ HS
✤ Limitations: scheduled meals/snacks, consistent
carb intake, higher risk of hypoglycemia, hard to
get to target A1C
Insulin supplies comparison
WalMart Relion brand
✤ Insulin Syringes - 100 ct.
$12.58
31g, 3/10 ml, 8mm
✤ Pen needles – 100 ct.
(2 boxes of 50 ct)
$18.00
31g x 8mm
BD brand
✤ Insulin Syringes – 100 ct.
$30.16
31g, 3/10 ml, 8mm
✤ Pen needles – 90 ct.
$62.94
31g x 8mm
Title
Inside Rx card
www.insiderx.com
Easy to use to determine
eligibility
Needy Meds card
Specifically for Iowans
For uninsured AND those w/
insurance, but unable to
afford meds, copay
To get cards in bulk:
Email: [email protected]
1-866-282-5817
Prescription Savings Cards
Title
provides free and low cost meds/diabetes supplies to
Iowans in need
Used by Community Health Centers, some non-profit
hospitals/clinics (i.e. Spencer Hospital)
Donated meds & diabetes supplies:
come from LTC, jails, medical facilities, individuals
are reviewed by a pharmacist before distribution
www.safenetrx.org
Iowa Drug Donation Repository Program
Title
Federally Qualified
Health Centers
Receive federal
funding to provide care
to the medically
underserved
Community Health Centers (CHCs)
Provide affordable,
comprehensive and quality
health care:
medical
dental
vision
mental health
prenatal care
Title
Anyone can receive healthcare at a CHC
NOT just for low income, uninsured, immigrants &
refugees
Accepts commercial insurance, Medicare, Medicaid
They are NOT free clinics
Sliding fee scale according to income, family size
Affordable option if uninsured, low income, high
deductible insurance
Facts about CHCs
Title
Sioux Center IA -
Promise CHC
Sioux City, IA -
Siouxland CHC
Storm Lake, IA -
United CHC
Sioux Falls, SD -
Falls Community Health
Where are the nearest CHC’s?
Title
Many reasons patients can’t afford DSMT
No insurance
High insurance deductible
Haven’t met insurance deductible yet
Cost for self pay patients is very expensive
Diabetes Self Management Training (DSMT)
Title
Options for financial help:
Hospital Financial Assistance Program
Set up a monthly payment plan with hospital
Health Coaches/Care Coordinators
Find a Community Health Center Diabetes Program
Consider One Drop online program
DSMT
How can a Health Coach help?
✤ Services are free
✤ Usually an RN
✤ Help with health plan and
goals
✤ Weight loss
✤ Eating healthier
✤ Getting more active
✤ Lowering blood sugars,
lipids, BP
✤ Managing stress
Title
Hunger and food insecurity are not “visible” problems
May cause shame and embarrassment
ASK: “Is buying groceries ever difficult for you and
your family?”
“Food Deserts” can exist in small, rural towns
May not have a grocery store
May only have local convenience store
Transportation to other towns may be an issue
What About Food Insecurity?
Title
Free Community Meals
Free Food Pantries
NW Iowa list: www.casasiouxcounty.org – under
Resources
Free “Sack Pack/Back Pack” weekend food
supplement program for kids
Sioux Center, Orange City, Hull, Hawarden & others
Local Solutions for Food Insecurity
Title
✤ Sioux Center
✤ “2nd Thursday, 6 – 7pm
✤ New Life Reformed Church,
232 16th St SE
✤ Orange City
✤ The Shepard's Table, locations vary
✤ 4th Thursday, 6:30-7:30pm
✤ Trinity Reformed Church,
201 St Paul Ave.
✤ 1st & 3rd Wed. 5:45-6:30pm
✤ Rock Valley
✤ 1st Monday, 5:30-7pm
✤ Locations vary
✤ Sheldon
✤ 3rd Monday, 6-7pm
✤ Living Water Community Church
610 2nd Ave.
✤ Hawarden
✤ Community Center
✤ Meridan
✤ .1st Tues, 5-7:30pm
✤ Meridan E-Free Church
Local Free Community Meals
Meet one of our patients
✤ New Type 2 diabetes, high BP, high lipids, obese
✤ Has insurance with $5000 deductible
✤ Hasn’t met any of deductible this year
✤ Started Metformin
✤ Referred for initial DSMT, but only came to one class
due to cost
Possible strategies
✤ Apply for hospital Financial Assistance
✤ Set up an affordable payment plan
✤ Refer to free Health Coach program
✤ Refer to One Drop online for meter, strips, DSMT
✤ Other suggestions?
Meet patient #2
✤ Type 2 diabetes for 15 years, A1C 8%, foot ulcer
✤ Working full-time, but uninsured
✤ Not a US Citizen or Legal Permanent Resident
✤ Not testing BG…cant afford meter, supplies
✤ On max doses of Metformin ER & Glipizide
✤ No previous DSMT
Possible strategies
✤ Apply to Merck PAP for free Januvia or Janumet
✤ Use Relion Prime or other low cost meter and strips
✤ Refer to local CHC DSMT program (Siouxland CHC)
✤ Partner with local CHC to provide DSMT together
✤ CHC Health Coach teaches BG testing, sees
monthly for FU, accountability – no charge
✤ SCH teaches “need to know” modified DSMT
✤ Other ideas?
Patient #3
✤ Type 2 for 20 years, overweight, high A1C
✤ Medicare with basic Part D plan (generic drugs only)
✤ Max doses of Metformin ER, Glimepiride, Januvia
(through Merck PAP)
✤ Provider wants to start insulin
Possible strategies
✤ Consider low dose pioglitizone
✤ Use low cost insulin, such as Relion 70/30, N, R
✤ Advise patient to consider new Part D plan at next
open enrollment that would cover brand name
diabetes meds/insulins
✤ Other ideas?
Summary
✤ Patients who are uninsured, low income, or have
high deductibles face many challenges
✤ Learn about and use resources for free or discounted
supplies, meds, food
✤ Collaborate with others – health coaches,
pharmacists, CHC’s, other educators, drug reps
Thank you!
Judy Hauswald, RN, BSN, CDE
Sioux Center Health
1101 9th St SE, Sioux Center IA 51250
P: 712-722-8114
F: 712-722-8315