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When Patients Cant Afford Diabetes: Helping People with Limited Resources Judy Hauswald, RN, BSN, CDE Diabetes Program Coordinator

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Page 1: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

When Patients Cant Afford Diabetes:

Helping People with Limited Resources Judy Hauswald, RN, BSN, CDE

Diabetes Program Coordinator

Page 2: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

Title

I have no conflicts of interest

Conflicts of Interest

Page 3: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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.

Page 4: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 5: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 6: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 7: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 8: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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?

Page 9: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 10: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 11: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title
Page 12: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

Prodigy Autocode

Starter Kit (no strips) =

$12

50 Strips = $10

EasyTouch lancet

device = $2

100 Lancets = $1.49

TOTAL = $25.49

Page 13: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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)

Page 14: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 15: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 16: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 17: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 18: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 19: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 20: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 21: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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”)

Page 22: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 23: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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)

http://www.azandmeapp.com/
http://www.azandmeapp.com/
http://www.lillycares.com/
http://www.janssenprescriptionassistance.com/
http://www.merckhelps.com/
http://www.lillycares.com/
http://www.gskforyou.com/
Page 24: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 25: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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)

Page 26: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 27: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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)

Page 28: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 29: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 30: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

http://www.insiderx.com/
mailto:[email protected]
Page 31: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

http://www.safenetrx.org/
Page 32: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 33: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 34: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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?

Page 35: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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)

Page 36: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 37: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 38: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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?

Page 39: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

http://www.casasiouxcounty.org/
Page 40: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 41: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 42: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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?

Page 43: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 44: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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?

Page 45: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 46: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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?

Page 47: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

Page 48: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title
Page 49: When Patients Cant Afford Diabetes - Floyd Valley 2: “preferred” brand name – lowest co-pay for newer meds Tier 3 & 4: non-preferred brand name – most expensive copays Title

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

[email protected]

mailto:[email protected]

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MEMBER 2020 PREFERRED DRUG LIST · 2020-03-16 · List of Abbreviations G Generic Drug. G-S Generic Specialty Drug. NPB Non-preferred Brand Drug. NPB-S Non-preferred Brand Specialty