2019 year-end expenses hit CGee hard. Between the car insurance, property taxes and household maintenance issues hitting all at once, all money in the budget has been spoken for with only a few dollars left in the checking account. CGee wonders now how he will afford the copay for his once daily basal insulin. CGee decides to ration what insulin he has left and actually feels he has a plan.
The ushering in of 2020 may create dreadful challenges in
affording diabetes medications depending on your prescription drug coverage. A few questions to consider prior to the
start of the new year.
- Is your drug formulary (list of medications
covered by your insurance usually put into tiers) changing?
- Are your medication copays changing?
- Is the deductible for medications changing? If
uncertain, for employer-based health plans, contact your employee benefits
department or human resource department for answers to these questions. If you are participating in a government sponsored
health plan, contact the phone number provided most likely on the back of your
prescription drug card.
For those who have an employer-based health plan, inquire if
any employee wellness program or disease state-based program pairs you with a nurse
or health coach for additional support in managing your diabetes. The perk of these programs is often reduced
or $0 medication copays.
Bottom line – Be proactive regarding drug formulary changes
by doing your homework before going to the pharmacy to pick up your refill this
month.
Additionally, regarding generic medications, always ask whether the cash price is less than copay through insurance coverage. A really helpful tool for generic medications is to find the lowest cash price using GoodRx.
Additional helpful resources throughout the year:
- Discount programs (savings on generic and brand
medications)
- Please note: while these programs offer savings,
the cost of brand medications can still be pricy.
- If enrolled in commercial insurance plan (i.e. employer based), many pharmaceutical companies offer savings programs through co-pay cards.
- NeedyMeds is the best website to find all available savings programs for medications. They even have a page specifically devoted to diabetes.
- Insulin specific savings programs for cash
paying patients: may be less than insurance copay
- Sanofi Insulins Valyou Savings Program (Lantus,
Toujeo, Admelog, Apidra) – $99 monthly prescription program
- May receive up to 10 vials or 10 boxes of pens (or
any combination of the two). Fixed
- Novo Nordisk Cash Card Program
- $99 per month for 3 vials or 2 packs of
FlexPen/FlexTouch pens with any combination of NovoNordisk analog insulin
(Novolog, Tresiba, Fiasp)
- Summary of insulin cost savings programs (EXCELLENT
RESOURCE)
- New update from Novo Nordisk
- Free, one-time supply of insulin to people in
immediate need and at risk of rationing medication
The costs of all medications continue to be a challenge no
matter your walk of life. Rather than
simply not taking medication or not filling a prescription, let your
pharmacist, physician, nurse practitioner or physician assistant know that you
cannot afford your medication and work with them collaboratively to find
affordable medication options. Your
medical team is here to help, and they will be glad that you explained your
personal situation to allow them to assist you with other available
options.
Back to CGee, he debates internally whether to cancel his
appointment with his medical team. CGee
feels embarrassed there is no money to afford the medication and does not read
the “non-adherent to your medications” label attached to the medication
again. The last time he did this it was
painful enough. CGee decides to bite the
bullet and keep the medical appointment.
During the visit, CGee shares with his medical team that medication cost
is a real challenge for him. To his
delight, they empathize with CGee and identify ways to help him afford the cost
of medications.
Remember, your medical team wants to help you and not judge you. The medical team can’t help if you don’t share your challenges with cost of medications. Trust me, you will not be the only one asking!
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