Top Eight Tips for Managing Diabetes on an Affordable Budget

By Connor Keane and Alexander Wolf

Twitter summary: Expert Dr. Irl Hirsch shares eight tips to optimizing #diabetes management on a budget

Short summary: At Keystone 2014, we heard from diabetes expert (and fellow type 1!) Dr. Irl Hirsch on optimizing diabetes management on a budget. To cut costs, he suggested that patients consider buying generic brands; buying from bulk suppliers for discount deals; looking for different prices at local pharmacies; using companies’ financial assistance programs; reconsidering the type of insulin; and sensibly re-using supplies. He also shared several areas where cutting costs could be dangerous: prolonging infusion set life to more than three days, using “off-shore” blood glucose meters that may have issues with accuracy, reducing the frequency of blood glucose monitoring and fingersticks, and using NPH insulin without frequent testing.

For many, diabetes care is a delicate balance between increasingly high costs of care and intensive management. This balance has become harder to handle as costs of insulin and other essential supplies have drastically increased in the past decade. According to Dr. Hirsch, the cost of type 1 diabetes management – covering insulin, syringes, and strips – has risen to $7,910/year for people without insurance. Even for those with insurance, high co-pay costs are unaffordable for many. Although the number of uninsured Americans has dropped from 18% to 13% over the past year, many people are still left without the financial means to fully care for their diabetes. At this year’s excellent Keystone conference, Dr. Irl Hirsch (University of Washington, Seattle) shared his views on the best ways to manage type 1 diabetes in the least expensive way possible. We’ve listed his eight tips below.

1. Generic brands provide a cheaper alternative. Though “generic” insulin analogs are not yet available, many pills for type 2 diabetes are available as generic brands. For example, a bottle of 60 tablets of 500 mg branded Glucophage tablets costs about $80, while the same amount of generic metformin (same active ingredient) costs as little as $10

2. Bulk suppliers can offer great discount deals. Essential supplies, including test strips, lancets, and syringes, can be bought in bulk for relatively low prices from suppliers such as ebay.com or Amazon.com. For example, a year’s supply of Freestyle Lite strips from the store costs around $2,190 (cash price) when using four strips/day; buying from bulk suppliers can cut this cost to less than $1,000 per year. Insulin and other medications can also be bought in bulk for modest savings from online suppliers like ebay, Amazon, ADW Diabetes, Health Warehouse, or USMED, although it’s important to be particularly careful about counterfeit products, making sure medications are within the expiration dates, and other issues with buying from third-party suppliers. 

3. Different vendors sell the same medications at lower prices.  Websites like goodrx.com provide a convenient way to find the cheapest pharmacy in your area. Prices vary substantially across pharmacies, so it is worth checking up on different pharmacies in your area. In general, stores like Walmart and Costco have the least expensive pharmacies. Reputable online pharmacies can also provide a cost effective way to get the medications you need. Insulin analogs like Lantus, typically costing in the range of $400 per bottle, can be found for as little as $150 per bottle online (these should always be shipped refrigerated!).

4. Many pharmaceutical companies provide financial assistance programs. Nearly all of the major suppliers of diabetes medications and supplies, which include Novo Nordisk, Eli Lilly, and Sanofi, among others, offer assistance programs to help those with and without insurance gain access to essential medications. Check the websites of the producers of your diabetes supplies or ask your healthcare provider to find information on applying to these programs.

5. Different insulin types have varying cost/benefit ratios. There are now many different types of insulin available for both type 1 and type 2 diabetes. Human insulins, such as Humulin or Novolin, can drastically lower the cost of diabetes treatment compared to analog insulins. Despite the sarcastic moniker assigned to NPH by some frustrated people with diabetes – “Not Particularly Helpful” – Dr. Hirsch explained that NPH is a possible alternative for those on a tight budget who are not as concerned about hypoglycemia. He also pointed out that analog insulins reduce hypoglycemia in type 1 diabetes by about 25%, but with the added cost of around $4,920 per year vs. using human insulin. If you have insurance, this may well be worth the cost, although we understand it can be a difficult expense for those without coverage.

6. Some supplies can be reused. This is one tip to be extra careful with, but reusing or extending supplies can help stretch their lifetime of use as far as they are needed. For example, some people choose to wear their CGM sensors past the recommended date of seven days and see no drop in accuracy or reliability. Lancets are another item that patients typically reuse (instead of using a new lancet for each fingerstick). This is of course dependent on your individual situation and comfort level.

7. There are “bad places” to try to save money that can be dangerous to your health. Dr. Hirsch highlighted several “bad places” to try to cut back on spending: prolonging infusion set life to more than three days, using “off-shore” blood glucose meters that may have issues with accuracy, reducing the frequency of blood glucose monitoring and fingersticks, or using NPH insulin without frequent testing to prevent hypoglycemia.

8. Diligently monitoring and managing blood glucose can help prevent the major costs of hypoglycemia. Well-managed blood glucose may prevent a whole host of potentially expensive complications. Severe hypoglycemic events are also costly, with an average cost of $17,564 for an inpatient admission and $1,387 for an emergency department visit. As with anything, prevention is the surest way to avoid dangerous or costly situations. Multiple management strategies exist, so please discuss what strategy works best for your management and your budget with your health care provider. Also, check out our Patient Guide to Individualizing Therapy for advice on how to discuss your diabetes plan with your health care provider, and read last issue’s Adam’s Corner on four game-changing strategies for improving blood glucose levels, which are almost all doable on a tight budget.