Diabetes & Deductibles
It’s the new year, and suddenly your prescriptions are astronomically expensive!
What happened? Likely, it’s your deductible! Whether you have Medicare or a private/employer commercial insurance plan – almost everyone can experience the “sticker shock” of paying full price for their medications until their deductible is met.
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Below are my top 7 tips to help with affordability:
1) ASK ABOUT GENERIC OPTIONS
“Generic” medications are less expensive than “brand name” since the drug company patent has expired. The problem is there are not that many generic options to treat diabetes (examples are: Metformin, Glipizide/Glimepiride, Pioglitazone, and Alogliptin) and they generally don't work the same or have the same benefits as some of the newer diabetes therapies.
2) SPLITTING PILLS
Splitting pills can be especially financially helpful during the deductible period or if you are paying a percentage of your medication costs. Usually, the cash price of a given quantity of a lower dose is the same amount as that same quantity at a higher dose… so splitting the pills in half could make the medication last twice as long and cut your cost in half.
As an example, if you are taking 5 mg of Farxiga every day - you could consider getting a prescription for Farxiga 10 mg and taking only 1/2 tablet/day, which would be an identical dose of 5 mg/day but for less money.
However - dosing options can vary, so check with your doctor or pharmacist about whether this could be an option for you. If your doctor puts you on a lower dose of a medication, it is especially a good idea to be mindful of diet and exercise. Read some of my lifestyle recommendations here.
3) MANUFACTURER COPAY CARDS
This is a great option if you have a commercial plan (Medicare patients are NOT eligible). If you take any brand name medication or insulin, you can search online on the medication company’s website for “coupons”. Depending on the medication, you could get $100+ off your medication costs every month for a whole year. Some companies even offer upwards of $500 off every month.
4) MANUFACTURER FREE TRIAL CARDS
This is different than an ongoing copay card – anyone can use this, Medicare or non-Medicare alike! These cards allow you to use a one-time coupon to obtain a 14- or 30-day supply of a medication for free at the pharmacy. These usually are not available online, but many doctor’s offices have access to them if you ask.
5) ASSISTANCE PROGRAMS
If you truly can’t afford your medication, you may be eligible for various low-income assistance programs. If you have Medicare, the best option to start with is called “Medicare Low Income Subsidy” (visit https://secure.ssa.gov/i1020/start). Otherwise, consider contacting the drug company directly. Almost every manufacturer has their own assistance program and they can help you to apply over the phone and fax your doctor any necessary paperwork. These programs can help reduce deductible costs, monthly premiums, and copays.
6) UNDERSTAND YOUR FORMULARY
Show a copy of your formulary to your doctor or pharmacist to make sure you are on the lowest “tier” medication within its class (your healthcare provider will usually be more helpful than the insurance agent directly). You can obtain this list by calling your insurance company or they likely sent you a list at the beginning of each calendar year.
7) DOCTORS OFFICE SAMPLES
Sometimes doctor’s offices will be able to provide small quantities of medication samples or insulin to bridge a short-term gap. It never hurts to ask, but don’t rely on this as an ongoing option!
If you have diabetes, generally a high deductible plan isn’t ideal since most medications and supplies are very expensive when not covered under insurance. Consider working with your local pharmacist for help selecting a new plan next year that has a lower deductible.
Wishing you a Happy & Healthy New Year!
-Dr. Stephanie Redmond, PharmD, CDCES, BC-ADM