Carol Phillips is facing a serious problem, and a common one for many patients, as she grapples with the expense of treating diabetes.
Since her diagnosis, she has been able to control her blood sugar with the diabetes drug rosiglitazone/metformin and lifestyle changes. “I’ve been a different person as far as what I do and what I spend,” she said. She has been exercising daily and has lost 22.6 pounds.
She hopes to reduce the cost of treatment by stopping her diabetes medications altogether and controlling her blood sugar through diet and exercise alone. For patients diagnosed early in the course of the disease, this goal is potentially achievable.
Diabetes spending: strategies to save money
Even if medication must be continued, Carlo is reducing his spending on diabetes by taking a combination of medications. Many people with type 2 diabetes take more than one medication. “It’s not uncommon to take two or three medications at the same time,” said Paul Jellinger, MD, president of the American College of Endocrinology.
The drug Carlo was taking was a combination of metformin and rosiglitazone, which can work by reducing the amount of sugar produced by the liver or by increasing the body’s sensitivity to insulin. Combination drugs also include glipizide/metformin and glibenclamide/metformin. “There are more compounded drugs of this type,”, Paul described.
Generic drugs can also reduce the cost of treatment, with extremely significant results in individual cases. Generic drugs generally have lower retail prices. Generic drugs available in diabetes medications include:
- chlorosulfonylurea;
- Glipizide;
- Glibenclamide;
- Metformin.
However, drug spending isn’t the only item in diabetes treatment spending. Caro said the test strips she saw on eBay were more affordable, and she was willing to give them a try, “as long as they were sealed and not expired.”
Gavin did not explicitly encourage buying test strips on eBay, but he said people with diabetes should compare prices at multiple stores and try to haggle as much as possible, just like they do for other items.
Diabetes spending: insulin pumps
Many patients who use insulin like to try insulin pumps, but they are expensive.
Martin Abrahamson, MD, acting chief medical officer of the Joslin Diabetes Center at Harvard University, notes, “Insulin pumps are not suitable for all patients and are not easy to repair.”
“At Joslin, we have very strict criteria for choosing patients for whom an insulin pump is appropriate,” he said, “and to use an insulin pump, you have to be strict. You have to check your fingertip glucose at least four times a day, preferably about seven times. One must know how to count carbohydrates and fully understand the complexities of nutrition, and of course one must understand how the insulin pump works.”
For some patients, receiving assistance from a pharmaceutical company is not a bad idea. “Some programs are worth a try,” described Cubanski. “It’s great for patients who are taking drugs made by these companies and are not on other drugs.”
But the downside of such programs is that they only involve brand-name drugs, Cubanski said. Kubansky said, “If consumers move from taking a brand-name drug to a generic drug, they don’t necessarily have access to that information.”
Good control = good treatment
In a 2004 study published in the journal Diabetes Care, researchers at the University of Michigan found that 11% of patients with diabetes surveyed nationwide in the United States missed medications because of cost. In a related study published in the journal Medical Care, researchers found that patients with diabetes who missed medications had poor glycemic control.
Gavin said that if you can’t afford the medication, look for alternatives, but habitually skipping medications to reduce spending “can end up costing more.
Poor blood sugar control increases the risk of diabetes complications, and treating those complications can be many times more expensive than spending on medications.
More importantly, the poorer the glycemic control, the more medications you may end up needing to take. This is because, for poorly controlled type II diabetes, the longer it lasts, the more dramatically the body’s ability to produce insulin declines. Gavin said, “It’s easier to continue to maintain a manageable blood sugar in a controlled state than it is to control it again after poor blood sugar control.”