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

Transcription

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

2 Title Conflicts of Interest I have no conflicts of interest

3 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.

4 Title Outline Healthcare Barriers Poverty/Insurance statistics Resources for: Diabetes supplies Diabetes medication Diabetes Education (DSMT) The role of Community Health Centers Food insecurity and resources

5 Title Healthcare Barriers Financial : poverty, insufficient insurance Low level of education Low health literacy Language other than English Cultural differences re: health/wellness/disease Lack of transportation

6 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

7 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

8 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?

9 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

10 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

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12 Prodigy Autocode Starter Kit (no strips) = $12 50 Strips = $10 EasyTouch lancet device = $2 100 Lancets = $1.49 TOTAL = $25.49

13 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)

14 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

15 Title One Drop online program Online program started by person with T1 diabetes Provides One Drop meter and strips/month Personalized coaching with CDEs Cost: $15 - $40/month, including supplies and DSMT Must upload meter to website (to prevent stockpiling)

16 Title One Drop online program App and coaching available in Spanish Good for: uninsured patients Medicare patients frustrated by strip limits patients not attending DSMT

17 Title One Drop online program App and coaching available in Spanish Good for: uninsured patients Medicare patients frustrated by strip limits patients not attending DSMT

18 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

19 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

20 Title Formulary App free app can search insurance coverage for specific meds Search by: general location (use Sioux City IA or Sioux Falls SD) type of insurance

21 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 ( donuthole )

22 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

23 Patient Assistance Programs (PAP)) Oral Meds Insulins/GLP1 injectables (Onglyza, Farxiga, Bydureon) (Humalog products, Basaglar, Trulicity, Glucagon) (Tradjenta, Jardiance) Sanofi Patient Connection (Lantus, Apidra, Toujeo, Soliqua) (Invokana) Novonordisk PAP (Novolog products, Tresiba, Victoza, (Januvia) Glucagen HypoKit) Takeda PAP Helping At Hand (Nesina, Oseni, Kazano) (Tanzeum)

24 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

25 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)

26 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

27 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)

28 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, HS Limitations: scheduled meals/snacks, consistent carb intake, higher risk of hypoglycemia, hard to get to target A1C

29 Insulin supplies comparison WalMart Relion brand BD brand Insulin Syringes ct. Insulin Syringes 100 ct. $12.58 $ g, 3/10 ml, 8mm 31g, 3/10 ml, 8mm Pen needles 100 ct. Pen needles 90 ct. (2 boxes of 50 ct) $62.94 $ g x 8mm 31g x 8mm

30 Title Prescription Savings Cards Inside Rx card 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:

31 Title Iowa Drug Donation Repository Program 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

32 Title Community Health Centers (CHCs) Federally Qualified Health Centers Receive federal funding to provide care to the medically underserved Provide affordable, comprehensive and quality health care: medical dental vision mental health prenatal care

33 Title Facts about CHCs 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

34 Title Where are the nearest CHC s? Sioux Center IA - Promise CHC Sioux City, IA - Siouxland CHC Storm Lake, IA - United CHC Sioux Falls, SD - Falls Community Health

35 Title Diabetes Self Management Training (DSMT) 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

36 Title DSMT 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

37 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

38 Title What About Food Insecurity? 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

39 Title Local Solutions for Food Insecurity Free Community Meals Free Food Pantries NW Iowa list: under Resources Free Sack Pack/Back Pack weekend food supplement program for kids Sioux Center, Orange City, Hull, Hawarden & others

40 Title Local Free Community Meals Sioux Center 2 nd Thursday, 6 7pm New Life Reformed Church, th St SE Orange City The Shepard's Table, locations vary 4 th Thursday, 6:30-7:30pm Trinity Reformed Church, 201 St Paul Ave. 1 st & 3rd Wed. 5:45-6:30pm Rock Valley 1 st Monday, 5:30-7pm Locations vary Sheldon 3 rd Monday, 6-7pm Living Water Community Church nd Ave. Hawarden Community Center Meridan.1 st Tues, 5-7:30pm Meridan E-Free Church

41 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

42 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?

43 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

44 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?

45 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

46 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?

47 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

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49 Thank you! Judy Hauswald, RN, BSN, CDE Sioux Center Health th St SE, Sioux Center IA P: F: Judy.hauswald@siouxcenterhealth.org