Original post HERE
WRITTEN BY: Julia Flaherty
Editor’s note: If you or a loved one are struggling to afford insulin, learn more about the options that exist here .
With rising unemployment rates due to the COVID-19 global pandemic, many Americans are concerned, especially those with chronic health conditions like type 1 diabetes. While the last thing we want to worry about now in the type 1 diabetes community is unemployment and no healthcare coverage, it’s important to know how to handle the situation if it becomes a reality for you.
The first question many people in the type 1 diabetes community will ask is: “How will I pay for my meds if I don’t have insurance?”
Many people in the type 1 diabetes community already struggle to answer this question outside of this global crisis and with their existing insurance, so the idea of it becoming completely unavailable may feel jarring. However, there is power in knowledge. Information and awareness will help empower you in the event you become unemployed.
There are workarounds that can help you sustain your insulin and testing supplies should this happen. Here’s what you should know:
Insurance resources
COBRA
COBRA (the Consolidated Omnibus Budget Reconciliation Act) is a health insurance program that allows an eligible employee and their dependents to continue to have access to health benefits in the event that they lose their job or experience reduced hours.
If you are unexpectedly laid off or lose your benefits due to the COVID-19 pandemic, your employer may offer you this if they meet certain criteria; businesses with 20 or more full-time employees are usually mandated to offer COBRA coverage.
In order to qualify for COBRA, as an employee you must have been enrolled in your company’s sponsored group health insurance plan on the day before the qualifying event occurred. The qualifying event must result in a loss of the employee’s health insurance. This means the employee has suffered:
- Voluntary or involuntary job loss (except in the case of gross misconduct)
- A decrease in the number of hours the employee works that result in a loss of employer health insurance coverage
From the date of the qualifying event, COBRA coverage extends for a limited period of 18-36 months. However, the employee may qualify to extend this period if qualified beneficiaries in their family are disabled and meet certain requirements.
In the event you become unemployed, COBRA may be an option but may not be the best option price-wise. With COBRA, individuals are usually required to pay the entire health insurance premium, including whatever part of the premium was previously being covered by the employer, and at times responsible for a 2% additional administrative charge.
Medicaid
Medicaid is a government issued health insurance program for low-income and disabled people. The American Diabetes Association reports that 3.5 million people with diabetes use Medicaid for some or all of their medical care. Medicaid is not the same as Medicare.
DiabetesSisters.org explains the differences best:
“Medicare for older individuals is not dependent on the individual being poor. Medicaid, however, has restrictions on the amount of assets any individual may have and/or the amount of income an individual can receive to be able to receive Medicaid assistance.”
These specifications are determined on a state level. Required benefits of every state in the U.S. include:
- Inpatient and outpatient hospital services
- Doctor office visits
- Laboratory and X-ray services
- Long-term care services
- Community-based care
According to DiabetesEducator.org, patients enrolled in Medicaid should consider options like this with their endocrinologist (or other doctor helping them manage their type 1 diabetes):
- Insurance plan formulary alternatives
- Prior authorization processes
To understand exactly what is covered by your state and to see if it’s right for you, visit Healthcare.gov or call 1-800-318-2596. If you are unemployed, you and your loved ones may qualify for low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP) .
Healthcare Exchange
Anyone who has experienced a qualifying life event, such as losing their job or health insurance coverage, is eligible to attain health insurance through the healthcare exchange. This is the same program through which you can see if you qualify for Medicaid or CHIP. Visit Healthcare.gov or call 1-800-318-2596.
Editor’s note: When picking a plan, utilize this Health Insurance Guide to help you navigate premiums, deductibles, and other important elements to consider when choosing the best plan for Type 1 diabetes coverage.
Additional cost-saving options
Samples from your Doctor
Being underinsured or left with no insurance often means that we cannot see our doctors in-person due to the high costs of in-office visits. However, this doesn’t mean we can’t communicate with them. Reach out to them in times of crisis. You still should have access to your doctor’s healthcare messaging portal or can call them over the phone. Speak to their nursing staff or with them directly.
Often, endocrinologists get samples from insulin and diabetic supply manufacturers. While it’s not a long-term solution, if your endocrinologist is able to get you samples of different insulins in the interim, this is a good short-term solution. It never hurts to ask and have an open dialogue about your situation with your provider.
They are here to help you, and endocrinologists should be fairly available since they are specialists, despite the overwhelm our front-line healthcare workers are currently suffering.
Biosimilar (generic) insulins
The biosimilar insulin market is changing rapidly as the FDA adopts new regulatory pathways to more efficiently approve interchangeable insulins that may be available for a lower price. Ask your healthcare provider for the most up-to-date options for you. A few options available are:
- A generic version of Humalog — Insulin Lispro — is available at pharmacies in the U.S. for $137.35 per vial and $265.20 for a package of five KwikPens (50% the price of Humalog.) If you have a prescription for Humalog, you do not need an additional prescription for Lispro; your pharmacist will be able to substitute the cheaper option. Insulin Lispro is not currently covered by insurance.
- Authorized generic versions of NovoLog and NovoLog Mix at 50% list price are stocked at the wholesaler level. People can order them at the pharmacy and they’ll be available for pick up in 1-3 business days.
Blood sugar testing supplies options
Being aware of our blood sugar levels at all times is an important element of our care. While becoming unemployed and underinsured or left with no insurance can mean we may be left without our (necessary) continuous glucose monitor (CGM) supplies, we still have options. Test strips are not the best form of blood sugar management, but they are better than nothing.
Companies like One Drop, Diathrive, and Livongo offer customers diabetic testing supplies for a flat monthly fee. The services come with a glucose meter, lancing device, and carrying case with your first order, plus a monthly supply of test strips.
Manufacturer Programs
The $25 Walmart-brand insulin we often see in diabetic memes across the internet should be used as an emergency, last case resort option; still, be aware that it is an option, worse comes to worse. Insulin manufacturers also offer care and assistance programs for those who qualify:
- Lilly Cares Program
- Novo Nordisk Patient Assistance Program (PAP)
- Sanofi Patient Connection Program
- Mannkind (Afrezza) Direct Purchase Program
In addition to these manufacturer programs, there are also coupon programs for eligible individuals that can help reduce costs:
Explore all of your options with or without insurance in this guide from ADCES that was published on January 1, 2020. This guide is a thorough resource for endocrinologists and diabetics alike. As a person with type 1 diabetes, it’s best to have a transparent view of your health and resources to ensure it’s optimal.
To further support low-cost medications in your state, you may also consider supporting the petitions for insulin affordability with Change.org or start one of your own. Almost 1 million people have signed their names already to help the Type 1 diabetes community. Click here to sign petitions for low insulin costs across the United States.
Hang in there – we are here to provide the resources, care, and support you need to thrive throughout the year and especially during crises like this.
