Seniors with Diabetes
Diabetes affects seniors disproportionately to the general population. Nearly 26% of Americans 65 and older are diagnosed with this condition; this is three times the rate of the general population. The problem is further concentrated among low income seniors. In 2017, approximately 11 million American seniors are dealing with the challenges of managing their diabetes.
Costs of Diabetes
As if managing diabetes alone was not enough of a challenge, the financial constraints make it even more of a problem for many seniors. A study from the American Diabetes Association (ADA) found the average annual health care costs of persons with diabetes was twice that of those of a similar age without the condition. Annual health care spending was almost $12,000. One in five seniors reports reducing their use of diabetes medication and supplies due to financial constraints. What’s more is the cost of diabetes is not limited to medication and supplies; it also costs more to eat healthy and properly manage one’s diet.
Fortunately, financial assistance for diabetes medication and supplies is available. When seeking financial assistance, it is helpful to think of two major categories of assistance. First is understanding the benefits of one’s insurance coverage to make certain one receives all of which they are entitled. The second category is outside financial assistance. This is a diverse grouping, which can come in the form of cash, free supplies, reduced medication costs, and even assistance to pay insurance co-payments or monthly premiums. The sources of outside financial assistance are equally as diverse as the types of assistance. These include pharmaceutical companies, state governments, non-profit organizations, and clinical studies, to name just a few.
Understanding and Maximizing Insurance Benefits
Most seniors have Medicare and Medicare has multiple parts. Combining these parts can cover much of a senior diabetic’s medication and supply needs. The Medicare.gov website does a superb job of breaking down the program’s coverage. Rather than reproduce their efforts here, we recommend readers simply view their Medicare diabetes chart here.
Medicaid is health insurance for very low income individuals. Typically an individual must have an annual income of less than $26,000 and assets valued at less than $10,000 (excluding their home) to be eligible. Recently the Affordable Care Act this has changed the rules somewhat, though less dramatically for seniors. All states Medicaid programs cover the majority of the cost of prescription drugs for participants including diabetes medications and diabetes supplies. However, participants have very little flexibility with regards to the choice of medicine, supplies and monitoring equipment. Per prescription co-payments range from as low as $.50 per prescription to about $5.00. The Kaiser Family Foundation maintains an excellent chart of Medicaid Prescription Drug benefits by state.
Finding Financial Assistance Programs
Patient Assistance Programs
Patient Assistance Programs, also called PAPs or Diabetes Care Programs, are financial assistance programs created and managed by diabetes drug and supply manufacturers. They are intended for patients that do not have insurance or whose insurance co-payments are prohibitively expensive. Assistance is provided with the cost of diabetes supplies, such as test strips, glucose monitor kits, lancing devices, insulin pumps, as well as with diabetes medications.
The eligibility requirements differ for each manufacturers’ diabetes assistance program. Typically a diagnosis of diabetes and one’s annual income are the only qualifying factors. Age, marital status, and other information related to health conditions may be requested during the application process. However, it will not likely be used to disqualify a candidate.
Many programs use the Federal Poverty Guidelines, also referred to as the Federal Poverty Level (FPL), as income thresholds. For example, if one’s income were less than 300% of the FPL, then they would qualify for assistance. In 2017, for a single individual, 300% of the federal poverty level is $36,180. For a two-person household, the level is $48,720.
Some assistance programs are two-tiered. For example, if your annual income is below $20,000 / year, the prescription or supplies might be completely free, or if your income is under $30,000, you might receive a 75% price reduction.
Some programs for the elderly require the individual to have insurance; others are only available to those without insurance. So, while insurance can be a determining factor, its impact is specific to each assistance program.
Benefits are almost always provided in one of the following four ways.
1) Reimbursement – your costs or a percentage of your costs are reimbursed after purchasing and providing receipt.
2) Coupons – discount coupons that you redeem directly with your pharmacy or diabetes supplies company.
3) Direct discounts at your pharmacy – the program has a direct relationship with the pharmacy and the discount is applied at the time of purchase.
4) Free product – shipped directly to the program participant.
Our organization has partnered with NeedyMeds.org to provide a complete and exhaustive list of diabetes patient assistance programs. One should apply for help directly with the pharmaceutical company or diabetes supply manufacturer. Since these programs are designed for the financially needy, typically there is no cost to participate in or apply for the program.
Some programs for the elderly require the individual to have insurance; others are only available to those without insurance. So while insurance can be a determining factor, its impact is specific to each assistance program.
State Pharmaceutical Assistance Programs
Several states, though fewer each year, offer pharmaceutical assistance programs which help their residents financially. While these are not specifically intended for diabetes, their benefits still apply.
State Assistance and Medicare Wraparound Programs
Mail Order Pharmacies
Certainly the easiest and most convenient way to save on diabetes medications and supplies is to use a mail order pharmacy. While this may not really be considered financial assistance, the cost reductions can be significant and the net result is the same; less money spent out-of-pocket. In addition to lower pricing and the convenience of regularly delivered re-supplies, some mail order pharmacies offer free shipping of products for seniors with Medicare coverage.
Clinical studies provide free supplies and pay participants as much as $500 for their assistance.
Participation is clinical studies are another option to receive assistance for diabetes medications and supplies. In these studies, participants receive all of their supplies and medications free of charge in exchange for detailed record keeping, completing surveys, and an occasional medical appointment. In fact, many diabetes clinical studies actually pay their participants for their assistance.
Note that if a program bills itself as a clinical study and they offer “discounted supplies” but actually charge the participant in some way, then that program may very likely be a scam targeting seniors.
Discount Drug Cards
Discount Drug or Prescription Drug cards are a great tool for reducing out-of-pocket medication and supply expenses. Cost reduction estimates range from 15% – 25%. However, it is important to realize how discount drug cards work and how their issuers make money. While the cards do save seniors money on diabetes supplies, the savings come at a cost. That cost is their use of their personal information. If one is greatly concerned about their privacy, they should read this article before using a card. One can download a free, discount drug card from an organization whose privacy practices our organization finds to be commendable here.