“It knocked the socks off of me. It just devastated me,” Suvak said.
Patients and providers alike have noted the rising cost of insulin, which the American Diabetes Association says nearly tripled in price from 2002 to 2013.
But that is only one of the hurdles that seniors with diabetes face. There’s also the emergence of high-deductible insurance plans, shifting more of the cost of care to patients, and formularies that may change the insulin brands that covered at a lower cost.
“This isn’t just about the increase in cost. It’s about Part D not covering every form of insulin in the same way or even covering them at all,” said Bill McKendree, coordinator for the Allegheny County (Pa.) Apprise program that yearly helps about 25,000 seniors select Medicare plans.
Some patients “are paying a much higher price and some can’t even afford their co-payment,” which may run $150 for a three-month supply, said endocrinologist Patricia Bononi, medical director of Allegheny Health Network’s Center for Diabetes and Endocrine Health in Pittsburgh.
For some, she said, it comes down to a simple question: “Are you going to pay for your food, your electricity and other utilities, or are you going to go for the insulin?”
To contain costs, pharmacy benefit providers may switch preferred-brand insulin, so patients are told they have to switch or pay more to stay with their current brand, Bononi said. “As a physician, you have to be aware of this because the change could affect their blood glucose level,” she said.
Then there’s the “doughnut hole,” a gap in Part D prescription coverage between the end of the basic benefit until the beneficiary’s costs reach the threshold when catastrophic coverage kicks in for the rest of the year. With insulin’s higher cost, “we have patients who start hitting the doughnut hole in April,” Bononi said.
Most never get out the rest of the year.
Nick Radovich, 68, said he has already used up his basic benefit this year so he’s “skimping” on the pills and his insulin dosages. He had been able to get free samples of Victoza to boost the insulin but was told about a month ago that no more samples were available.
He’s had consistently high sugar readings since, he said.
“I need that darn insulin,” he said, but after he makes the car and house payments, “There’s nothing left. There’s no money.”
Insulin manufacturers often offer discounts, but Radovich said he and his wife make a little too much money to qualify for such programs. Meanwhile, he said he’s having problems with one of his eyes, a common complication of diabetes.
Typically, seniors who enroll in Medicare Advantage plans offered by private insurers will get a Part D prescription benefit as part of the package. While offering convenience and, at least for now, lower costs, Medicare Advantage plans lock beneficiaries into a plan’s formulary and, in some cases, limit them to the insurer’s contracted provider network.
“Some people, because of the necessity to stay with a provider for other reasons, are going to be reluctant (to switch) just because they can get a better deal on their insulin,” McKendree said.