Monday, May 9, 2016

On Health Insurance Coverage

In the diabetes community, the the hot topic these days is around health insurance: the rising cost of medications, preferred brands, diabetes technology not covered at all, etc.

There are so many variables with this, most of which I have limited knowledge of, but I don't see it improving - especially with the rising cost of doing business, rising  costs of clinical trials for FDA approval, lawsuits (the US is quite the litigious country), and so on. I'm not saying it's right, I'm just saying.

What I do know,  is that this is isn't new.

When I was diagnosed with type 1 diabetes in 1974, diabetes management was a daily (yes, just one!) insulin injection and urine testing for glucose. .  In my early years with diabetes insulin syringes were not covered by insurance.  The only tool for me to get the insulin that kept me alive, was not covered. Eventually it was covered but I have vivid memories of going to Rite Aid with my mom and having her  plead with the pharmacists at Rite Aid to help us out. To note, the urine testing kits were not covered either.

When home blood glucose testing came to market they were not covered, nor were the strips. I worked at diabetes a diabetes camp in those days and the counselors got to take home the extra supplies at the end of the summer, which usually got me through most of the year.

The same pattern followed with insulin pumps, and continuous glucose meters.

My preferred glucose meter strips, insulin, thyroid medication aren't covered by my private insurance. They haven't been for quite same time..  Some of this I fought since it mattered more, some I did not. Some I fought and won, some I fought and lost. Some I kind of half-assed fought.

Not to forget the tiered prescription costs many pharmacy benefits have.  You can go with their preferred and pay the lowest co-pay.  Mine has 3 tiers, and with each tier, the co-pay goes up, often doubles. If you opt for out of network coverage, or not  preferred (if approved) costs go up exponentially.

All of this comes at a cost to us, the patients. A finical cost.  An emotional cost.  Don't health care provides tell us all that reducing stress helps with diabetes management?

It's a catch-22 of sorts.  We want access to what we and our health care providers determine is best for our disease management.  But we also want it cheaper, or at least not more expensive.  Not to factor into those rooting for public health care -  which in my opinion will end up limiting choices even more.

There is no quick fix, or easy answer to any of this.  My advice to anyone who going is to pick one battle at a time.  If you need help, or not sure how to ask a friend,, call your state senator, call the ADA, JDRF, and me too!

Updated/re-worked June 8, 2016