If you have insurance, check your plan’s website or app for a cost estimator or call the member services number on the back of your insurance card to find out which insulins are covered and which pharmacy your plan prefers. You might save hundreds of dollars by filling your prescriptions at a different retail or mail order pharmacy. Preferred pharmacy status can change during the year so know before you go.
What We Do
Convene, Collaborate, Communicate
Diabetes Health Care Reform
Politicians keep talking about fixing the U.S. health care system. The Diabetes Leadership Council wants to show them the way. That’s why we led 12 national diabetes advocacy organizations to develop a roadmap on U.S. health care reform for people with diabetes.
Public and private health plans generally cover long-term diabetes complications, including amputations, blindness, end-stage renal disease, heart attack and stroke.
It’s time to give people with diabetes affordable health coverage to prevent or delay these costly and life limiting complications.
The shift is better for people with diabetes and their families, and a wiser investment of our nation’s health care dollars in the face of the diabetes epidemic.
Providing health benefits is critical today to retaining and attracting new employees. However, health insurance is one of the leading costs for businesses – especially service businesses – and healthcare costs continue to rise. Treating chronic diseases accounts for 86% of those rising healthcare costs.
With more than half of Americans insured through their company, employers play a key role in impacting access to and quality of care, especially for those with diabetes and other chronic diseases. And with diabetes, in particular, being a self-managed disease, there are many opportunities for health plans to support self-management that lead to better care and greatly reduced costs.
The Diabetes Leadership Council (DLC) partners with employers, employer organizations, benefit consultants, and insurance agents and brokers to create awareness among employers and foster adoption of key health plan design techniques that:
- Reduce out-of-pocket costs and improve care for employees and their dependents who have diabetes and other chronic diseases
- Reduce costs and risk for employers
- Ultimately enhance productivity by helping reduce absenteeism due to sickness, additional medical appointments, and more
Health Plan Design Solutions
IRS allows chronic disease management to be treated as preventive coverage especially in high-deductible health plans. Exempt diabetes management from your plan deductibles.
Average rebate on a branded drug is 48%. So employees are paying twice what it costs the plan, creating an unnecessary barrier to care. Extend plan rebates to patients at the pharmacy counter, covering prescriptions just like other health care services.
Generics & Biosimilars
Only 1 in 4 are covered in the year of introduction. Less than half of generics and biosimilars are placed in the generic tier by PBMs. Ensure plan participants have access to lower-cost medications.
Most plans will cover expensive and invasive bariatric surgery, but not the counseling and medications that can avoid it. Include counseling and the new, proven anti-obesity drug therapies in your plan.
Reducing Insulin Out-Of-Pocket Costs
DLC is committed to reducing insulin costs in the U.S. Insulin is an essential, life-sustaining component of diabetes care. Affordability should not depend on patients’ shopping savvy or savings programs. It’s encouraging to see policymakers paying attention to the problem, but policy changes take time, and many people with diabetes struggle to afford insulin today.
Personal circumstances and insurance plans vary so there’s no one-size-fits-all shortcut – but if you are uninsured, underinsured or in a high deductible plan, these steps may help reduce your out-of-pocket cost for insulin and other diabetes medicine and supplies.
Help is available for people struggling with high insulin costs. Often the best place to start is with your diabetes care team. Several new analog insulin products are available with retail prices as low as $40. Your diabetes care team can help you decide which insulin is best for you.
They might help bridge short-term gaps by using product samples or by transitioning you safely to a lower cost insulin. They can also help people with diabetes reduce longer term insulin costs by navigating insurance formularies and coverage appeals; writing prescriptions to optimize insulin units available under 30- or 90-day dispensing limits and cost sharing requirements; or documenting medical necessity to support coverage appeals or assistance program enrollment.
Several new insulins were recently introduced at significantly lower list prices – including a follow-on biologic and authorized generic analog insulins. Your diabetes care team can help you decide which insulin is best for you.
Insulin manufacturers Lilly, MannKind, Novo Nordisk, Sanofi and Viatris offer various patient assistance and discount programs. You can contact manufacturers directly or go to getinsulin.org to understand options for immediate and long-term insulin needs. Consumer costs range from zero to $100 for a month’s supply of insulin, depending on the program and an individual’s eligibility. The Association of Diabetes Care & Education Specialists also assembled valuable guides to help connect people with diabetes and their health care providers to assistance programs, discount plans and other resources. Eligibility and application requirements vary, but you could qualify for discounted insulin, other diabetes medications, supplies or other assistance even if you have insurance or earn a middle class income.
Search here or contact your state or local health agency to find a community health center nearby. These hospitals and clinics purchase discounted insulin and other medicines through a federal program so that their pharmacies can dispense them at no or low cost to their patients. There may be a wait time to see a provider, but community health organizations and facilities nationwide form a vital safety net for uninsured or underinsured people with diabetes.
Search here to find the nearest Dispensary of Hope site. Dispensary of Hope is a non-profit organization distributing free insulin and other medicines for low income, uninsured patients in need. Manufacturers and health care facilities generate billions of doses of surplus medications every year. These safe, unused products are donated to Dispensary of Hope, which then distributes them for free to patients through a growing national network of licensed outpatient pharmacies, charitable pharmacies, federally qualified health centers and safety net clinics.
Checking prices at GoodRx, Blink Health or InsideRx could shave hundreds of dollars from your pharmacy bill. Visit their websites or download the apps to access discount codes and coupons, and compare prices at nearby pharmacies. You may need to sign up in advance, but there is no cost to use these services. Amazon Pharmacy and Walmart now offer lower cost analog insulins. If you have insurance, remember to check whether these purchases count toward your deductible.
Cash prices vary, so check with several pharmacies – chains and independents – to compare. Even if you have insurance, the cash price could be lower than your coinsurance or copay. Cash payments may not apply to your deductible, so decide which option is best for you.
Costco or Sam’s Club mail order and retail pharmacies may save you money on insulin and other prescriptions. Check online and talk to the local pharmacy to find the lowest price. Many states allow non-members to use warehouse pharmacies too. You won’t need a member card to enter the warehouse – just tell the door greeter you’re a pharmacy customer.
DLC has partnered with JDRF to share with employers how health benefit plans can be structured to help people with diabetes afford the care they need by:
- Passing along discounts and rebates at the point of sale
- Keeping cost sharing low and predictable throughout the year
- Covering the full range of insulin delivery devices and other vital diabetes supplies and services
- Adding insulin to the preventive drug list, exempt from deductibles and cost-sharing
If your employer offers health insurance, learn more about the DLC Employer Initiative. Visit JDRF, DPAC’s Affordable Insulin Project or Advocacy for Access for resources to help you understand your coverage and talk to your employer about insulin and other diabetes costs.
Diabetes Care is Preventive CareDownload the PDF
The Diabetes Leadership Council believes that diabetes care is preventive care. Every person with diabetes needs preventive coverage for their diabetes management essentials, benefitting from their health coverage on day 1 of the plan year instead of paying a high annual deductible before insurance kicks in.
First dollar, preventive coverage for comprehensive diabetes care offsets much more costly complications such as heart attack, stroke, amputations, blindness or kidney disease.
We work with employers to structure health benefits with first dollar coverage, rebate pass through and other features that reduce plan risk and manage diabetes costs. And we work with other advocacy organizations to improve insurance literacy – helping people with diabetes choose and use the right health plan.