“I would say at least half of my patients are affected by the cost of insulin,” says Diana Isaacs, PharmD, CDCES, a clinical pharmacy specialist at the Cleveland Clinic Diabetes Center in Ohio, who also is a spokesperson for the Association of Diabetes Care and Education Specialists. She sees a wide variety of people using PAPs. “They can range from a person with Medicare who just has to pay a lot or is in the [Part D coverage gap] doughnut hole; to the person who just lost their insurance; to a person who has commercial insurance and has an employer, but is going to the pharmacy and getting stuck with really high copays,” she says. RELATED: 10 Diabetes Care Tips During the Coronavirus Pandemic Now Dr. Isaacs is seeing a rise in queries about PAPs as more people lose their jobs and insurance coverage during the pandemic. An estimated 7.3 million people and their families in the United States could end up losing their insurance as a result of pandemic-related job losses through June, according to research shared in the Annals of Internal Medicine in April. This is on top of at least 28 million people who were already uninsured. As mentioned, that’s on top of the existing treatment affordability issue, especially when it comes to insulin. The average annual cost that people with type 1 diabetes spent on insulin doubled between 2012 and 2016, from $2,864 to $5,705, according to the Health Care Cost Institute. The cost of other diabetes prescriptions rose by more than one-third over the same period, from $3,022 to $4,119. People with type 1 diabetes do not make insulin on their own, so they must inject the hormone in order to survive. Many people with type 2 diabetes also take diabetes medication, and some take insulin. RELATED: Why Is Insulin So Expensive? (and What to Do if You Can’t Afford It)
Novo Nordisk Opens Free Insulin Program to People Who Lost Insurance Due to COVID-19
Novo Nordisk is among the insulin manufacturers who are modifying their patient assistance programs to respond to the COVID-19 crisis. The manufacturer announced on April 14, 2020, that people who have been prescribed Novo Nordisk insulin and lose their health insurance because of a COVID-19-related change in job status may be eligible to receive free insulin for 90 days through the company’s diabetes PAP. The company makes Novolin R (insulin human injection), Novolin N isophane insulin human suspension, NovoLog (insulin aspart injection), Levemir (insulin detemir injection), and Tresiba (insulin degludec injection), among other insulin products. Before the extension, U.S. citizens or legal residents who were uninsured or on Medicare and also had a total household income at or below 400 percent of the federal poverty level were eligible for free insulin and diabetes medications under Novo Nordisk’s PAP. Those on Medicaid, Veterans Affairs benefits, or certain other local, state, and federal programs were not eligible. People who are now eligible because of COVID-19-related insurance loss must provide proof of insurance termination or a COBRA notification, but not proof of income. Assistance can be extended to the end of 2020 if a person has been denied Medicaid benefits. Additionally, as of April 1, Medicare recipients are no longer required to pay $1,000 for medicine before becoming eligible for the PAP. “We already have a lot of programs to help people afford insulin, but the impact of COVID-19 goes beyond that,” said Doug Langa, the president of Novo Nordisk, in a released statement. “We know people need more help right now, and we want to do something that could make an immediate difference.” Isaacs has been encouraging her patients to take advantage of Novo Nordisk’s free insulin offerings. “I’ve been using that program a lot for patients to hold them over until they get enrolled in a patient assistance program,” she says, because the time between submitting documentation and getting approval for enrollment in a PAP can be several weeks. Visit NovoCare to learn more about the PAP and other free or low-cost options.
Dexcom Offers a CGM-Supplies PAP for People Who Lost Insurance Due to COVID-19
Dexcom has announced plans to launch a PAP for continuous glucose monitor (CGM) supplies for current customers who lost their insurance coverage as a result of the pandemic. Eligible participants will receive two 90-day supply shipments of Dexcom CGM system supplies for a reduced cost of $45 each. Each shipment will include one transmitter and three boxes of three sensors. Costco lists the price of a Dexcom 6 sensor three-pack at $318.54 and a transmitter at $146.04. On May 7, James Mcintosh, a spokesperson for Dexcom, said the company had been finalizing logistics and would launch within the next several weeks. They invite people who are interested in receiving updates about the program to visit Dexcom.com/assistance and complete the interest form.
Tips for Getting Into a Diabetes Patient Assistance Program
Isaacs and other diabetes care professionals give the following advice for finding out if a PAP will help you afford insulin and other diabetes treatments and supplies.
Don’t Assume You’re Ineligible
“Many times, people actually are eligible for these programs but they make assumptions that they are not,” says Isaacs. “The income ceilings are often higher than people think.” For instance, Novartis, Lilly, and Sanofi all require a household income at or below 400 percent of the federal poverty level for their long-standing PAPs, which is $51,040 for individuals or $104,800 for a family of four, according to the patient assistance nonprofit NeedyMeds. Anne Wanliss, a spokesperson for Lilly, says that 88 percent of people who apply for Lilly Cares do qualify and receive their insulin for free.
Be Candid With Your Healthcare Team About Your Financial Situation
The unexpected loss of a job — and your insurance with it — can feel humiliating, but remember that it is happening to millions of people right now. Even before the pandemic, making affordability a normal part of the conversation between you and your diabetes healthcare team was helpful. “During my diabetes self-management training appointments, I always ask patients about financial barriers and affordability of their insulin or related diabetes supplies,” says Mary Houle, a registered nurse and certified diabetes care and education specialist at the Joslin Diabetes Center in Boston. You may save a lot of money by being willing to discuss your finances. RELATED: How to Avoid the Risks That Come With Financial Stress
Lean on Your Healthcare Team for Help With the PAP Process
“There is actually a number of different types of programs,” says Isaacs. “It can be difficult to navigate all the programs that exist.” Your doctor’s office or diabetes care and education specialist are trained to help you find the right one and then make sure the paperwork is submitted.
Gather All Your Paperwork and Submit It at the Same Time
You will fill out part of the application, and your healthcare provider will complete the rest. “PAP applications most often have three parts: patient demographics, the prescription portion, and income verification (such as your tax returns or W2 forms),” explains Alex Evans, PharmD, a pharmacist and the founder of PharmCompliance in Jacksonville, Florida. “In the past, I’ve made the mistake of faxing parts separately, and the manufacturer was unable to find each piece of the application, so it caused delays as I resubmitted it.” Some healthcare providers will use an online portal to submit your paperwork, he adds.
Ask Your Doctor to Prescribe a 90-Day Supply of Your Medications
“It can be a hassle to request refills and have them shipped, so it’s much better if the doctor will just write [a prescription for] a 90-day supply,” Dr. Evans advises. “The PAP applications are good for a year anyway, so it’s better to get it that way.” RELATED: What Is Financial Wellness?
Request a Fax or Electronic Submittal Confirmation From Your Healthcare Provider
Get proof that your application was submitted. “It can be helpful when following up with the manufacturer; for example, if they say they didn’t receive the application,” says Evans. “I’ve had a few where things have gone wrong. Once the manufacturer was switching contracted companies and telephone hold times were five-plus hours, so we definitely didn’t want to have to call them.”
Additional Patient Assistance Programs to Check Out
Which PAP you choose to apply for depends on what your doctor has prescribed, says Houle. Beyond the offerings by Novo Nordisk and Dexcom, the following companies also have programs.
Lilly Cares
Lilly’s PAP, titled Lilly Cares, provides free medications to U.S. citizens and legal residents who are uninsured or have Medicare Part D and have household incomes at or below 400 percent of the federal poverty rate. Those on Medicaid, with VA benefits, or low-income subsidy benefits do not qualify. The program covers Basaglar (insulin glargine injection), Humalog (insulin lispro injection), Humulin N (human insulin [rDNA origin] isophane suspension) and Humulin (insulin human injection), among other insulins. Lilly has a tool for finding the best affordability option for each individual. According to a company representative, the PAP serves more than 140,000 U.S. patients each year. Responding to conditions created by the COVID-19 pandemic, in April the company also launched the Lilly Insulin Value Program, which allows commercial insurance users and the uninsured to receive insulin for a copay of $35 per month. As of May 11, more than 1,000 people had participated in it. Visit InsulinAffordability.org to learn more about the company’s other options for free or low-cost insulin and other diabetes medications. RELATED: A Complete Glossary of Diabetes Terms
Sanofi
The company’s Sanofi Patient Connection PAP provides free medications to U.S. citizens and legal residents who have household incomes at or below 400 percent of the federal poverty level and are uninsured, lack insurance coverage of prescribed Sanofi medicines, or have Medicare Part D, and spend at least 2 percent of their annual household income on prescription medications. Covered medicines include Admelog (insulin lispro injection), Apidra (insulin glulisine injection), Lantus (insulin glargine injection), Toujeo (insulin glargine injection), and Soliqua 100/33 (insulin glargine and lixisenatide injection).
Medtronic
The maker of insulin pumps and CGMs has a financial assistance program for people in the United States who meet specific income guidelines that are not listed. Inquire to find out. The program also provides temporary coverage for people who have become unemployed within the past 12 months, have a gap in insurance coverage due to a preexisting condition, have multiple people using pumps in one household, or have a permanent disability. In response to the pandemic, Medtronic has donated $1 million worth of pump supplies to the nonprofit Insulin for Life USA, including sensors, infusion sets, and reservoirs. The supplies will go to 15 U.S. clinics that serve people with type 1 diabetes, according to a company statement.
Omnipod
The maker of insulin delivery pod therapies has a U.S. financial assistance program for current users who have been negatively impacted by COVID-19. Upon meeting certain financial criteria that are not listed, a person may receive up to a six-month supply of free Omnipod products. To learn more, call the company at 800-591-3455 and select option 2. RELATED: When CGM Service Fails: 5 Tips for Creating a Backup Plan
Additional Resources for Finding Free and Low-Cost Medicines and Treatments
During COVID-19 and beyond, you can take advantage of these other online tools for affording your treatment.
ADCES Affordability Toolkit
The Association of Diabetes Care and Education Specialists has a toolkit that summarizes a number of PAPs, discount programs, and other resources in one place. Find it at DiabetesEducator.org/Affordability.
Insulin Help
The American Diabetes Association has a site with information about the PAPs offered by the major makers of insulin and diabetes medications in the United States, plus drug discount programs. It links to a searchable database of community health clinics or pharmacies near you that may offer free or low-cost services and medication. Go to InsulinHelp.org. RELATED: What to Know Before Buying OTC Insulin
JDRF Resources Page
The JDRF, a nonprofit focusing on advocating for and educating people with type 1 diabetes, has a fairly exhaustive resource page listing ways you can obtain free or low-cost insulin and diabetes treatment medications and supplies, through: patient assistance programs, state and nonprofit programs, community clinics, medication discount cards, and prescription alternatives.
NeedyMeds
This nonprofit helps people find affordability options for a wide range of medicines and treatments. Go to the diabetes diagnosis page and search by medication for programs that you may qualify for, and then click on the icons displayed for more information. RELATED: A Comprehensive Guide to Insulin Pens
One Final Word of Advice on Managing Diabetes During the Pandemic
Finally, as you search for ways to afford your diabetes treatments and other living costs, remember to be patient with yourself, advises Isaacs. The pandemic has left millions of people in the same predicament, on top of those who were already feeling the strain. “It’s important for a person not to be hard on themselves,” she says. “This is a really stressful situation for everyone.”
