Diabetic self-pay patient describes his experience

The Federalist is a web site that I’ve occasionally written for on health care matters, and it has featured from time to time other people describing their self-pay experiences. Today Scott Erlich, who is president of a consulting firm focused on consumer marketing of pharmaceutical and health care products, shared his experience as a diabetic with a high-deductible who found ways to save substantially as a self-pay patient.

How To Cut Your Health Expenses Without Waiting For Congress To Get Its Act Together

I was diagnosed with diabetes about a year ago. I also had what is basically a catastrophic insurance plan, meaning I would pay 100 percent out of pocket for everything (other than an annual physical) up to $3,000 in annual expenses. For me, $3,000 is three months of daycare for my son, three months of mortgage payments, and eight months of car payments, so I was in no hurry to pay that deductible. So I worked hard to see if there were any way I could get good treatment cheaper…

Of the long-lasting insulins on the market, I decided to try Tresiba… Tresiba has similar effectiveness as the other long-lasting insulins on the market, but stays in your system slightly longer, giving me a bit more flexibility in my dosing. Also, their insulin could last a bit longer than others, meaning it was less likely to go bad before I could use it…

Looking at retail prices, the sticker shock is pretty high. For example, the average price for five pens of Tresiba is $541. Five pens will last me about five months, but for people with much more severe cases of diabetes, could last as little as a month or so. Add in needles, glucose test strips, etc., and you could be looking at $700 or so per month retail in severe cases.

Toujeo, a competitor to Tresiba, is listed at just $275 for about an equivalent dosage. Tresiba is my preference for the reasons above, but are those advantages worth $250 per dose? No, but I still went with Tresiba. Why? Well, those coupons. While GoodRX offers some useful coupons, they work better on older drugs in a competitive space. For example, through them I cut my price in half on Effexor XR, to the point that it was cheaper to cash pay than to use my insurance…

But for newer drugs, the best way to save is on the websites of the drugs themselves, and, with that coupon, Tresiba became quite affordable. Since manufacturers know the incremental cost of the pill is small, and most people are resilient to switching drugs once they have started, they will provide savings that allow you to get newer drugs for a fraction of the price. As the Tresiba site states, “With the Tresiba® Instant Savings Card, you pay as little as $15 per prescription for up to 24 months and receive a FREE box of Novo Nordisk needles.”

Now, if you read the fine print, it likely won’t be quite that cheap, and the box of needles is of negligible value. But that still cut my price for five pens to around $100, bringing my annual expenses closer to $250 a year than $1,300. So because of the savings offered and researched, I was able to purchase something at a reasonable rate regardless of my insurance.

$25o a year, down from $1,300 – not bad! The key to Scott Erlich’s savings was researching alternatives to the insulin his doctor initially prescribed, and he cites GoodRx.com, www.drugs.com, www.sharecare.com and www.webmd.com as helpful sources of information to find out what his options were.

There are a few more things I’ve run across in recent days that I’m hoping to share soon!

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6 Responses to Diabetic self-pay patient describes his experience

  1. The repeal of prescription laws would allow people to “try out” medications to see which suits them the best. As it stands, the lowest cost insulin is Novolin 70-30 which can be purchased at prices ranging from $22.89 to $24 a vial according to GoodRX. However this type of insulin requires more careful monitoring so more test strips will be needed.

    • JJM says:

      Novolin 70-30, Regular & NPH all at $24 at Walmart without GoodRX subscription and w/o prescription. Note that when I was purchasing the older insulins sometimes Walmart’s low price was for Novolin and sometimes for Humulin instead, depending on which they had the contract with.

  2. The other option is actually reversing or getting rid of your diabetes. That’s what really decreases the cost. And its doable in many cases with only a moderate one time investment.

    • JJM says:

      So what secret is hidden from T1Ds that would allow our bodies to properly maintain/generate our insulin and glucose, that is a moderate investment????
      Your comment without facts is useless.

  3. JJM says:

    If you do comparative shopping for other items, it makes sense to do so for your health needs.
    There are several Patient Assistance programs for those who need help. One I know provides insulin FREE.
    Recently I walked into a lab for doctor ordered tests. Before allowing any draws I found out my Cash Price would be over $1000 so I walked out. Found online sites where I could pre-purchase the same tests for much less. Purchased the tests for a bit over $300 and returned to the same lab much happier. Received results and faxed copies to doctor within 4 days after visit to lab.

  4. Why take insulin when you can go without it by taking control of your diet to reverse your diabetes? I was pre-diabetic until I started learning from a Toronto nephrologist who is reversing diabetes in many of his patients with kidney problems caused by diabetes. Check out his explanation of why you shouldn’t take insulin at all: https://intensivedietarymanagement.com/insulin-resistance-protects-insulin-t2d-26

    Hope that helps!

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