The Financial Impact of Living with Diabetes: Helpful Resources
There is no doubt that living with diabetes will impact your budget, but there are ways you can get assistance if you need it. We hope that you will find the below resources helpful.
Medicine, Supplies, Healthcare, Insurance, Assistance Programs and Companies that Donate
- Covering the Cost of Your Coverage: If you are concerned that you cannot cover the costs of diabetes care, a publication titled “Financial Help for Diabetes Care” can help you learn about your options. Published by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this easy-to-read guide offers an overview, with contact information, about resources such as Medicare, Medicaid, and health insurance programs that cover diabetes-related medical expenses or low or no-cost health care for people with diabetes. You can view this publication on the NIDDK website or order copies from the National Diabetes Information Clearinghouse at (800) 860-8747.
- Laws Protect You: An important insurance issue a person with diabetes may face is when a new insurer defines diabetes as a “pre-existing condition” and excludes or limits diabetes-related care coverage. There are laws that protect people with diabetes who encounter pre-existing condition exclusions. For people with individual (as opposed to employer-sponsored or group) health insurance coverage, 46 states now have laws requiring health insurance coverage to include treatment for diabetes. (The exceptions are Alabama, Idaho, North Dakota, and Ohio). Laws governing health coverage vary from state to state, and you will want to start with the healthcare regulations and laws for your state. “A Consumer Guide for Getting and Keeping Health Insurance,” a resource published by the Institute for Health Care Research & Policy at Georgetown University, is available for each of the 50 states. It can be accessed online.
For those insured through an employer-sponsored group health plan, protection from coverage being denied to a person with diabetes is offered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Act also helps workers who change or lose jobs to maintain their health insurance. (The HIPAA provision, however, only refers to group plans, such as employee health plans, and not individual health plans.) You can read detailed information about HIPAA on the U.S. Department of Health and Human Services Website.
- Insurance Programs for Children: For children of families with limited financial resources, there are multiple programs available at the state level. Medicaid is a state-administered program and each state sets its own guidelines regarding eligibility and services. You can find information for your state at the Medicaid site for consumer information.
For families who earn too much to qualify for Medicaid yet still find their resources too modest to cover their children’s diabetes care, the states operate a low-cost private insurance program called the State Children’s Health Insurance Program, or SCHIP. To find out more about this program covering eligible children until the age of 19, go to the Insure Kids Now! website offered by the U.S. Health and Human Services Department, or call 877-KIDS-NOW.
- Help with Supplies and Prescriptions: Many drug companies offer pharmaceutical assistance programs to help offset the cost of supplies or prescription medications for people with diabetes who have little or no insurance. Enrollment in the programs requires a letter or application from your doctor. Listed below are some of the companies offering patient assistance:
Aventis: (800) 221-4025 (Donates Lantis Insulin)
Bayer Corporation: (800) 998-9180
Bristol-Myers Squibb: (800) 437-0994
Eli Lilly & Company: (800) 545-6962 (Donates Insulin – Patients can apply for a 3 month supply for free)
Novo Nordisk: (800) 727-6500
Roche Diabetes (Accu-Chek): (800) 858-8072
- In addition, the Partnership for Prescription Assistance offers a point of access to 275 assistance programs including 150 programs through pharmaceutical companies that have joined together to provide savings to the uninsured. To see if you qualify for any of these programs, visit Partnership for Prescription Assistance website or call (888) 477-2669.The Children with Diabetes Foundation also offers diabetes supplies on a short-term basis for children with diabetes who are in emergency situations in which their families are unable to obtain basic supplies for diabetes care. You can find information on this program at the Children with Diabetes Foundation website.
- Additionally, leading pharmaceutical companies have created the Together Rx Access Card to provide access to savings on prescription products. To learn more about the card, visit the Together Rx Access website or call (800) 444-4106.
Pfizer has a Share Card Program that enables needy patients to purchase a 30-day supply of any Pfizer prescription medicine they need for a flat $15.00 fee per medication. The Medicine Program provides prescription medication for people who do not have adequate insurance coverage or are experiencing financial hardship – there is no toll free number available, call (573) 996-7300 or visit The Medicine Program website.
Ciba Pharmaceuticals can be covered by Medicare, Medicaid or third party insurance as long as prescriptions are not covered. Eligibility is determined by the physician based on company guidelines. (800) 257-3273
Additional Assistance Programs
- Are Pumps and Pump Supplies Covered? Last, but certainly not least, pumps can present a financial burden for families, with the devices themselves costing on average $5,000 and basic supplies more than $100 a month. Insurance companies vary in their coverage of pumps, but most insurance plans cover costs associated with pump use. Pumps and supplies are usually included in the Durable Medical Equipment (DME) component of major medical plans. Some plans have a deductible or co-pay, so ask your health insurance carrier or check your benefits summary to find your level of coverage. The major pump manufacturing companies have insurance experts who can verify your benefits and out-of-pocket expenses when you consider the purchase of a pump. These manufacturers are aware that their products are costly, and they often are able to work with potential customers and/or their insurance companies to make them more affordable. Here is contact information for several leading pump manufacturers:
As one further option, the Diabetes Trust Foundation (in partnership with Animas) provides financial assistance through its Insulin Pump Program for Children, as well as assistance for medications and testing supplies for individuals who qualify. For more information, visit the Diabetes Trust Foundation website.
- Insurance Coverage for Continuous Glucose Monitors (CGMs): New monitoring technologies come to market frequently, offering significant benefits such as the ability to read blood sugar levels continuously and provide information on blood sugar trends. While increasing numbers of people are using continuous glucose monitors (CGMs), many health plans have yet to make broad coverage decisions about them, and are waiting for the results of clinical trials – such as those now under way as part of JDRF’s Artificial Pancreas Project. In the meantime, some health plans grant individual or case-by-case coverage. JDRF encourages people using or planning to use CGM technologies to apply for coverage. Here are a few tips we have culled from insurance experts that can increase your odds of success.
- FREE Online Diabetes Management Program – Stay Connected and Informed: MyCareConnect is the easy-to-use Online solution for your child and all Their caregivers – parents, school Nurses, teachers, doctors & more. Start living connected today for FREE and Share BG’s, carbs, notes and more instantly with all your caregivers via e-mail and text message. With MyCareConnect, everyone wins. For more info, please visit the MyCareConnect website.
- Some Additional Resources:
Local Low Cost Clinics
If your child has diabetes and is about to turn 18
Money Saving Strategies
JDRF is a leader in setting the agenda for diabetes research worldwide, and is the largest charitable funder of and advocate for type 1 diabetes research. The mission of JDRF is to find a cure for diabetes and its complications through the support of research. Type 1 diabetes is an autoimmune disease that strikes children and adults suddenly, and can be fatal. Until a cure is found, people with type 1 diabetes have to test their blood sugar and give themselves insulin injections multiple times or use a pump – each day, every day of their lives. And even with that intensive care, insulin is not a cure for diabetes, nor does it prevent its potential complications, which may include kidney failure, blindness, heart disease, stroke, and amputation. To help improve the lives of people with type 1 diabetes while working toward a cure, one of JDRF’s research goals is to support research to develop products that can dramatically improve blood glucose control in people with type 1 diabetes so they can live healthier lives with less risk of developing disease-related complications.
Since its founding in 1970 by parents of children with type 1 diabetes, JDRF has awarded more than $1.5 billion to diabetes research, including more than $107 million last year. More than 80 percent of JDRF’s expenditures directly support research and research-related education.
Information compiled from several articles on the Juvenile Diabetes Research Foundation International website.
To learn more about the JDRF Dallas chapter, visit our JDRF Dallas website!