Managing Diabetes During a Down Economy: Preventing Complications of Chronic Disease When Money is Tight

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Diabetics and other people with chronic illnesses are falling on hard times, just like many Americans. Some creativity will help them maintain control of their condition.

2.6 million Americans lost their jobs in 2008 (CNN Fortune & Money). Many of these workers (an unknown number of whom are diabetics) also lost their health benefits.

For individuals with chronic diseases, health insurance—including prescription drug benefits—is literally a life saver. Without this umbrella of financial assistance, many people with potentially life-threatening conditions cannot afford to buy the medications and supplies that keep their illnesses under control.

In the long run, these individuals will develop disease complications, and their need for urgent medical care (amputation, hospitalization, etc.) will inevitably add to the overall economic burden of health care—not to mention the devastating deterioration in personal quality of life.

While no one yet knows how effective any proposed changes in our health care system will be, there are options that diabetics—and those with other chronic conditions—should consider when they are out of work or facing the imminent loss of employment.

Insurance Options for Unemployed Diabetics

Options may be limited by a person’s financial resources or state of residence:

  • Consolidated Omnibus Budget Reconciliation Act (COBRA): Allows temporary continuation (18-36 months) of benefits for workers who were covered by plans that included 20 or more employees.
  • Continuation: Some states allow workers to continue their previous coverage after employment is terminated. Usually applies to companies with fewer than 20 workers.
  • Conversion: Some states and policies allow workers to convert group plans to individual policies; this may entail a new pre-existing-condition period.
  • Medicaid: Insurance for individuals and families with low incomes and limited resources (assets may be included in determination of eligibility).
  • HIPAA-eligible: Federally-mandated coverage for certain individuals who have been previously covered under group plans and who have used up COBRA or continuation benefits.
  • High-risk pools: Many states provide insurance pools for individuals who are turned down by private insurers because of health status. Typically more expensive than other plans, but deductibles are usually lower, and no one can be denied coverage.
  • Individual policies: In some states, applicants cannot be denied coverage, regardless of health status.

Prescription Options for Unemployed Diabetics

  • Seek prescription assistance: Nearly all pharmaceutical companies offer programs that subsidize the cost of drugs and supplies for people who cannot afford them. Qualification criteria vary. (Programs for Diabetics)
  • Modify current regimen: Generic medications can often replace brand-name drugs. For a person who takes, say, 20 mg of a given drug, purchasing the 40 mg size and splitting the pills may confer a cost savings (pharmacists can advise patients on availability of different dosages and advisability of breaking pills). Higher priced, but more convenient dosage forms (e.g., Lantus insulin), can sometimes be replaced with cheaper formulations (i.e., R or NPH insulin). With better compliance and appropriate lifestyle changes, dosages can often be reduced.
  • Try different suppliers: Walmart’s drug plan, for example, offers a three-month supply of some medications for as little as $10. “Big-box” pharmacies often offer lower-cost prescriptions, but it pays to shop around for better prices. Monitoring strips, an expensive part of diabetic management, may be available on the Internet for 1/3 the cost of locally-purchased supplies. For well-controlled diabetics (even those on intensive insulin programs), the frequency of monitoring can often be decreased—checking blood sugars once daily at different times of the day (e.g., breakfast one day, lunch the next, supper the next, etc.) may help to reduce strip usage.

Diabetes is a chronic disease whose complications can be prevented with proper management. Innovative thinking might be necessary to help diabetics who have lost their jobs maintain control of their disease.

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