Ask D’Mine: What to Do When You’ve Got No Insurance, No Money

Got diabetes and need some help? You’ve come to the right place.

Every week, we take reader questions and do our very best to be informative and helpful (and make you smile a little) here at our diabetes advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Send us your queries related to life with diabetes — nothing is off-limits here! (except of course specific medical instructions for your own care; that’s what doctors are for)

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

It’s tough times out there, and for proof, here’s a pair of questions from the trenches that’ll make you reach for the Kleenex box:

Steve from Minnesota, type 2, writes: I had my diabetes well under control a couple of years ago with an A1C under 6 once, and in the low 6 range typically. Then I lost my insurance and can no longer afford medical care. The critical drug that helped me achieve good numbers was Actos, but it’s so expensive I had to stop taking it. Now my blood sugars are screaming high. I finally just quit checking because there’s no point in knowing if it’s 450 or 500. What to do?

Wil@Ask D’Mine answers: First and foremost, let’s all sit down and have a good cry.

There. Anybody feeling better? No? Yeah… it didn’t help me as much as I thought it would either. Next time, we’ll all try Primal Scream Therapy.

So you’re absolutely right: you can’t afford your Actos. I checked with Epocrates and they show the “approximate retail price” ranges from a low of $193.48 per month for the 15mg tabs, up to a high of $239.99 for a month’s worth of the 45mg tabs. Not exactly chump change. I’d also bet even though this was your “critical” diabetes drug, it probably wasn’t your only one.

So what to do?

Naturally, I have a plan.

First, I want you to go on the Akins Diet. (Hey, I said I have a plan, I didn’t say you were going to like it.) Don’t worry, this won’t be forever. But in your case, an as-close-to-zero-carb-as-possible diet is good medicine. For God’s sake, your blood sugars were running in the 500s last time you checked! You’re at risk for glucose toxicity at this point. Cutting the carbs to the bone is an emergency measure to try and save your kidneys from extinction until we can get your diabetes medicated into submission again.

Second, go here to find the closest Federally Qualified Health Center (FQHC). These are non-profit clinics that are subsidized by the feds and will see you on a “sliding fee” basis. You don’t need health insurance. How much you pay depends on how much you earn. You may be able to see one of their docs for free, or for a very small co-pay. Get the next appointment available.

Third, and here’s where it gets really good, most FQHCs are really well plugged into Patient Assistance Programs, called PAP in the biz. This is all you need to know about PAP: you can probably get your Actos for exactly zero dollars and zero cents per month. PAP programs are run by the Pharma companies and are actually pretty generous when it comes to helping out those who are uninsured and sorta broke. For instance, Actos is made by Takeda, which uses an annual income of at or below 300% of Federal Poverty Level (around $32K for a single person) to qualify patients for assistance.

Oh… but there’s one other little thing I forgot to mention. There’s… umm… ah… a dark cloud of sorts over Actos at the moment. Actos may, or may not, be the smoking gun in an increased risk of bladder cancer. The FDA issued heads-up warning about the drug in June of this year and within 5 hours the water was filled with sharks in suits. There’re now dozens of law firms licking their lips and trying to line folks up for class action suits against Takeda. Late night TV is full of call us if you took Actos ads and there are gazillions of websites launched by law firms trolling for clients.

So… I dunno. The jury is still out on Actos—literally and figuratively. You’ll need to talk to your new doc at the FQHC about whether the Actos is still the best bet for you at this point or not. But if so, remember that it’ll take about six weeks to spool up to maximum effectiveness in your body, so keep on the Akins thing until the med is working again.

Bottom line, you’ll need to take something for your diabetes, given how high your blood sugar is, and in your circumstances, the FQHC and PAP is the best way to get from where you are back to an A1C in the sixes. Whether you re-start Actos, or start something entirely new really doesn’t matter.

So let’s reserve the screaming for Primal Therapy and our politicians, rather than your blood sugar altitude.

Note: a fact often missed in the media is that not having insurance is only one problem facing PWDs in our country. Sometimes you can have insurance and still be in the same I-don’t-make-enough-f*ing-money-to-pay-the-bills-and-keep-myself-healthy boat. Consider, for instance:

Janet from California, type 1, writes: I am a single mother of three kids in college. I have diabetes, I have insurance, however I can’t afford the test strips, needles, and now 4 diabetic medications along with depression, high cholesterol, high triglycerides, and low vitamin D medications. I need to take care of myself but I cannot afford the co-pays. Do you have any suggestions? My A1C is 10. Now the doctor has added more testing and increased my units on Lantus & Apidra. I am ready to give up and just stop taking all medications. HELP!!! 

Wil@Ask D’Mine answers: So I looked into it, and the cost of an average funeral in the United States is between $7K and $10K.  According the Federal Trade Commission funerals “rank among the most expensive purchase many consumers will ever make.” How’s that for depressing?

My point?

Oh sorry. I wasn’t being clear. I was just letting Janet know that she actually can’t afford to “just stop taking all medications.” She’s a type 1. If she stops her insulin she’ll die. And dying is expensive. And her three kids will have to drop out of college and spend the rest of their lives flipping burgers at McDonalds.

Believe it or not, Janet is actually in a worse situation than Steve is. If you have insurance, you can’t get PAP. So that route is closed. Being underinsured, or being well-insured with an empty bank account is a special kind of hell.

But not to worry. Again, I have a plan. And again, it’s not a great one, but it will do for now. So there are two approaches here, and we can mix and match them. The first is medical triage. Triage is just a way of prioritizing the most urgent needs. Remember in the old M*A*S*H TV show when the helicopters would bring in the wounded soldiers and the docs would dash out and figure out who needed to go into surgery right now and who could wait an hour or two? (Oh crap, now I’ve got the M*A*S*H theme music stuck in my head where it will haunt me for the next three weeks.)

Well, when times are tough, you can do the same thing with your health care—and I like to say “blood sugar first.” Hey, at an A1C of 10 your blood sugar is cytotoxic. You’re killing yourself in slow motion and the folks at the dialysis center are getting excited thinking of all the money they’ll make off you (at more than $70K per year, that’s better than seven funerals!). So in my mind, nothing else really matters if your blood sugar is a train wreck. That means insulin and test strips are the top priority. I wasn’t clear if you were on anything other than the two insulins for your diabetes, but in a crunch, you could drop any other diabetes meds because it’s more than possible to control your diabetes with the Lantus and Apidra alone. Ya just gotta take enough.

So using triage, you might choose to just take care of your diabetes for a while until you get it on track. Ignore everything else for a time. Will high cholesterol kill you? Yeah. Probably so. But it will take a long time to do it. Eat smart for a while to minimize your risk, but if push comes to shove you could back-burner the cholesterol issue for a year, or until your oldest kid graduates and frees up some cash flow.

Stopping your depression meds cold turkey can be dangerous, so talk to your doc about how to safely get off them if you need to. And so on and so forth. Only treating your most urgent needs during a financial emergency is a valid form of medical treatment called harm reduction. It’s not the “standard of care,” but desperate times call for desperate measures.

But, wait, maybe you don’t need to ignore your other health challenges. Do I hear the thundering hooves of charging horses and the sound of bugles? I do believe the cavalry is coming over the hill to rescue you and it’s… it’s… Wal-Mart?!

OK, not quite the boys in blue that I was expecting.

Here’s the deal. Open your medicine cabinet and look at your cholesterol med. Is it a fancy brand-name drug or an older generic? Rather than stop your cholesterol med altogether, talk to your doc about getting a prescription for a generic that you can get on the $4 formulary at Wal-Mart, or one of the other big-box stores. Meds for your depression and trigs are also available as generics. You can also get vitamin D supplements over-the-counter in bottles that are the size of rain barrels. And even if the generics aren’t quite as effective as the fancy-pants name brand ones (and many are much closer than we’ve been lead to believe), it’s still better to have some control over your cholesterol than none at all.

Now, on to diabetes penny pinching: One thing to check is whether your insurance has a preferred insulin brand. On the fast-acting front we have Apidra, Humalog, and Novolog. Frankly, it’s the same as Tide, Cheer, and Gain. Hey, they really all work pretty much the same, and if one insulin brand carries a lower co-pay, so much the better for your wallet. Similarly, the basal insulins Lantus and Levemir are more-or-less interchangeable (there’s more of a difference between them than there is with the fast-acting juice, but if you can save a bundle of money, then you can adjust).

Next, let’s look at delivery devices. We all love pens, but many insurance companies will give you a lower co-pay on vials and syringes. If you’re out-and-about a lot, it’s hard to beat a pen of fast-acting to cover meals in public, but most of us take our basal in the privacy of our homes anyway, so using a syringe once or twice a day really isn’t that big of a deal if it will help you keep the lights on, food on the table, gas in the car, and the kids in college.

And if push really comes to shove, depending on how high your insulin co-pays are, you can buy old fashioned Humulin-R, 70/30 mix, and NPH insulins at Wal-Mart under the ReliOn label for $24.88 per vial. That may be less than your co-pay. Speaking of ReliOn, I’ve been playing with their Micro meter recently and have found it to be remarkably accurate. The strips run twenty bucks for 50. Again, if this beats your co-pay, switch over. You should also Google your favorite test stip. You might be surprised. I saw Presto strips online at Amazon for only $14. Crazy!

Bottom line: just because you have insurance doesn’t mean you always have to use it. Sometimes just getting out your wallet is cheaper than going through your insurance.

So shop smart. Stop (some meds) smart, if you must.

But don’t stop all your meds. Oh, and my apologies to the funeral industry. I know times are tough for you guys, too.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

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