Diabetes is a life-threatening disease affecting more than
20 million Americans. Individuals with diabetes must
manage and treat their condition on a daily basis with the
guidance of physicians and other medical professionals.
Multiple studies have shown that, in order to successfully
manage the disease and stave off complications, people
with diabetes must frequently check their blood glucose
levels. Unfortunately, many patients do not have affordable
and adequate access to blood glucose test strips and other
related supplies required to effectively manage their condition
on a daily basis. Endocrinologists and other physicians, while
able to provide guidance to patients on how to manage the
disease, are frequently unable to provide direct assistance
to individuals who cannot access or afford these supplies.
The Diabetes Control and Complications Trial (DCCT)1 and
the UK Prospective Diabetes Study (UKPDS)2 demonstrated
that in patients with diabetes, complications of the
disease could be avoided or significantly reduced when
blood glucose levels are strictly regulated. Complications
such as diabetic retinopathy, kidney disease, and nerve
disease can result when blood glucose levels remain
uncontrolled. With access to the vital and necessary
tools a person with diabetes needs to manage their
condition, such as blood glucose testing meters and
strips, these expensive complications can be avoided.
People with diabetes require medications and supplies on a
daily basis, including such things as insulin, oral medications,
lancets, syringes, and testing supplies including a blood
glucose meter and blood glucose testing strips. Even with
generous health coverage, co-pays for such supplies,
as well as periodic doctor appointments, and any care
required for complications of the disease, can become
financially taxing. While generic versions of medications and
supplies exist, blood glucose test strips remain one of the
costliest aspects of diabetes care. In fact, blood glucose test strips can cost up to $.80 - $1.00 apiece.3 People
with diabetes use one test strip every time they check
their blood glucose levels, which can occur upwards of 6
times per day or more. For a person with diabetes requiring
multiple daily blood glucose checks, this cost, even with
adequate health coverage, can become overwhelming.
Many pharmaceutical companies offer free or low-cost
samples of diabetes medications and insulin to patients
who lack health coverage. Additionally, endocrinologists
and other medical professionals may have access to some
free samples to share with their patients. Unfortunately,
very few manufacturers of glucose testing devices and
supplies offer free or low-cost blood glucose test strips to
individuals who cannot access or afford them. Those that
do provide assistance generally offer it only for a limited
time. Additionally, the programs that do exist do nothing to
assist the many Americans with diabetes who may have
health coverage but whose coverage either does not include
blood glucose test strips, or whose co-pays are too costly
to purchase an adequate supply of test strips each month.
Today, 46 states and the District of Columbia require that
state-regulated health plans provide coverage for necessary
diabetes supplies and medications, including blood glucose
test strips and blood glucose meters, though co-pays
still apply. Other health plans, however, including those
regulated by the federal government are not bound by such
requirements. While many employer-sponsored health plans
governed by federal law do provide coverage for diabetes
supplies including blood glucose test strips, they are not
required to do so. Even when health plans do cover these
diabetes supplies, they may impose restrictions on the
amount available to a patient in a given month, or impose
excessive co-pays. Without the ability to obtain an adequate
number of test strips, patients may have trouble maintaining
control of their diabetes and may ultimately experience one
of the costly complications associated with the disease.
Several employers have experienced cost savings as a result
of providing greater coverage for diabetes care needs and
reducing employee co-pays. Pitney Bowes4 has undertaken
a project to provide increased coverage of diabetes supplies
including blood glucose meters and test strips for employees
with diabetes. The City of Asheville, North Carolina5 has
also instituted a program for residents with diabetes that
provides free diabetes care counseling by pharmacists and
provides free blood glucose meters. Pitney Bowes has
found that as a result of this initiative, absenteeism has been
reduced and the employer’s overall health expenditures
were lowered. Asheville, NC has also experienced better
health outcomes, and decreased health expenditures.
Because diabetes affects each person differently, no one
treatment plan or program is appropriate for everyone.
Patients must work with their health care providers to
determine appropriate medications and care regimens.
Patients must also be able to test their blood glucose levels
to determine how those medications, as well as exercise,
food, and other outside influences affect their blood
glucose levels. Because diabetes is managed exclusively
by the patient with assistance from his/her physicians,
it should be the determination of the patient and doctor,
not affordability and adequacy of health coverage that
determines a patient’s access to needed care and supplies.
The Endocrine Society strongly supports efforts to ensure
the accessibility, affordability, and adequacy of blood
glucose test strips and other related supplies for the
millions of Americans who require such care. As such:
Federal and state governments must determine
ways to ensure the affordability of blood glucose
test strips and related supplies that are not hindered
by the high cost of co-pays or deductibles.
Federal and state governments must ensure that
health care coverage options provide access to
an adequate number of blood glucose test strips
– as determined or prescribed by a physician
– to maintain optimal glucose control.
The Society encourages medical device manufacturers to
adopt policies that provide broader access to free or lowcost
diabetes supplies such as blood glucose test strips.
The Society encourages insurers and health plans to
classify blood glucose test strips as a pharmaceutical
product, not durable medical equipment, so as not to
inflict separate and costly deductibles on patients.
Diabetes Control and Complications Trial. National Institute of
Diabetes, Digestive, and Kidney Diseases. National Institutes of Health.
Accessed online at http://diabetes.niddk.nih.gov/dm/pubs/control/.
UK Prospective Diabetes Study. The Oxford Center for Diabetes,
Endocrinology, and Metabolism Diabetes Trial Unit. Accessed online
Georgetown University Health Policy Institute and American Diabetes Association. Falling
Through the Cracks: How Health Insurance Can Fail People With Diabetes. 2005. Pg. 2.
Accessed online at http://web.diabetes.org/Advocacy/healthresearchreport0505.pdf.
The American Journal of Managed Care. Reducing Patient Drug Acquisition Costs Can
Lower Diabetes Health Claims. August, 2005. Pg. S-170-S-176. Accessed online at
Pharmacy Times Supplement. The Asheville Project. October, 1998. Accessed
online at http://www.pharmacytimes.com/files/articlefiles/TheAsheville