Pharmacists can help patients who can't afford diabetes meds

When diabetes patients can't afford their medication, they often forego treatment and get sicker. This drives up overall healthcare costs. But there is help available for these patients: state, federal, and private programs that assist people who can't afford their drugs, usually through reducing the cost of medication. Pharmacists should familiarize themselves with these programs so they can advise their patients on where to get help, experts contend.

"We are the last link in the safety net for our patients, so it's essential that pharmacists know about cost alternatives," said Katheryne Richardson, Pharm.D., a consultant for the federal Health Resources & Services Administration's Pharmacy Affairs Branch. "Our role should be to provide information and point patients in the right direction. It's impossible for pharmacists to complete and send in applications and manage prescription assistance for all patients. But it's very possible for us to connect patients to program resources."

For example, there is a wide range of prescription assistance programs (PAPs) to help patients, and pharmacists should aid their customers in learning about such initiatives. According to Volunteers in Health Care (VIH), a nonprofit organization based in Pawtucket, R.I., there are about 150 different PAPs offering access to 850 different medications, including insulin, oral diabetes medications, and blood glucose monitoring tools such as meters, lancets, and strips.

Ellingson and other experts assert that diabetes is a very costly disease, for society and patients. Here's an idea of how costly: The Centers for Disease Control & Prevention in Atlanta reported that in 2002, the latest year for which aggregate data are available, the direct medical cost of treating diabetes in this country was $23.2 billion for medical care of the disease, another $24.6 billion for chronic diabetes-related medical complications, and $44.1 billion in what CDC calls "excess prevalence of general medical conditions," or, in other words, conditions that could have been avoided through adequate treatment.

So of the total cost in direct medical expenses of nearly $92 billion a year, more than two-thirds is related to complications that are directly affected by treatment noncompliance. (Indirect medical costs from lost workdays, restricted activity days, mortality, and permanent disability add another $40.8 billion a year, according to CDC.)

Academic studies bear out the high cost of noncompliance. A seminal three-year study by University of Michigan (U-M) and Veterans Affairs researchers of 8,000 people who suffer from diabetes and other chronic diseases found that 76% of participants suffered a significant decline in their overall health. And they were 50% more likely to have had a heart attack, stroke, or chest pain episode when they cut back on their medication because of cost. This was the first longitudinal study of the effect on diabetes-related health status of noncompliance related to cost.

"One lesson we can take from our research is that treatment of clinical need should not be blocked by cost," said Michelle Heisler, M.D., a research scientist at the Center for Practice Management & Outcomes at the Veterans Affairs Ann Arbor Healthcare System in Michigan. Heisler and colleagues published their results in an article titled "The Health Effects of Restricting Prescription Medication Use Because of Cost" in the July 2004 issue of Medical Care, a journal of the American Public Health Association in Washington, D.C.

Lack of patient ability to pay for medications poses a significant national healthcare dilemma: Another study by U-M and VA researchers found that about one in five older diabetes patients cannot afford necessary medications. The study's results were "disturbing," said John D. Piette, M.D., lead author of a report titled "Problems Paying Out-of-Pocket Medication Costs Among Older Adults With Diabetes," which was published in the February 2004 issue of Diabetes Care."This is a major healthcare threat to millions of people," he said.