The cost of having diabetes in Alaska isn’t cheap or easy
Diabetes isn’t cheap. Luckily, the number of Alaskans who have it are relatively few. Still, those who do can expect to pay out the nose ... and in more ways than one.
The state Department of Health and Social Services reports that an estimated 6 percent of people in the state are diabetics, slightly less than the rest of the country. Granted that’s not a huge number, but it does amount to more people than those in all but one of our cities. And that means a lot of individuals spending some extra money.
I happen to be one of these guys and so I know how much the costs can add up. Actually I don’t. No one does. All I know is it’s an extra expense that isn’t always convenient while residing in a state not known for affordable living.
Insurance plays a vital role in giving people like me enough to afford necessary supplies plus the occasional meal. Still, it’s not free.
Take the most basic obligations like insulin, followed by glucose testing supplies. These are things you need daily to do what other people do by, say, waking up.
Insulin prices vary depending on your insurance and doctor. But mine is fairly reasonable at $10 per month with insurance covering the other $244. This is average pricing for my type (Humalog) among many insurance companies. Blood test strips are something many diabetics forget to get prescriptions for since they’re available over-the-counter. But $15 for a bottle that lasts maybe a month sounds a whole lot better than $50.
So now with the insulin paid for, that part’s over, right? Not so fast. Diabetics still need a way to get it into themselves. Again, that costs. Syringes were the most common way for a long time, which by the way, are not for sale in Alaska without prescriptions, although some pharmacies may sell without them.
Now I use an insulin pump, which have grown substantially in popularity over the last decade. The pump itself, depending on the type, can cost up to $6,000. That is, unless insurance helps cover all or most of the bill. Then there’s the infusion sets that must be changed regularly. These must be shipped from special companies, as they’re not available from the doctor or pharmacy. The co-pay on each shipment can vary. Mine have been as low as $90 and as high as $170. To give an idea of the actual cost, my insurance paid $376 on my last batch while I shelled out $94.
One note to add about insurance, with insulin, supplies and doctor visits, diabetics tend to burn through their deductibles rather quickly, meaning they can spend hundreds at the beginning of each cycle.
Insulin itself is a sticky thing that people like me must deal with, namely in getting our hands on it. This seems like the most appropriate of any medication that should be freely available but is extremely regulated in real life. It would seemingly make sense that diabetics — even with proof of an existing prescription — should be able to buy extras to keep around in case of emergencies or be able to grab a new one any time something goes wrong with a current vial. After all, glass breaks from time to time. But prescriptions are set to a timer for renewals.
Even working around this, insurance companies don’t cover anything between their set intervals, which could mean shelling out a couple hundred dollars in an emergency ... or for extras if they were only allowed.
My endocrinologist told me that this regulation is due mostly to insurance companies’ cost models that don’t take into account the emotional or physical need for spares. An emergency alternative is to purchase an older insulin like regular and Nph, which may be purchased without a prescription.
Insurance companies can also dictate which insulin your doctor can prescribe. I found this out with a sudden bill for several hundred dollars for my regular refill,
I had been on NovoLog for many years and it always got the job done in terms of keeping me alive. My insurance then decided to stop covering it. which required a waiting period of several days for a different prescription for Humalog by phone.
Costs can go beyond the regular doctors too. Diabetics are more prone to problems necessitating more attention from specialists for retinas, feet, teeth and nutrition among others, each demanding a different co-pay.
There are more than one ways to measure cost when dealing with a disease like this. There’s the element of danger, and not the fun kind either. I myself have always thought of my diabetes as more of an inconvenience than anything else. Like the others, I have to stop to check up or shoot up, but that’s not a huge deal. However, things can go wrong.
Insulin reactions and other insulin-related anomalies can strike at any time and there’s really no way to plan for them, hence the term “anomaly.” Many diabetics can expect to lose consciousness sometime in their lives. We only hope it’s not when we’re behind the wheel.
There are long-term risks, e.g., vision loss, immunity problems, circulation issues. However, these aren’t nearly as frightening as knowing something can happen inside you without warning. Even diabetics who take good care of themselves will probably face complications. And once that happens, someone’s going to pay.
This was drilled home to me more than a year ago. I had an A1C — which measures average glucose levels — of 6.1, which is a reading you’d expect from a non-diabetic. Still, I awoke strapped in an ambulance one morning. At that point all the paramedics could do was monitor me until my body righted itself as blood sugar spikes can do. This has only happened a few times in my life and will mostly happen again without warning: all part of the price tag. The $1,000 emergency room bill: also part of the price tag.
Part of that downside was there were no local specialists to look into this. Alaskan diabetics have a special concern for proper care. Many must rely on family physicians or nurse practitioners for care or insulin prescriptions because there are only a handful of endocrinologists in the entire state, and most of those are concentrated near Anchorage. Even Fairbanks has no endocrinology available. Juneau has one ... who is based in Wasilla and only travels there once a month. Diabetics in rural areas can often be even more restricted from specialized care, as many must travel to find a regular physician to get the basic prescriptions. This doesn’t include referral for more complicated cases. Regular doctors can get the job done but more specialized care can be called for.
Location in Alaska can also play a part in medical fees. In Juneau, my A1C lab work had to go through the hospital, which the insurance somehow didn’t feel was medical enough, costing around $500. In Anchorage, the same work was done in-office at an endocrinology clinic and so didn’t cost at all.
I admit I’m a diabetic minority: a type 1. The American Diabetes Association estimates that only 5 percent of diabetics have this kind, which is usually diagnosed during childhood. I was diagnosed with type 1 when I was 5 years old, so my comprehension of what was ahead was basically “bleh.” Today, knowing more about the costs, it’s “bleh plus 10.”
Jonathan Grass can be reached at jonathan.grass@alaskajournal.com.
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