Tuesday, 16 May 2017

Diabetes Care, It Is Not Cheap

It's amazing what you take for granted. I've had my eyes opened over the last couple of years when I realize just what I don't have to pay for. That's right. What I DON'T have to pay for.

I re-order my diabetic medication and supplies every 3 months. I deal with a big pharmacy chain. Each time I complain (actually I b**ch) about the $4.50 I have to pay beyond the actual costs that are paid out by the benefits companies. I'm referring to the pharmacy markups. Our benefits companies, both mine and my husband's, have a set amount they will co-pay for each item. I believe it's pretty standard throughout the industry. The pharmacy then charges over that. In another words, more profit beyond the huge profit they already make along with the dispensing fee (about $14) on each prescription item. 

For example:
Actual cost for pills: $3
Pharmacy dispensing fee on each item: $14
Overcharge cost (on that item only): $0.75
Total cost now: $27.75

Now that $0.75 doesn't sound like much but consider that they are charging that amount or more on each item in my bag, as well as the dispensing fee on each item in my bag, and then on every person that gets that same drug. Blows my mind but I grudgingly pay the $4.50.

I need to state for the record, what benefits we get in my case are negotiated by our union contracts. Oh, the benefits companies make us jump through some hoops but for the most part, they pay for what we need.

In Ontario, for those who need assistance to live, there is the Ontario Drug Benefit, that we as a province help pay for. I am so very proud that we have a system that assists those who can't, or don't have the skill to, help themselves. I took a look at what ODB covers. The only real difference is they pay for more generics where our benefits will sometimes pay for name brands. Should medication and supplies require costs beyond what the person or family can afford, then there is the ability to apply to the Trillium Foundation for more support. The family still might have to fork out $300 or more a year. Still...that's pretty good.

What this means is that the more fortunate, me, and the less fortunate have it pretty good. The people who don't have it so great are those in lower paying jobs who are likely working full time to make ends meet and have no benefits. They can also apply to the Trillium Foundation to help with costs. It breaks my heart to know there are diabetics who cannot afford their supplies. One solution: don't test, can't afford the strips. Another solution: only use half the insulin needed so it lasts longer. Add to that the cost to buy healthy foods...it costs a bundle to eat healthy!! Spaghetti and sauce are cheap to buy. So are potato chips and other junk foods. A buck and a half for a bag of chips or five dollars for apples...

Let's talk accessibility. We have a system of universal health care so we don't pay outright for Drs visits or hospitalizations. That is covered through our tax base. And we have a high tax base. We don't have restrictions on which Drs we can see in or out of the area. (The discussion for another day is what is broken in that system that needs to be fixed.) So again, we have it pretty damn good overall.

But here is another issue for diabetics. You are newly diagnosed. You are referred to what is referred to as a diabetic education centre. You have some, very little, one on one time or care with the CDEs that are RNs or RDs. Everything is groups. When I was diagnosed I was 46 yrs old. I was the youngest person by 20+ yrs in the group session. Very little common ground there. No individualized care. I'm now 58 yrs old and only now do I have access to an endocrinologist mainly because I embraced my health early on but also because I wasn't on insulin. There was a pecking order for who had priority and I wasn't it. I wasn't, and fortunately still am not, on insulin. So the need for an endo was not considered to be necessary. I still have access though to a lot of solid information and research. So on the whole I could get what I needed.

Being a person with a decent income, I could afford extras like satellite radio. As I'd commute to and from work, I'd tune in to Doctor Radio. I have learned so much. But the show that blows me out of the water is Health Care Connect. This is where I hear the challenges people face with access to health care in the USA. With benefits companies that have made the system so complicated that the average person can't maneuver through it. I listened to a woman describe how she couldn't afford her diabetes medications because she didn't have $400 every 3 months to pay out for it. It was insurmountable for her. This is not the first time I've heard these painful stories. I can't imagine...

As I whine about what I don't get, I am humbled by what I do get. And a saying always come to mind

"There but by the grace of God go I."


  1. I think we tend to trade access of cost. Our cost is so high because we have relatively unrestricted access to medication and technology. Until we are ready to have less access, our costs will be mammoth compared to other places.

    1. I agree Rick. Our costs are skyrocketing. That's why things are changing, because our system as good as it is has some flaws.

  2. Overcharge cost? Does that mean they are charging you money to let them overcharge you???? I know, there must be some reasonable explanation, but that sure is what Overcharge cost sounds like to me.....

    1. Karen what this means is that the pharmacy has decided they, for this example, charge and get 0.75 cents more than the billable amt that both insurance companies combined will pay. Believe they are making a bundle. But interestingly, specialists like dentists have been doing it for years and we don't even blink when they do it. We just pay.


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