Family physician Marcus Blackstone, MD, puts his finger squarely on the cost of insulin as a key reason patients fail to comply with their treatment regimens. Thus, Blackstone, who treats patients at Bon Secours St. Francis Health System in Greenville, South Carolina, recommends that payers and providers partner to create more affordable options for patients’ medications.
Insulin vials typically cost patients with insurance as much as $50 a month, and the cost of pens runs close to $100 a month, says Blackstone. For patients without insurance, vials set them back more than $300 a month and pens more than $445. In addition, you’ll find very few diabetes patients who are just on insulin; they often have multiple other conditions along with diabetes, he adds.
During conversations with patients, Blackstone says primary care providers need to continually reinforce the long-term complications associated with the disease, and the need for active monitoring and dietary changes.
Patricia Bononi, MD, medical director of the Center for Diabetes at Allegheny Health Network in Pittsburgh, describes diabetes as an “overwhelming” disease. “The majority of treatment falls in the hands of patients who are faced with food choices and activity choices every day. Basically, everything they do affects their diabetes,” she says.
Thus, Bononi advises physicians to stop making assumptions about patients’ diet choices, for example. It’s not as simple as poor access to food, she says. Often, it’s because patients don’t know how to cook those foods. Or, if their medications are too expensive, it could be that they’re too embarrassed to tell their physicians that they can’t afford them.
Another reality is many patients have high-deductible plans. Many physicians will assume that if their patient is employed that they should be able to afford their medications. Insulin, however, represents a significant out-of-pocket expense for these patients, she says.
Here are nine ways physicians can help their diabetes patients adhere to their treatment plans:
1. Seek community support. Not everyone has access to a nutritionist, says Bononi, who recommends that physicians connect patients with food insecurity issues to a local food pantry. Further, she has advice for food pantries serving diabetic patients: Teach them how to cook the healthy foods available at the food pantry. “It all comes down to communication,” she says. “You have to meet patients where they are.”
2. Educate nearby skilled nursing facilities on nutritious food choices. For example, Blackstone recommends having a diabetes educator walk through the kitchens of these facilities to assess the relative healthiness of the food provided to patients. He notes that while Bon Secours St. Francis doesn’t own the 10 skilled nursing facilities where the health system sends patients, the facilities are grateful for access to diabetes educators. The health system’s clinicians also take part in weekly calls with these skilled nursing facilities to determine where dietary support for patients is appropriate, he says.