According to the American Diabetes Association (ADA) publication on the Economic Costs of Diabetes, the total annual cost of diabetes is around $412 billion, including $306.6 billion in direct medical costs and $106.3 billion in indirect costs. This is an increase of about 35% over the past 10 years, which can result in financial difficulties for several adults with diabetes. Regardless, utilizing high-quality diabetes supplies and taking a proactive approach to diabetes care is essential for longevity and overall quality of life. Here, we aim to discuss a few of the financial challenges of diabetes management along with resources for combating costs and prioritizing your well-being.
In this article, you’ll learn:
- How the rising cost of diabetes care impacts individuals in the U.S.
- What drives the increasing costs of diabetes management, such as higher insulin prices, the growing use of medical technology, and an aging population with more complications.
- How financial stress affects mental and emotional health, and why addressing both emotional and economic challenges is important for overall well-being.
- What health insurance typically covers for diabetes care, including medications, monitoring devices, preventive screenings, and education programs.
- What financial assistance programs are available through organizations such as the ADA, Patient Advocate Foundation, PAN Foundation, and manufacturer-sponsored insulin savings programs.
- How to reduce financial challenges of managing diabetes by reviewing insurance plans, using prescription discount programs, and working with trusted providers.
The Rising Cost of Diabetes Care in the U.S.
The financial impact of diabetes management throughout the United States has grown significantly over the years. On average, people with diabetes tend to spend an average of $19,736, of which approximately $12,022 is directly attributable to diabetes. This can equate to about 2.5 times more than the medical care that individuals without diabetes spend. Aside from adjustments to account for inflation, what factors have been contributing to the climbing costs of diabetes care? Below are some of the most notable costs among people with diabetes and how they've changed.
Rising Prices of Insulin and Medications
The price of insulin in the U.S. is more than nine times higher than in 33 high-income comparison nations, and has continued to increase dramatically since the early 2010s. Although the Inflation Reduction Act of 2022 limits cost-sharing for insulin under Part B to $35 per month and requires all Part D plans to charge no more than $35 per month for all covered insulin products, this only applies to individuals covered by Medicare (i.e., people age 65 or older and those with specific disabilities). This leaves millions of other Americans needing to pay higher out-of-pocket costs.
Greater Use of Technology and Devices
There's also been greater expenditures related to technological advancements. While these tools in diabetes care can help with ongoing management and more accurate blood sugar readings (thus resulting in a potential reduction of long-term complications), they can raise upfront costs. Although many health insurance plans cover things like insulin pumps and continuous glucose monitors, there may still be some out-of-pocket costs for individuals with diabetes.
Complication Management and an Aging Population
Complications from diabetes remain as major cost drivers in older adults. According to the CDC, the average cost associated with complications in people aged 65 or older with type 2 diabetes is about $5,876 per year. Moreover, 61% of total diabetes costs for US adults were attributed to adults aged 65 and older. This highlights the importance of early management to help reduce the impacts of chronic disease later in life, and how cost-related non-adherence can increase financial burdens.
The Emotional and Psychological Toll of Diabetes Care and Financial Stress
Recent research findings indicate that 30% to 60% of people living with diabetes experience financial toxicity, with household expenditures ranging from 5% to 40% of income associated with diabetes management. There are also several demographic disparities evident across the country, making it increasingly difficult for some individuals to cover basic needs and self-care. This can inevitably lead to financial distress and poorer health outcomes, especially when financial barriers limit or prevent proper diabetes care.
Over time, these factors can have a significant impact on mental health. Constantly worrying about affording insulin, supplies, or doctor visits can lead to anxiety, depression, and diabetes distress, which can create an ongoing cycle that can lead to a higher risk of adverse diabetes outcomes. The chronic stress from significant financial challenges can also make blood sugar levels more difficult to control, further perpetuating a cycle where financial hardship worsens health outcomes, and poor health further deepens financial strain. Therefore, recognizing and addressing emotional burdens can be just as important as managing the medical side of diabetes.
Does Insurance Cover Diabetes Care?
Health insurance can make a tremendous difference in how affordable diabetes care is, but coverage varies widely depending on the plan, provider, and where you live. While most health plans are required to offer some level of diabetes coverage, patients often still face significant out-of-pocket expenses. Therefore, if possible, try to choose the best health insurance plan for diabetes care, making sure to consider long-term and specialized care costs.
What’s Typically Covered?
Under the Affordable Care Act (ACA), diabetes is classified as a chronic and preexisting condition, which means insurers cannot deny coverage or charge higher premiums because of it. Most health insurance plans, including employer-sponsored insurance, Medicaid, and Medicare, cover many core aspects of diabetes care, including:
- Insulin and oral medications for blood glucose management
- Glucose meters, test strips, and lancets
- Continuous glucose monitors (CGMs) and insulin pumps (when medically necessary)
- Routine lab work, such as HbA1c testing and lipid panels
- Preventive and maintenance care, like annual eye exams and foot screenings
- Diabetes self-management education (DSME) programs
The coverage of a broad spectrum of diabetes-related supplies aims to help patients maintain glycemic control, reduce the risk of complications, and ultimately lower long-term healthcare costs. However, there still may be some out-of-pocket costs depending on your insurance carrier and the specifics of your plan.
It's also essential to understand the differences in coverage based on Medicare and Medicaid or private health insurance plans, the latter of which may be more expensive upfront, but provide greater coverage for services and supplies. It’s recommended to do some research and compare a few options to see which provider and plan is best for your needs and income level prior to committing to a plan.
Are There Any Coverage Gaps or Limitations?
Yes, even with insurance, many people encounter coverage restrictions or hidden costs that make diabetes management expensive. Common challenges include:
- Limited formularies: Some plans only cover certain insulin brands or medications, forcing patients to switch or pay full price.
- High deductibles and copays: Many private plans require patients to meet a deductible before coverage applies, making the first few months of the year particularly costly.
- Supply quantity limits: Some insurers restrict how many test strips or CGM sensors are reimbursed per month.
- Prior authorization requirements: Before approving CGMs, insulin pumps, or newer medications, insurers often require documentation from a physician, delaying access.
These restrictions can discourage patients from adhering to their treatment plans and, in some cases, lead to skipped doses or rationing insulin, an issue with serious health consequences.
Are There Any Financial Assistance or Support Programs?
Luckily, there are several financial assistance programs available to help people living with diabetes with their general economic situation. Most notably, in 2022, the American Diabetes Association® (ADA) and the Patient Advocate Foundation (PAF) proudly announced the opening of the diabetes fund, expanding PAF’s Co-Pay Relief Program (CPR) to serve people living with diabetes. This "provides financial assistance to people living with diabetes who meet the eligibility requirements to pay for co-pays, deductibles, and co-insurance for doctor’s visits, medications, and testing related to the treatment and management of diabetes, and for medical insurance premiums."
Additional programs and organizations that help those living with diabetes with financial support include:
- Patient Access Network (PAN) Foundation: Offers financial help for underinsured patients with Type 1 or Type 2 diabetes.
- Diabetes Foundation, Inc.: Offers emergency assistance for diabetes medications and supplies.
- Partnership for Prescription Assistance (PPA): Connects patients to hundreds of assistance programs from pharmaceutical companies and nonprofits.
- Help Hope Live: A non-profit that provides financial assistance for people with type 1 diabetes.
- HealthWell Foundation: Co-payment assistance for those with type 2 diabetes.
- NeedyMeds: A free online database listing patient assistance programs, drug discounts, and low-cost clinics.
- Lilly Insulin Value Program: A program that allows eligible individuals to get any Lilly insulin for $35 a month.
Many insulin manufacturers also offer co-pay coupons for those who are insured and may need additional financial assistance for high out-of-pocket costs.
Reducing Financial Challenges of Managing Diabetes
Small, proactive choices, like reviewing your insurance coverage each year, using prescription discount programs, and choosing cost-effective supplies, can make a big difference over time. It’s also essential to take advantage of financial assistance programs and patient support resources that can ease out-of-pocket expenses and help maintain consistent, effective diabetes management.
For many patients, partnering with a trusted provider makes the process easier. Byram Healthcare offers affordable diabetes products, transparent pricing, and dedicated customer support to help you manage your condition without added stress. Contact Byram’s diabetes helpline to learn more, today: 1-877-902-9726, ext. 43397.
