Exploring the Costs Associated With Diabetes and How to Save on Supplies

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More than 38 million adults in the U.S. - or almost 15% - were living with diabetes in 2021, according to the CDC. This figure included millions of adults who had undiagnosed diabetes.

There are several types of diabetes:

• Prediabetes

• Type 1 diabetes

• Type 2 diabetes

• Gestational diabetes, a type of diabetes that affects some people during pregnancy

People with diabetes can have substantial out-of-pocket expenses for insulin as well as for medical supplies such as a glucometer and test strips, a continuous glucose monitor with sensors and transmitters, and an insulin delivery system. Below, we examine the costs of common diabetes supplies.

What medical supplies are essential for people with diabetes?

With diabetes, it's important to keep blood glucose (sugar) levels within a target range. There are two devices that track glucose levels:

• Blood glucose meter (glucometer): A glucometer is a small, handheld device that uses a tiny drop of blood from a finger to measure glucose levels. Results are available in seconds. A glucometer requires diabetes test strips, lancets, and other supplies.

• Continuous glucose monitor (CGM): A CGM is a wearable glucose monitoring device. It uses a sensor that sits under the skin and measures glucose 24 hours a day. A CGM also requires replaceable sensors and potentially a transmitter and receiver.

Some people use a CGM that's connected to an insulin pump, which is a wearable insulin delivery device, so that their insulin is automatically adjusted in response to glucose changes. This technology is called an automated insulin delivery (AID) system.

How much do diabetes supplies cost?

On average, people in the U.S. with diagnosed diabetes spent nearly $20,000 on medical expenses in 2022 - with about $12,000 of those yearly costs attributed to diabetes, according to American Diabetes Association (ADA) research.

Out-of-pocket medical costs for diabetes care vary depending on several factors, including whether a person has health insurance or not. But even with health insurance, a person with diabetes could spend $3,922 annually on over-the-counter medical supplies, according to an April 2020 GoodRx report.

A 2020 study published in JAMA Internal Medicine found that children and adults with private health insurance spent more out of pocket on diabetes-related supplies than on insulin.

However, in many states, there are annual limits on out-of-pocket costs for diabetes supplies for people who have insurance. For example, Connecticut limits out-of-pocket costs for diabetes supplies such as syringes, pumps, and glucometers to $100 per year for insured residents, as of January 1, 2022.

Common diabetes supplies

Here are typical costs for common diabetes supplies.

Blood glucose meters

There are dozens of blood glucose meters listed in theADA Consumer Guide. Depending on the features, a glucometer can cost in the hundreds of dollars. But there are several options that range in price from around $15 to $50. Some manufacturers have promotional offers for free glucose meters because they profit from the regular purchase of test strips for the devices.

Insulin pumps

Insulin pumps typically cost $6,500 or more without insurance. Supplies for a pump, such as infusion sets and reservoirs, may cost an additional $3,000 to $6,000 a year. Insurance plans, including Medicare, often cover some or all of the expenses associated with an insulin pump.

You will need a prior authorization to get coverage for your insulin pump. Under Medicare, Medicaid, and other insurance plans, an insulin pump is covered as durable medical equipment.

CGMs

The price of a CGM is typically less than an insulin pump, but there are usually ongoing costs for sensors and transmitters. You can leamore about the handful of available CGM options in the ADA Consumer Guideand with thisGoodRx comparison of the popular Dexcom and FreeStyle Libre systems.

Without insurance or discounts, you could pay $450 or more per month for a Dexcom G6 or G7 CGM system - not counting the cost of an annual receiver. If you don't have insurance or are self-pay, there are savings available through a partnership between GoodRx and the manufacturer of the Dexcom systems. This program may be able to save you $200 or more per month on the Dexcom G6 system. For the G7 system, the program may be able to save you $210 on every three sensors (a month's supply) and $240 on each receiver.

For cash-paying consumers, there's also a savings program available directly from Dexcom that offers $200 off Dexcom G6 transmitters, as well as a patient assistance program for certain uninsured or underinsured consumers.

Infusion sets

Whether you're using a patch pump that attaches directly to the skin or an insulin pump that delivers insulin through tubing, there are ongoing costs for infusion sets. Infusion set options vary depending on the insulin device you have. In general, infusion sets are changed every 3 days. A month's supply can cost more than $100.

Lancing devices and lancets

Over-the-counter lancing devices typically cost less than $15 each. You can usually pay $30 or less for a lancing device and 100 lancets sold together. A pack of 100 lancets sold separately can be found for $10 or less.

Blood glucose test strips

The cost of diabetes test strips depends on the glucometer you choose and if the brand or style is covered by your insurance. Diabetes test strips are typically sold in 50-count and 100-count denominations. That means a single test strip costs from about 40 cents to 70 cents.

Syringes

Most people use syringes to inject insulin into their bodies. The cost for 100 syringes with needles is around $20 at some retailers.

Insulin pens

Insulin pens can offer a portable and convenient alternative to using vials and syringes for delivering insulin. Insulin pens combine the medication and syringe in one unit and are available with a prescription from your healthcare professional.

Using insulin pens requires you to buy pen needles. Depending on the size, pen needles can cost less than $10 or $20 for a pack of 100. You can leamore about insulin pens in the ADA Consumer Guide.

Adhesive skin patches

There are several brands of diabetes adhesives available in 25-count packages for less than $20. You can leamore about Simpatch and FixiC adhesive skin patches - both of which work with several types of CGMs and insulin pumps - in the ADA Consumer Guide.

Alcohol prep pads

Alcohol pads are often used to clean the skin before testing blood glucose, injecting insulin, and inserting insulin pump sites or CGM sensors. There are packages of 400 individually wrapped prep pads that cost less than $10 at some retailers.

In addition to the above supplies, you may need other items, such as:

• Disposal containers for needles

• Batteries for your devices

• Charging cables for your devices

Does insurance cover supplies for diabetes?

Most health insurance plans will cover some of the costs for diabetes care items, including devices and supplies. Here's are the benefits provided for different types of insurance:

• Original Medicare: After meeting your annual Part B deductible, original Medicare covers certain blood glucose monitors, CGMs, and their associated supplies. In general, you'll have to pay 20% of the Medicare-approved costs for these supplies, and the number of strips and lancets you'll have coverage for will depend on whether you take insulin. Medical supplies used to administer insulin - including syringes, needles, and alcohol prep pads - are covered under Medicare Part D prescription medication plans. You may be charged a coinsurance or a copayment when purchasing the supplies, and a deductible also may apply.

• Medicare Advantage: Most Medicare Advantage plans cover diabetes supplies and devices.

• Medicaid: People with Medicaid are diagnosed with diabetes at a higher rate than the general U.S. population. Coverage varies depending on your state or territory Medicaid program. Most Medicaid programs cover diabetes devices, including CGMs, and supplies but many limit coverage for diabetes supplies to certain vendors and brands. Usually, Medicaid deductibles, copays, and other out-of-pocket costs are very low. Contact your state Medicaid program for specific details.

• Affordable Care Act (ACA) marketplace plans: Under the ACA, health insurance plans are required to cover essential health benefits, including chronic disease management. The law doesn't specifically require coverage for diabetes supplies. Some states mandate coverage of supplies, while others do not.

• Employer-sponsored insurance plans: Employers offering group health insurance plans must provide certain benefits. But coverage for diabetes supplies is not a required benefit, unless it is mandated by the employer's state or territory.

• Tricare: Tricare covers certain diabetes supplies as part of its pharmacy or medical benefits. Your prescription copay applies to supplies covered by pharmacy benefits.

How can I get diabetes supplies for free?

If you do not have insurance or cannot afford the out-of-pocket costs for your diabetes supplies, you have options. Here are some sources for free or low-cost diabetes care items:

• Patient assistance programs: Depending on your insurance status and income, you may qualify for free or low-cost diabetes supplies through patient assistance programs sponsored by manufacturers. For example, several glucometer manufacturers offer free monitors and reduced-cost blood glucose strips.

• Patient Advocate Foundation: Known as PAF, this nonprofit provides a directory of organizations by state that specifically help individuals cover the costs of diabetes care. Visit the foundation's online financial resource directory and choose "diabetes" as your diagnosis to search for assistance.

• ADA: The association supports PAF's copay relief program for people in financial distress. Insured people with diabetes who have low incomes may be able to access grants of up to $1,500 annually for medical costs.

• NeedyMeds: This national organization helps people connect with programs that reduce the costs of medical products and supplies.

• National Institute of Diabetes and Digestive and Kidney Diseases: This member institute of the National Institutes of Health provides information about financial resources to help people with the costs of diabetes care.

• Federally qualified health centers: Known as FQHCs, these community health centers may offer free or reduced-cost diabetes supplies. Use this search tool to find an FQHC near you.

• National Council on Aging: The organization's BenefitsCheckUp search tool can be used to find healthcare resources, including ones that offer assistance with diabetes supplies, by ZIP code.

Frequently asked questions

Disclaimer

GoodRx Holdings Inc. published this content on October 01, 2024 and is solely responsible for the information contained herein. Distributed by Public, unedited and unaltered, on October 01, 2024 at 20:49:02 UTC.