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Pharmacists can assist with diabetes-related insurance, adherence issues
In this issue, Susan Weiner, MS, RDN, CDE, FAADE, talks with Mandy Reece, PharmD, CDE, BC-ADM, BCACP, FAADE, about how diabetes educators and prescribers can work with pharmacists to provide smooth and affordable access to medications, learn about new devices and manage drug adverse effects.
What are some common issues with insurance coverage for diabetes testing supplies?
Reece: The biggest breakdown in communication regarding diabetes in a retail pharmacy is diabetes testing supplies. Often, issues arise with insurance coverage — specifically, insurance not covering testing beyond twice daily, difficulty in determining preferred test supplies for individual insurance plans, and providers prescribing meter and testing supplies without specifying brand. Providers sometimes omit frequency of testing, which requires an additional phone call to the provider for clarification, or the pharmacist has to select the suggested testing frequency. Patients running out of test supplies before the end of the month happens all too often. As cost is a major concern for many patients, providers and diabetes educators can suggest their preferences for low-cost testing supply alternatives for patients who are self-pay or unable to afford the prescribed brand of testing supplies. When testing blood glucose, additional items, such as alcohol swabs or a sharps container for insulin, may be needed. Offering patients convenient, low-cost options for these additional items is essential.
What are common issues with insurance coverage for diabetes medications?
Reece: One of the most common issues relates to medication copay cards, which do not always work as easily as one would expect. For example, patients with government-funded insurance cannot use most copay cards. Additionally, if the copay card is for a nonpreferred medication for a particular insurance plan, prior authorization may still be required. For patients on a fixed income (or no insurance), it is important to keep in mind that the newer medications are very expensive, and these patients cannot afford them (patient assistance programs for newer medications can be an option for patients without insurance). In the environment of greater cost shifting to the patient, insurance medication formularies often require prior authorization for many branded and newer medications. Prescribers should check the drug formulary, which is updated at least annually, before sending a prescription to the pharmacy. They also should not forget to indicate the maximum number of units per day of insulin on the prescription. The pharmacy may be out of the medication and need to order it, so there may be a delay in the patient receiving medication. Remember, the pharmacist is the simply the messenger, as the insurance company dictates medication formulary.
What are some creative solutions with medication adherence and affordability that pharmacists provide for a charge?
Reece: Many pharmacies have developed price sheets for cash price of drugs as a resource for patients who need alternatives to higher-priced medications. A newer service that pharmacies offer is a medication synchronization, which aligns timing of refills for medications to prevent numerous trips to the pharmacy for refills. An automatic refill service to assist with patient medication adherence is another common service. When patients share that they have stopped taking a medication due to side effects, the pharmacist will call the prescriber so the patient has an alternative medication.
What counseling can pharmacists provide for people who are newly diagnosed with diabetes?
Reece: Pharmacists can provide in-depth counseling with patients who are newly diagnosed with diabetes. Topics of education can include a variety of areas, such as medication side effects and how to manage hypoglycemia. As pharmacists are the medication therapy experts, they can provide in-depth education on medication administration times and techniques, such as when to take metformin to decrease the risk for diarrhea. When it comes to hypoglycemia, pharmacists can provide education on how to treat low glucose with glucose tablets or liquid glucose products that are sold in the pharmacy. Pharmacists remind patients about testing their blood glucose and about the latest products (eg, continuous glucose monitors) that are available to ease the burden of checking glucose. Pharmacists engage with patients continually regarding glucose trends, ability to tolerate newly prescribed medications and inquiring about possible side effects and dietary habits. Many pharmacies sell specialty products for those with diabetes, such as diabetes shoes and lotions, that pharmacists can assist patients in obtaining. By the way, did you know that Medicare will pay for a pair of diabetes shoes each year? Lastly, many pharmacists have advanced training and certifications in diabetes.
What are ways to get to know the local pharmacists in your area?
Reece: Diabetes educators should take a field trip to the local pharmacies in their area to learn about the diabetes and other specialized services they provide. When you get to know the local pharmacists and pharmacies, you will find that many have specialized sections devoted to diabetes care. Getting to know your local pharmacists by name opens the door for collaboration and enhanced patient care. Inviting a local pharmacist to serve on your diabetes advisory committee and your American Association of Diabetes Educators Local Networking Group meetings is a great way to establish interprofessional relationships and patient care.
- For more information:
- Sara (Mandy) Reece, PharmD, CDE, BC-ADM, BCACP, FAADE, is vice chair and associate professor of pharmacy practice, director of interprofessional education with Georgia Campus–Philadelphia College of Osteopathic Medicine School of Pharmacy. She can be reached at sararee@pcom.edu.
- Susan Weiner, MS, RDN, CDE, FAADE, is the 2015 AADE Diabetes Educator of the Year and author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com.
Disclosures: Reece reports no relevant financial disclosures. Weiner reports she is a clinical adviser to Livongo Health.