This content originally appeared on Beyond Type 1. Republished with permission.
Beyond Type 1’s 2021 advocacy survey further confirmed findings from other studies that have shown that cost of care is a frequent barrier for the diabetes community. In the survey, a majority of respondents (56%) ranked access to affordable insulin and diabetes drugs as their most important access issue, while almost half of respondents (40%) ranked access to diabetes supplies as the second most important access issue.
40.4% of respondents indicated they incur a deductible of more than $1,500 per person for their insurance coverage, 55% of respondents stated they have paid more than $100 out-of-pocket in any month for any diabetes medication and 64% of respondents paid more than $100 out-of-pocket in any month for diabetes supplies.
Additionally, 21.6% ran out of medications or rationed due to cost, 15.0% skipped specialist visits or other healthcare to pay for diabetes care or supplies, 16.8% did not see a medical professional due to cost, 14.1% “borrowed” insulin or other diabetes supplies because of cost, 20.1% utilized a copay card for any diahcpbetes medication and 22.8% made a decision between bills and diabetes supplies
As a healthcare provider (HCP), you may not be familiar with these limitations of access that present significant barriers to diabetes care. By having a conversation with patients about their out-of-pocket healthcare costs, you can take a vital step toward providing equitable and actionable care that meets the individual’s needs. HCP’s must be knowledgeable, not only about the indications, risks and benefits of prescribed medications, but also about suitable alternatives when those medications are not accessible for the person with diabetes.
While conversations that address the cost of diabetes care can reduce financial distress and improve patient outcomes, research has shown that conversations around the cost of care are rarely taking place—even though both patients and HCPs think they should be. This article helps healthcare professionals identify potential barriers to these conversations and shares tips to overcome them.
Consider and Address Barriers to Healthcare Cost Conversations
A person with diabetes without affordable access to a medication, treatment or care faces the same risk of poor outcomes as if the HCP did not prescribe it at all. By talking to the individual about the affordability of medication or treatment, you can identify barriers and might even uncover other issues in the social determinants of health that limit access to health care.
Non-judgmental inquiries about cost as a barrier give HCPs the opportunity to connect patients with social services and non-medical assistance programs, such as housing, food, etc. that free up resources for medications and out-of-pocket healthcare costs.
Screening tools for social determinants of health are available to help you identify a patient’s needs beyond the practice setting, but before you embark on these conversations consider the potential barriers and address them.
Having the Cost of Care Conversation
It is important to create a safe and non-judgmental environment to be able to accurately assess the needs of each patient. As an HCP, you have great control over this by the tone, language, and body language used during the conversation. When bringing up the subject of cost of care, reassure the person with diabetes that your goal is to get them the care they need while minimizing problems, barriers, and the distress of cost. Emphasize that cost of care is a common issue and not a shortcoming of the individual, but of the expensive and difficult to navigate healthcare system. The American College of Physicians have developed some prompts that you may wish to adopt.
- “Our goal is for you to get the best care with fewer problems and lower costs. This may involve us asking new types of questions.”
- “I’d like to discuss any worries or concerns you have about the cost of your health care.”
- “I have heard from many of my patients that the amount they have to pay for medications or tests is becoming hard to manage.”
During your conversation, aim to get an understanding of the patient’s concerns, needs, and possible sources of financial barriers or distress. Select prompts and questions from the following table to help inform your assessment of the resources the patient may need.
When determining a treatment plan, it is important that shared-decision making is centered around and includes the patient as well as the HCP and other members of the care team. The patients and their family members are the “experts” of what their day-to-day needs are; it is the role of the healthcare professional to assist as best as they can by providing relatable suggestions. The following table provides some suggested guidance to promote productive conversations and build trust between the patient and the care team.
Where Do I Find More Information to Help My Patients?
While it is not expected for the HCP to be an expert on all available resources, it is important to know where that information is available. You may find it especially useful to be familiar with the prescription resources available to support patients who are struggling to afford their medications, including alternative brands, discounts and manufacturer coupons, copay cards, manufacturer patient assistance programs (PAPs), financing plans, and local, state, and federal financial assistance programs. Below are some practical resources to help you become familiar with some of these resources.
- Alexander GC, Casalino LP, Meltzer DO. Patient-Physician Communication About Out-of-Pocket Costs. JAMA. 2003;290(7):953–958. doi:10.1001/jama.290.7.953
- American College of Physicians. Cost Distress Screening and Conversation Guide. March 2019. https://www.acponline.org/system/files/documents/clinical_information/high_value_care/clinician_resources/cost-of-care/1-cost-distress-and-conversation-guide_.pdf
- Phillips, K. A., Ospina, N. S., & Montori, V. M. (2019). Physicians Interrupting Patients. Journal of general internal medicine, 34(10), 1965. https://doi.org/10.1007/s11606-019-05247-5
Read more about cost of health care, health care, insulin, Intensive management, U.S. Food & Drug Administration (FDA).