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I take several types of pills for my diabetes. How can I reduce the expense?

There are several ways in which the expense of your diabetes medications can be reduced. Many of them apply to medications in general. Whenever possible, you should try to use the medications that are on your insurance plan's preferred list or those that have the

Beta cells

The insulin-producing cells of the pancreas.

lowest co-pays. These are generally the generic medications. Your doctor should consider prescribing generic medications whenever possible, always weighing in mind the benefits of saving money versus giving you the most effective and safe treatment for your individual condition. If brand-name medications are necessary, whenever possible your doctor will be willing to prescribe the specific brand that is preferred by your healthcare formulary with the lowest co-payment (first or second tier if more than one brand are available that have little difference between their efficacy and safety). Many plans will fill mail-in prescriptions for a 90-day supply with the same single co-pay as a 30-day supply at a retail pharmacy. Recently, some retail pharmacies have begun to offer the same programs. Also, some large national chain pharmacies, such as Walmart, have begun to maintain their own formularies with very low co-pays that discount further from those offered by your medical plan. Walmart, Target, and some Ralph's pharmacies, along with others, will provide a 30-day supply of some generic antidiabetic, blood pressure, and cholesterol drugs for $4. They will honor these prices even if you do not have medical insurance coverage for your medications. Although the items on these formularies tend to be limited in number and are usually generic, several of the medications commonly used by people with diabetes and related conditions can be found on them. Some plans cover only certain dosage strengths of medications at the lowest co-pay, so these should be prescribed by your doctor when there is a choice. Finally, a number of brand-name medications are available in a combination formula with a generic medication (for example, pioglitazone with metformin and sitagliptin with metformin) usually at the same price as the brand-name drug alone. In this case, the generic medication is free, as there is only one co-pay for a prescription. However, be sure that the combination preparation is not in a higher tier (co-pay level) than the individual preparations, as there may then be no saving.

Remember that one way not to save money is to ask your doctor to prescribe more medication than you are actually required to take on your prescription in order to make it last longer. This violates the terms of both the doctor's and your contract with your healthcare plan and the agreements between the healthcare plan and the pharmacy and could result in loss of coverage.

Why is it so important for people with diabetes to control their blood pressure and cholesterol as well?

It is very important for people to control their blood pressure and cholesterol because of the increased risk of vascular disease carried by people with diabetes (see Question 35). High blood pressure and abnormal levels of cholesterol and other blood fats are frequently found in people with diabetes and contribute additional risk for vascular disease. In some studies involving people with type 2 diabetes, control of cholesterol and blood pressure has been found to confer more protection against progression of small vessel (microvascular) disease than control of blood sugar itself! Not only is this the case, but the serious complications in the eyes, nerves, and kidneys caused by damage to the small blood vessels (discussed in Questions 32, 33, and 34) have been shown to be reduced by treatment of cholesterol and blood pressure. Some of the drugs used for these conditions may even provide a minor benefit in control of the blood sugar itself, while some may worsen it. When possible, your doctor will choose those medications for blood pressure and cholesterol that will improve (or not worsen) control of your blood sugar and prevent or delay the progression of the complications of diabetes.

In some studies involving people with type 2 diabetes, control of cholesterol and blood pressure has been found to confer more protection against progression of small vessel (microvascular) disease than control of blood sugar itself

Cholesterol

A fatty substance normally present in blood.

Basal insulin

The insulin required to control your blood sugar in the absence of food intake.

Bolus insulin

The insulin required to remove the energy derived from a meal from the bloodstream and into the tissues to replenish energy stores. Bolus insulin can also be given when the blood sugar is too high.

 
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