Samantha Walsh
Samantha Walsh has lived with type 1 diabetes for over five years since 2017. After her T1D diagnosis, she was eager to give back to the diabetes community. She is the Community and Partner Manager for T1D Exchange and helps to manage the Online Community and recruit for the T1D Exchange Registry. Prior to T1D Exchange, Samantha fundraised at Joslin Diabetes Center. She graduated from the University of Massachusetts with a Bachelors degree in sociology and early childhood education.
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Did cost have a factor in deciding which diabetes technology devices you use? Share more in the comments about this process for you (or a loved one)! Cancel reply
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When fighting to get my 1st insulin pump, the major battle was the prior authorization required by my then “HMO”. That was in 1998. I couldn’t have afforded the cash price if my health insurance didn’t cover. A lot has changed in the past 20+ years. No longer a young college student along with studies proving the effectiveness of the therapy insulin pumps provide, getting approved is no longer a hurdle.
There are many factors in choosing new technologies- cost is just one aspect
never have had a pump so I haven’t dug into the costs but I’ve heard that they are quite expensive which obviously is a big negative for me.
I answered “other” because the initial cost wasn’t so much the main idea but if it was covered by my insurance. Thankfully they covered the technology I thought was best for me!
I answered ‘no’ because my insurance pays 100%, even before meeting my annual deductible, for my tech devices.
Not anymore. Fifteen years ago I was purchasing in bulk vials from Canada and even changed insulin types.
I make sure insurance covers the technology
I live in Kosovo where the overall diabetes management is not at a satisfactory level. There are no CGMs here. As a non-EU member, we do not have access to such a technology. This is an op-ed I have written lately on this (it is in Albanian but you can have it translated): https://sbunker.net/op-ed/91842/realiteti-i-hidhur-i-menaxhimit-te-diabetit-ne-kosove/
As a result, CGMs and insulin pumps are not available and one has to buy them from abroad which adds to the costs, plus that there is a constant stress that even if you order them online, you are not going to receive them regularly on time. Periodically, there are CGMs available for sale, but these are either old models and cost a lot. We do not have public health insurance in our country, whereas private health insurance companies do not cover these (as a pre-existing condition). So, all in all, yes the cost had a factor in my and many other patients’ decisions about which diabetes technology devices we use. Consequently, I use old school blood glucose meter.
This is really an unfortunate situation Luljeta and it makes me more grateful to have what we have in the US IF you have insurance. Interestingly, my brother lives in Kosovo ( works at NATO). How do I translate your op-ed? Thanks!
Cost didn’t have a factor but it depended on my insurance and what device I was able to use
Yes- I went with what is on the formulary. Not what I wanted but it works.
When looking for new pump I had to consider what Medicare would cover – I will be 65 soon.
I would prefer to have an OmniPod but it’s too expensive under Medicare because the company has it under Pharmacy. The cost than puts me into the “donut hole” by March. After that, I have to pay way too much out of pocket.
But I have to say I’m very happy with my A1C results with the T slim Tandem IQ
But I prefer not having the tubing to deal with.
I’m in the same boat!
I don’t have insurance. After using a Minimed pump for several years, I wanted to try the Omnipod. It is extremely expensive. I ended up buying the Tandem tslim. I will also be changing from Dexcom to Freestyle Libre 2.5 now that it is compatible with my pump.
I may have answered incorrectly. I said “yes” because cost is a factor in just about every decision I make. However, my health insurance covers my technological devices. But, I wouldn’t order something that was too expensive for me to pay.
Insurance stopped paying for Medtronic 670G sensor, so switched to Dexcom G6 for coverage, and when pump warranty expired, switched to Tandem Control IQ for algorithm pumping.
No. No calibrating sensors and no tubing did!!! God has always provided enough money for what my family needs. Not wants, but needs. We are so blessed.
I’m very lucky that Medicare + supplemental insurance completely covers all of the devices that I want to use. I didn’t have to change anything devise-wise when I turned 65.
My insurance covers next to nothing as far as diabetes devices goes. So I have to pay full price to use the libre 3 system which is significantly cheaper than any of the other options. I can’t afford a pump either so I do MDI.
My insurance covers Libre sensors completely but not Dexcom … Libre is what I’m using.
I would love a tubeless pump like Omnipod but Medicare won’t pay for it under part B as they do tubed pumps.
Monthly pump supplies were expensive even with my private insurance. Switched back to MDI and couldn’t be happier. Great A1Cs and no tubing! My sleep is better without a pump. So glad I switched back to MDI.
I said no, but not because I didn’t consider the cost. It always has an impact on our budget. But because managing my diabetes is a priority that forces compromise elsewhere.
No, you can’t put a price on better diabetic care
Unless you simply do not have the funds.
Back in 2007, yes. Now, no.
2007 – first pump but insurance didn’t pay anything towards CGM. That was $ 500 out of pocket plus supplies monthly to add that piece of functionality. Wasn’t until 2012 that I had insurance that would cover 80% of CGM. Now, I have 2 insurances and everything is covered 100%.
I’m well-controlled with MDI & know that switching to an insulin pump would increase costs & force use of a mail order medical supply company which is a huge hassle compared with a local pharmacy. This is one big reason I’m not using an insulin pump.
Insurance decided that for me
Medicare dictates what technology I use in addition to what kind of insulin I use.
I high start-up cost, as for pumps or Dexcom, had ooten deterred me from giving new technologies a try. High prices made it feel like a large commitment for something I had mixed feelings about.
When the more affordable Libre became available, I jumped on the opportunity. Happy about that choice!
My health insurance covers my insulin but barely makes a dent in the expense for my pump and CGM supplies. It’s a big expense for me. I will probably have to return to MDI therapy. Very disappointed.
🙁
On Medicare the CGM is free so I use that, whereas testing strips cost. I plan to use a pump, but I have to unenroll from my Part D plan first. $500 with Part D but free if I just have Part B.
My endocrinologist said Tandem T Sim X2 IQ so I went with his advice
I’m fortunate to have good insurance and coverage, had I not the answer might well be different!
I selected “No”, but that was for me. I live in the UK (United Kingdom of Great Britain and Northern Ireland) where my diabetes supplies are paid for by our NHS (National Health System), which is funded via direct taxation of all working people that earn more than a set amount.
As I was the first person, in the area that I live, to start using ‘pump technology’, my endocrinologist had to justify the expense to ‘the money handlers’, which he was able to do by comparing the costs of my repeated hospital admissions to what it would cost to furnish me with a pump and related supplies. Even now, some 30 years later, justification has to be made to ‘the money handlers’ when ‘new patients’ are deemed ‘fit’ to try pump technology, even though our NICE (National Institute for Clinical Excellence) has stated that many more patients should be considered for pump technology.
YES, but I answered “other”. Cost prevented me from getting a pump much earlier in my journey with T1D. I waited 62 years before purchasing a pump. After learning that I could apply for financial assistance from Animas, I was able to start pump therapy with their Animas Vibe pump. Two years later the company folded and I was again searching for a way to purchase a pump. At that point I had both primary and secondary insurance coverage. That’s where the “other” answer fits. I decided that I wanted a pump that would pair with a CGM and use AID to lessen my 24/7 burden. Tandem t:slim X2 offered that, but Medicare , my secondary insurance, would not cover the 20% remaining after primary coverage because my Animas pump was only 2 years old. That $900+ amount was a large portion of my savings, but because I was unwilling to return to MDI for the length of time remaining before Medicare would pay, I went ahead and paid the balance out-of-pocket. Using Control IQ has made a tremendous difference over the past 3+ years AND the $940 I paid was later refunded when Medicare ruled against Edwards (the DME supplier) for double billing.
I answered yes, to some extent. As long as Medicare covers it, I’m good.
No. I have been fortunate and have always made sure I had user friendly insurance coverage while I was covered by employers. Now I have a comprehensive Medicare Advantage plan and it covers everything I need except Baqsimi (nasal glucagon) which I prefer to have on hand to treat potential emergency episodes of severe hypoglycemia. I pay $180 out of pocket once a year to have a supply on hand.
However, a T1 diabetes sister friend who gets refills for a $10.00 co-pay with her Medicare Advantage plan (she lives in another town and county in my state) sends me some from her excess supply. We have also helped each other out with sensors, pump supplies and other diabetes self-care supplies when mail order shipments are delayed.
Insulin pumps should be the standard of care for all type 1 diabetics. Why are the manufacturers of these devices are so greedy? I had a minimed 506 for over 10 years. It was built like a freakin’ brick and reliable. These days the devices are made so cheaply. They break if you blow on them hard. It’s a such a shame this question even needs to be asked.
Cost is not THE sole and governing factor re: all our supplies and technology. If I cannot AFFORD it, I cannot USE it.
Yes, I would have liked to remain on Omnipod but they stopped distributing their only version available via DME (Eros/Classic) so I switched back to Medtronic instead of having to pay for DASH via Pharmacy.
Yes. I chose Tandem because it’s covered by Medicare Part B, so that with my supplemental plan, all expenses are paid. If I had chosen OmniPod, it would’ve gone through Medicare Part D and I would’ve had to pay co-pays out of pocket. My supplemental plan covers only items covered by Medicare Part B.
We are fortunate to be able to cover the huge out of pocket costs at the beginning of year to get the supplies and medicines that works best for him. This is a HUGE equity issue and encourage everyone to message their legislators to be more inclusive/less barriers to obtaining CGMs and pumps on Medicaid and Medicare.
My endocrinologist plays a part in my decisions about managing my T1D; my pump will be 5 years old in June and I’ve heard that Medicare will replace insulin pumps after 5 years. My endocrinologist said to stay with my Tandem Tslimx2 pump. This week I also started using the Dexcom CGM 7 and so far it’s been great and more accurate than the CGM 6 was.
I took into consideration what brand(s) my insurance would cover. So, I answered Yes because of this. My out of pocket was not a consideration though.