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Dolla-betes



Healthcare is such a tricky subject. Ironically, it seems the conversation has shifted away from health CARE in favor of divisive politics with a healthy side of cash. But I'm here to tell you there are real people dealing with real diseases behind all those numbers. And with a laser focus on the rising cost of insulin lately and advocacy groups like #insulin4all making waves, it prompted me to take a look at my own T1D cost breakdown.

**Please keep in mind I have (pretty good!) private insurance through my husband's employer and our income allows us to absorb these costs without pinching too many pennies. We have also been graced with good health (diabetes notwithstanding) and rarely order any prescriptions outside of those for my T1D. But its clear only a slight shift in this delicate equation can make for a dire situation.

Here's what my out-of-pocket looks like to cover type 1 diabetes annually:



The numbers above reflect simply the "baseline operating costs" of this disease - they don't include things like an insulin pump refresh (that will be on next year's bill since it is refreshed every four years), or extra backup supplies like insulin pens, needles or glucagon kits (I had enough saved from last year). It also doesn't include things like glucose tablets for raising low blood sugar, adhesive patches to keep sites on longer or special lotion to ease adhesive irritation after site removal.

Even with great insurance, this is not a trivial amount of money.    

And as an engineer who faces risk trades literally every single day, the trades involved with diabetes treatment at the insurance level are stunning. The treatment options that give me the most data and therefore allow for the most fine-tuned dosing decisions and control, staving off costly complications later in life, cost as much as rent in some parts of the country. The insurance plan we have financially encourages the use of standard blood glucose checks via finger prick - providing the meter and "unlimited test strips" at no charge. I use quotes there because the meter sends the blood sugar data to a central server via mobile network - it just so happens our house seems to be smack in the middle of a dead zone for whatever mobile carrier the service uses and therefore the readings never make it to said server. When I attempt to reorder test strips I am met with an error that I "still have plenty left" - a frustrating side effect of connected (or disconnected in this case) technology. This is all besides the fact that I can simply wear a sensor that will alleviate the need for finger pricks and provide blood sugar data every 5 minutes with trends instead of a random data point 4-5 times per day. 

The most stomach turning of all the price tags is insulin itself - the drug that sustains my life, a biologic of a naturally occurring human hormone. The exact insulin formula I use was approved by the FDA 23 years ago - so, not exactly a cutting edge magic potion. However, Bloomberg News recently reported that this brand of insulin, Humalog, increased it's list price 138% between 2009 and 2015, while the net price to the manufacturer increased by only 6%. That's a hard pill to swallow (or injection to take?) when so many middle men in the insulin supply chain are benefiting and forcing terms like "insulin rationing" to enter the patient lexicon.  

All of these confusing insurance terms and high deductibles and technology risk trades seem like a 180 from those early days of insulin discovery. Before Fredrick Banting discovered insulin in 1922, type 1 diabetes was a death sentence - and it was in this spirit, the spirit of providing life saving treatment to all those who needed it that Banting sold the patent for only $1.

As national diabetes awareness month comes to a close I think its important to shed light on these financial side effects of living with a chronic disease. Unlike a pregnancy or other "temporary" medical condition like a broken bone or corrective surgery - these costs come rain or shine, every single year. No chance to save up for a big procedure or bank on a recovery year after an unexpected medical bill. Diabetes is expensive, and tight management requires mental and financial agility. 

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