Tuesday, May 16, 2017

The Cost of Diabetes

Since the Trump election, I have watched with growing concern, my American friends comments and fears (on Social Media) about the cost of their basic needs for living with Type 1 Diabetes.
I am appalled that people have to beg the manufacturers to get insulin, I am appalled that insurance companies can dictate which 'brand/s' of insulin and other supplies, they will cover. I feel humbled by the knowledge that our system here in Australia, whilst far from perfect, ensures that everyone can afford their basic life-saving medication, and no-one, even the unemployed have to go without access to insulin. I guess you will see lots of posts that detail the actual expenditure to access supplies here in Australia, I'm not sure you will see many that explain how the system works.
We have a system which affords every Australian two things, basic treatment and basic drugs.
The system is made up of the following parts.
1: Cover under the Medicare legislation.
This cover guarantees treatment for basic health at General Practicioners and Hospitals.
People who are employed pay a 1.5% levy on their tax to help fund this. This levy will increase soon, but not by much, considering the benefit it gives.
2: Pharmaceutical Benefits Scheme (PBS)
PBS is like a government funded insurance scheme for supply of Prescribed drugs, ie; drugs that are registered by NHS and Prescribed by a registered Doctor. A prescription or 'script' for drugs may cost $15 or more (depending on the drug). When I get a script for insulin, my doctor will write a script for about 3 months supply and it will cost me about $15.
3: Private Health Insurance, (PHI)
PHI offers higher levels of health cover - private hospital, physio, dental, prosthetics, etc. I think that most PHI costs between $1500 and $3000 per annum. They don't usually cover supply of drugs, but may offer 'gap' insurance to cover out of pocket expenses.
4: Social Security Health Care Card 
The Health Care Card is available if you are unemployed or on a very low income. It allows you to purchase prescribed PBS drugs at an extremely low cost - about $6 per prescription. So if you are unemployed and need Insulin, your doctor will write a script for about 3 months supply of insulin and you will pay $6 for that supply.
5: Extra Medicare benefits for the chronically ill
Type 1 diabetes is recognised as a chronic illness here in Australia. GP's are allowed to refer us for other treatments at a reduced cost, mental health care plans, podiatry, optometrist, dietician advice and other allied health care needs that will enhance health care for us.

All the government funded schemes only cover basic needs, insulin, syringes or pens, glucometers & strips. Insulin pumps and cgms are not subsidised (for adults) and you need PHI to be able to access them. This is slowly changing. Some years ago insulin pump consumables, (sets and reservoirs) were added to PBS and now cost me about $80 for 3 months supply. CGMs are not covered for either sensors or transmitters. Some PHI's will cover the transmitter. This situation is evolving with our government committing to supply insulin pumps for under 18yr olds, and more recently, CGMS on a limited basis (for about 4000 children, there are 15,000 T1 children under 18 in Australia).
I think that the technology is improving so rapidly, that they are taking a cautious approach to funding.

On a personal level, I believe that access to insulin is a basic human right, as should be access to any life-saving drug, including proven cancer treatments. I am also well aware that hundreds of thousands of people globally, are completely denied any access to this drug at all.

In the balance, we need to convince governments that every dollar spent on supporting our access to
premium health care, will be returned and multiplied by the reduction of the need for support for associated long term complications and by the ability of the person with Type 1 to live a full and productive life including paying taxes.

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