Program Motivates Employees to Reduce Risk, Live Better With Diabetes

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Nov. 4, 2021

Costs related to diabetes in the United States total $327 billion annually. This includes $17,000 in average employer costs for each employee with diabetes. In South Carolina, about 1 in 7 adults have diabetes, the eighth-highest rate in the country. 

About 7 million Americans with diabetes use some form of insulin to control the disease. BlueCross BlueShield of South Carolina’s new program, My Diabetes Discount Program, encourages healthy behaviors by discounting the cost of insulin. 

The cost of insulin has tripled over the last 10 years from about $100 per vial to $275 – $300 per vial with little or no product improvement. Our data suggests members with a higher copay for insulin prescriptions are less likely to keep up with their recommended treatment plans. Research also shows increasing medication costs often prevent patients from taking medications as prescribed.

The BlueCross pharmacy team lead by Dr. Jay Patel, director of clinical pharmacy management, Dr. Joshua Arrington, director of clinical pharmacy management, and Jakki Grimball, a nurse and clinical account manager, was instrumental in creating the program.

“It is increasingly clear that diabetics who have high out-of-pocket costs struggle to afford the medications their doctors prescribe. As a result, their adherence suffers, leading to the development of comorbidities and worsening of their overall condition. We want to eliminate the cost barrier as adherence rates already struggle with insulin,” Arrington says.

Uncontrolled diabetes can cause dangerous health complications. Employees with diabetes require more medications, doctor appointments and emergency room visits. They are at higher risk for cardiovascular complications, such as heart attack, stroke, and diseases of the eyes and kidneys.

In turn, this means higher costs for the employer and increased absenteeism.

In contrast, people with controlled diabetes have a 10-percent decrease in health care costs. 

My Diabetes Discount Program takes a pragmatic, value-based approach to these challenges. The incentive is significant: a copay of no more than $20 for a prescribed 30-day supply of insulin medications. Members in a consumer-driven health plan will have a $0 copay. 

In return, members must complete a program checklist to access the benefit. The checklist includes visiting a primary care provider for a checkup with a diabetes risk factor assessment of feet and eyes, an A1C test twice a year and a comprehensive metabolic panel. Members must also get an annual flu shot and complete diabetes education sessions. 

Members will continue to have access to these benefits as long as they complete this checklist on an annual basis. A health coach will direct them through the program. 

My Diabetes Discount Program works with BlueCross’ weight management program that launched last year. That program, My Health Novel℠, matches members to proven programs to help them achieve their health goals. As part of My Diabetes Discount Program, members must complete diabetes education sessions like the ones offered in My Health Novel. 

Together, the two programs fit within an overall continuum of care that demonstrates how we can manage a member’s care holistically. 

The bottom line is: Every employee who starts taking his or her diabetes medications as prescribed drops plan-sponsored health care costs by about $2,200 per year. 

To find out more about helping your employees with diabetes and lowering your costs, talk to your BlueCross account representative.

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