Beyond Insulin: Insurance Rules Can Slow Delivery Of Crucial Diabetes Supplies : Shots - Health News Type 1 diabetes can be well managed with insulin if blood sugar is consistently monitored. But insurance rules can make it hard for patients to get the medical supplies their doctors say they need.
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It's Not Just Insulin: Diabetes Patients Struggle To Get Crucial Supplies

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It's Not Just Insulin: Diabetes Patients Struggle To Get Crucial Supplies

It's Not Just Insulin: Diabetes Patients Struggle To Get Crucial Supplies

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RACHEL MARTIN, HOST:

The surging price of insulin has become a rallying cry for health activists, but people with diabetes also need other crucial medical supplies, and insurance rules can make getting those an unexpected challenge. Here's Bram Sable-Smith.

BRAM SABLE-SMITH, BYLINE: Managing Type 1 diabetes is about managing blood sugar. If it gets too low, patients risk sudden seizures and loss of consciousness; too high and they risk long-term effects, like vision loss, nerve damage and even limb amputation. Ric Peralta knows these risks well.

RIC PERALTA: I speak very openly about my blood sugar.

SABLE-SMITH: Peralta spent years checking his blood sugar by drying drops of blood from his fingertips and placing them on a device called a glucose meter. Doctors suggest doing this four to 10 times a day, but that can leave even the most diligent testers with large gaps in knowledge about what their sugars are doing.

PERALTA: I didn't realize that I had rather severe peaks and valleys happening in between my mealtimes.

SABLE-SMITH: An optician in Whittier, Calif., Peralta says everything changed last year when one of his patients told him about something called a continuous glucose monitor. It's a small device patients can easily insert under their skin for 10 days that gives accurate blood sugar readings every five minutes or 288 times every day. Peralta called up Dexcom, one of a few continuous glucose monitor makers, and within two weeks, he had the system on his doorstep.

PERALTA: I still didn't even 100% appreciate exactly how it was going to change my life. It was amazing.

SABLE-SMITH: In the first three months, he lowered his average blood sugar by three percentage points. When he took his family on road trips, he used to worry his blood sugar would get so low without his realizing that he'd pass out while driving. Now...

PERALTA: Hey, Siri, what's my sugar?

SABLE-SMITH: ...He can just ask Siri.

SIRI: Dexcom G6 says you're 134 and steady.

SABLE-SMITH: But for Peralta, the problems started when it came time to refill his supplies. The continuous glucose monitor has three parts - the sensor you stick under your skin and also a transmitter and a receiver. Each one requires something called prior authorization. It's a rule from his insurance company that requires his physician to seek approval from insurance to prescribe the device. And while his sensor needs authorization every three months, the transmitter gets it every six months and the receiver, once a year.

PERALTA: Yeah, it's exhausting to deal with.

SABLE-SMITH: Once, the authorization requests for Peralta's sensor and transmitter got bundled together by mistake and the whole order got denied and delayed. He says this kind of mix-up happens a lot.

PERALTA: I've gone at least a month or longer without having any kind of Dexcom unit and having to go back to the old finger prick.

SABLE-SMITH: Kate Berry's with America's Health Insurance Plans, a lobbying and trade group. She says insurers use prior authorizations to guard against large variations in how doctors prescribe.

KATE BERRY: Prior authorizations are in place to protect patients, to improve safety.

SABLE-SMITH: She says insurers have identified five ways to improve the process, but in a recent survey of 1,000 doctors, 91% said prior authorizations have a negative impact on the health outcome of their patients. And endocrinologists like Scott Isaacs, whose specialty includes diabetes, say doctors are getting increasingly frustrated.

SCOTT ISAACS: It's a huge burden for the doctor as well, and they have no way of billing for the time it takes to do these prior authorizations.

SABLE-SMITH: But for Ric Peralta, keeping track is not just a bureaucratic headache. It's a matter of survival.

PERALTA: If I do not have my proper management of this disease, I'm going to die from it. And they're making it as difficult as possible. And it's really frustrating.

SABLE-SMITH: Frustrating because he knows this technology can change lives but only if patients can depend on their supply. For NPR News, I'm Bram Sable-Smith in Madison, Wis.

(SOUNDBITE OF SUN GLITTERS' "WHAT ARE WE WAITING FOR")

MARTIN: That story is from a reporting partnership between NPR and Kaiser Health News.

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