Managing diabetes can be expensive, and continuous glucose monitors (CGMs) are a significant advancement in diabetes care but also come with costs. If you’re looking into ways to make diabetes management more affordable, especially concerning CGM costs, you might be wondering about patient assistance programs. Specifically, you may be asking: will programs like the Lilly Cares Foundation cover the cost of CGMs?
Patient assistance programs (PAPs) are designed to help individuals who are uninsured or underinsured access the medications they need. Pharmaceutical companies often offer these programs to provide support for their own medications. While the original announcement from Novo Nordisk focused on reducing insulin costs and enhancing their patient assistance for insulin, it highlights a broader need to understand how PAPs work and what they typically cover.
Novo Nordisk, for example, has taken significant steps to lower insulin prices and expand access to their insulin products. Their initiatives, announced in March 2023, include:
- Substantially reducing the list prices of NovoLog® and NovoLog® Mix 70/30 by 75%.
- Lowering the list prices of Novolin® and Levemir® by 65%.
- Matching the prices of unbranded insulins to their branded counterparts.
These changes, effective from January 1, 2024, aim to ease the financial burden of insulin for many. Novo Nordisk also offers a robust Patient Assistance Program. To be eligible for the Novo Nordisk PAP, individuals must:
- Be a U.S. citizen or legal resident.
- Have a household income at or below 400% of the federal poverty level.
- Be uninsured or enrolled in Medicare.
- Not be enrolled in other government assistance programs like Medicaid.
This program can provide free insulin for 90 days to eligible individuals. Additionally, Novo Nordisk has programs like My$99Insulin, follow-on brand insulins at reduced prices, immediate supply programs for emergencies, and the availability of ReliOn™ insulin at Walmart for a lower cost. Copay savings cards are also available to help those with commercial insurance.
However, when it comes to CGMs and programs like the Lilly Cares Foundation, the coverage landscape can be different. It’s crucial to understand that PAPs are typically medication-specific. Programs like Lilly Cares primarily focus on providing assistance for Lilly medications. While Lilly does manufacture diabetes medications, including insulins, the Lilly Cares Foundation program primarily assists with Lilly medications, and it is less common for pharmaceutical PAPs to cover devices like CGMs.
To determine if the Lilly Cares program covers CGMs, you need to directly consult the program details on the official Lilly Cares Foundation website or contact their program administrators. Coverage can vary, and program guidelines are subject to change.
Generally, coverage for CGMs is more often sought through insurance plans, government programs, or specific device manufacturer assistance programs, if available. Insurance coverage for CGMs has been improving, but out-of-pocket costs can still be significant depending on your plan.
In conclusion, while pharmaceutical patient assistance programs like Novo Nordisk’s PAP and potentially Lilly Cares offer vital support for medication costs like insulin, it is less likely they will extend to cover devices like CGMs. For CGM coverage, explore your insurance options, government assistance, and programs specifically offered by CGM manufacturers. Always verify the specifics of any patient assistance program directly through its official channels to understand what is covered and eligibility requirements. Understanding the nuances of these programs is essential for effectively managing diabetes costs.
