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It’s day two of the eighth annual #DBlogWeek, created by Karen from Bittersweet Diabetes. This is the sixth year I’ve taken part and it’s a great opportunity to not only write about some truly interesting topics, but also a chance to read some blogs you may not otherwise.  Make sure you check out the list for today’s posts here.

Today’s prompt: Insulin and other diabetes medications and supplies can be costly.  In the US, insurance status and age (as in Medicare eligibility) can impact both the cost and coverage.  So today, let’s discuss how cost impacts our diabetes care.  Do you have advice to share?  For those outside the US, is cost a concern?  Are there other factors such as accessibility or education that cause barriers to your diabetes care?  

Diabetes is an expensive condition with which to coexist. Every now and then, I tally my annual diabetes expenses, at which point, the reason for my frequent flyer status at the pharmacy becomes more than apparent. Between insulin, insulin pump consumables and blood glucose strips, it doesn’t take long for the costs to add up.

Then I add the fees to see diabetes-related HCPs. I choose to see all my HCPs privately, so there is a gap (out of pocket) cost for all these appointments. Fortunately, pathology is bulk-billed, so I don’t pay to have my A1c checked or for any other blood work.

Private health insurance (PHI) is a significant cost each year. We pay about $450 per month to cover the whole family for top hospital and extras cover. PHI means that every four years, the full cost of my insulin pump replacement is covered, and it also means a choice of doctors if we’re in hospital, subsidised stays at a private hospital, and we claim optical, dental and orthodontic each year, plus other things as well.

I wear CGM every day of the year, which adds about $4,000 per year to the tally.

It’s a lot of money. Without factoring in incidentals such as hypo treatments and other things that just seem to come up, my out-of-pocket expenses for diabetes (excluding health insurance) would be about $6,500 per year.

And yet, I feel oddly fortunate, because there are few surprises – or changes – each year when it comes to my medical expenses. I know how it will all play out in the family budget each year.

I know the prices that I pay for all my diabetes expenses are pretty much set, and that means I can plan for them.

I know that every time I walk into the pharmacy to fill an insulin prescription, I will hand over $38.80 for five 10ml vials of insulin. We are never at the mercy of Big Pharma’s arbitrary price hikes. (Last week’s announcement from Lilly of a 7.8 per cent increase on the cost of Humalog – after years of substantial increases – has left me reeling and astonished at how my American friends can afford to just survive with diabetes, let alone live or thrive…)

I know that my diabetes consumables will be the same price every time I order them thanks to the NDSS. The National Diabetes Services Scheme (NDSS) is celebrating 30 years this year – that’s 30 years of subsidised diabetes supplies for all people living with diabetes.

I know how much my doctor will charge me and I know the Medicare rebate. And I know that if I was unable to afford to see my doctors at their private offices, I’d have access to the free diabetes clinic at the tertiary hospital less than 10 minutes from my home, and a bulk billing GP of my choice.

I know that if I couldn’t afford private health insurance, my ability to buy insulin, diabetes supplies or see healthcare professionals would not be affected.

I know that there is no time that I will need to ration insulin doses. I know there will be no time that I cannot afford to see a doctor. I know my pharmacy will always be able to provide me with the supplies I need to live with diabetes and drive the devices I use to manage as best I can. I know I am not really limited by maximum rebate amounts or that if I need more BGL strips, I can get them.

And I also know – and acknowledge – the privilege that allows me to afford health insurance that pays for my insulin pump, and to self-fund CGM, and to see the endocrinologist of my choice privately.

I know there are many other Australians with diabetes who are not as fortunate.

The outcomes for Indigenous Australians are worse – far worse. Poorer Australians have poorer health outcomes. People living in remote areas often struggle to access decent, timely and appropriate healthcare. Australians from CALD backgrounds may not understand a new diagnosis or the treatment being prescribed which affects how they manage their health.

Our system here in Australia is not perfect and we should be continually striving to do better. But it is certainly better than in a lot of other places. The thing about diabetes is that, as many of us wrote yesterday, we are wrangling a health condition that likes surprising us. We often feel we are fighting our own bodies. We shouldn’t need to fight to afford our care – and our health – as well.

The cards that cover my diabetes – and other health – needs. (Oh – and a credit card for all the out-of-pocket expenses…)

Cookies!

Cookies!

I’ve just had a wonderful long weekend where pretty much every moment we were home, the oven was on with cakes, biscuits and pies filling the house with beautiful smells.

I spent the time out of the house doing the things that build me up – playing in the park and soaking up the sun, visiting bookshops, going to galleries, drinking coffee. We added artwork to our SHAG collection and I added a couple of new bracelets to my Kate Spade arsenal. I danced to Taylor Swift in the kitchen with my girl and watched Better Call Saul with my boy. Family dropped in, cups of tea were drunk, neighbours were visited. I took a Twitter break. We chased the moon. International Women’s Day was marked.

It was a good weekend – a great weekend.

Now showing on the wall in our living room.

Now showing on the wall in our living room.

And yet.

I start the week with a ball in the pit of my stomach and am incredibly distracted. I have an appointment tomorrow with my endo. And I am terrified.

It’s been too long since I last saw her. And if truth be told, I really don’t want to see her. I don’t want to sit there and discuss diabetes – my diabetes – and talk about how I have really dropped the ball. (Understatement.)

I don’t want to talk about the burnout that has overwhelmed me for so long and even though I feel myself emerging – there are glimpses of brightness – I don’t want to admit just how much it has affected my diabetes self-care.

I don’t want to discuss complications screenings. I don’t want to talk about them. I don’t want to know. I don’t want to face things.

I don’t want to sit in her office and cry, which I know is exactly what I will do the moment I sit down and she asks me how I have been in her incredibly non-judgemental, beautiful, concerned and caring way.

New jangly bracelets.

New jangly bracelets.

Throughout the last few days, in the middle of all the lovely stuff, I have paused and taken stock and thought of my upcoming appointment. I have thought about how it will play out. I have considered how, after the tears and admissions of feelings of guilt, I will leave feeling stronger and more determined – I always do after seeing my endo. But I am still scared and anxious about it all. I know that the truth of what has been going on scares me and the possibility of what has been going wrong. All of this terrifies me beyond belief.

I needed the long weekend to build me up and help with my resilience stores and I feel that it certainly did that. My support network is strong and I have people around me who are so gentle in the way the support and encourage me to live well with diabetes.

So with this in mind, I am focusing on getting through the next couple of days. And what happens after my appointment.

An expensive trip to Readings

An expensive trip to Readings

A full biscuit tin, an armful of noisy bangles, a library of new books and a gorgeous new Josh Agle artwork on the wall are all helping and keeping me grounded. All things I need as I face a tough week.

It’s #DBlogCheck day. Read about it here and go and give some love to – and leave a comment on – some of the diabetes blogs out there that help make up this wonderful community.

Apparently there is more to write about than diabetes. (The photo is blurred, but the book’s title is 642 Things to Write About.)

Things to write

 

After a busy #dblogcheck day, I’m not sure I believe that….

Totally irrelevant, but this was taken on a cold Friday night in Readings, Carlton at an in-store performance by local guitarists Paul Carey and Julian Scheffer. Check them out here, just jamming in the kitchen….As you do.

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