1. Cory Page PharmD.

2.  Understand the economic burden of medications.  Is the newest medication always the best medication?  Review cost saving measures  Needy Meds  Drug Coupons  Pharmacy Shopping

3.  Diabetes complications substantially increase the risk for hospitalization. In 2007, over 24,000 discharges for Utah residents listed diabetes as any listed diagnosis, with charges amounting to over $480 million.  Diabetes is the sixth leading cause of death in Utah. In 2007, diabetes contributed to one out of every 13 deaths in Utah, or over 1,100 deaths.

4.  The average patient with diabetes takes 6 medications on a daily basis.  Is asked to test their blood glucose 3 times daily  Pay usual bills  Has an increased risk of hospitalization  That hospitalization will cost approximately 30% more than other patients admitted with the same diagnosis

5.  Specifically in Utah County  Survey of 23 Pharmacies ▪ 6 Independent ▪ 17 Retail IndependentRetail Novolog2 Vial $ 229.56 $ 233.46 Lantus2 Vial $ 205.76 $ 210.03 Metformin 1000mg60 Tab $ 12.93 $ 15.75 Amaryl 2mg60 tab $ 14.67 $ 16.06 Byetta1 box $ 290.50 $ 299.39 Victoza1 box $ 398.85 $ 420.65 Januvia 100mg30 tab $ 212.40 $ 219.76 Total $ 1,364.68 $ 1,415.08

6.  It is important to note that this only accounts for the cost of medications used to treat Diabetes.  Not Hypertension  Not Dyslipidemia  Not Depression  Not Neuropathy  Not Nephropathy  Not Pain  Not Anxiety  Not Osteoporosis

7.  How do we help our patients to save money and enhance their compliance.  Ask them if they currently have their medications at home to take. ▪ Many patients are ashamed to admit they can’t afford their medication  Ask them if there has been any change in insurance and/or employment since their last visit.  Help them to use their insurance coverage fully.

8. Medicare Part D Donut Hole? Initial phase after deductible met patient pays 25% of drug cost up to $2830. After this amount is reached the patient is responsible for the TOTAL drug cost until the out of pocket expense reaches $4550 After this amount is reached the patient is responsible for a co-pay of $2.40 for each generic drug and $6.00 for other drugs (or 5%, whichever is higher). Beginning in 2011 The patient who has reached the donut hole will only be responsible for 50% of the cost of medications Beginning in 2012 The patient who has reached the donut hole will only be responsible for 25% of the cost of medications Beginning in 2013 There will be no donut hole!

9.  Medicare Part B helps pay for  Diabetes screening tests for people at risk of developing diabetes  Diabetes self-management training  Diabetes supplies such as glucose monitors, test strips, and lancets  Insulin pumps and insulin if used with an insulin pump  Flu and pneumonia shots  Foot exams and treatment for people with diabetes  Eye exams to check for glaucoma and diabetic retinopathy  Medical nutrition therapy services for people with diabetes or kidney disease, when referred by a doctor  Therapeutic shoes or inserts, in some cases

10.  Medicare Part D helps pay for  Diabetes medicines ▪ There are plans that do not have a donut hole! ▪ www.medicare.gov www.medicare.gov  Plan finder—you can enter in the medications that a patient is on and find the “best” plan for that patient.  Insulin, but not insulin used with an insulin pump  Diabetes supplies like needles and syringes for injecting insulin (not pump reservoirs)

11.  www.needymeds.org www.needymeds.org  Drug company sponsored patient assistance ▪ Each company has their own program. ▪ Patients who qualify receive their medications for 1 year free, and then they may re-qualify. ▪ Income based ▪ Signatures needed from provider

16.  Products include  Lantus  Apidra  Avapro  Lovenox  Plavix

17.  www.xubex.com www.xubex.com  Free medication  Discounted medication  Drug company patient assistance

18.  Government subsidized clinics  Mountainlands (UT county) ▪ Subsidized healthcare ▪ Office Visits ▪ Medication  http://www.freemedicalcamps.com/vcity.php?stat eid=UT http://www.freemedicalcamps.com/vcity.php?stat eid=UT

19.  Drug coupons ▪ Coupons are available for Humalog®, Novolog®, Januvia®, Janumet®, Lantus®, Onglyza®, Victoza®, Glucagon® ▪ Many of the coupons are for a free 30 day supply or an instant rebate at the pharmacy ▪ Medicare or Medicaid individuals may be excluded from offers

20.  www.needymeds.com www.needymeds.com  Family of 5 may earn $51,580  Free Medication mailed to the physicians office every 3 months.  Must fax in refill request form for refills  Medications include  Levemir  Novolog  Victoza  Novolog Mix 70/30  Novolin R  Novolin N  Novolin 70/30  Pen Needles  Glucagon Kit

21.  www.bridgestoaccess.com www.bridgestoaccess.com  Register to become an advocate ▪ Pharmacist ▪ Nurse ▪ Physician ▪ Family member over 18  Family of 4 may earn $55,125  Medications for 1 year free of charge in addition to a voucher for 1 month free at a retail pharmacy for the medication.

22.  Medications include  Avandia® ▪ Avandaryl ▪ Avandamet  Lovaza  Antibiotics ▪ Augmentin etc.

23.  www.needymeds.com www.needymeds.com  Family of 5 may earn $55,125  Medication mailed to physicians office every 90 days ▪ Refills handled by phone  Medications include ▪ Lantus ▪ Apidra

25.  Products include  Accupril  Protonix  Caduet  Calan  Celebrex  Glipizide  Lipitor  Lyrica  Norvasc  Viagra

27.  Products  Cialis  Cymbalta  Glucagon  Humalog, Humalog Mix 50/50, Humulin 70/30  Humulin R  Humulin N  Humulin R U-500  Prozac  Byetta

28.  Freestyle Meter  Freestyle Test Strips

29.  You are a US resident and have a prescription for a Merck medicine from a doctor licensed in the United States.  You do not have insurance or other coverage for your prescription medicine. Some examples of other insurance coverage include private insurance, HMOs, Medicaid, Medicare, state pharmacy assistance programs, veterans assistance, or any other social service agency support.  You cannot afford to pay for your medicine. You may qualify for the program if you have a household income of $43,320 or less for individuals, $58,280 or less for couples, or $88,200 or less for a family of 4.

30.  Januvia  Janumet  Hyzaar  Cozaar  Vytorin