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ASHP SAG Ambulatory Care Pharmacotherapy - A Thought from the Upcoming Diversity, Equity, and Inclusion Podcast

By Michelle Patterson posted 04-02-2022 18:13

  
The increase in use of medical technology over the last few decades has improved the quality of healthcare for many individuals. Technologies such as electronic medical records, remote patient monitoring, and online messaging portals have increased patients’ access to information and improved patient satisfaction.1 However, there are many patients for whom these technologies are more of a burden than a blessing. One of the technologies that I frequently introduce to patients in my practice is continuous glucose monitors (CGMs).

Several studies have shown statistically significant improvements in measures of glucose control including reductions in hypoglycemia and glycosylated hemoglobin. 2,3 However, the use of these technologies can be challenging and intimidating to older adults. When discussing the benefits and potential use of CGMs with adults over 60, I have found that intimidation with new technologies is a common barrier to implementation. Another major barrier is cost. While cost varies among different plan options, many people with Medicare Part D are required to pay 20% of the cost of their CGMs, which may equate to approximately $50 per month. In my practice, many of my older adult patients have limited, fixed incomes and struggle to afford this additional cost, especially since their current glucometers are often covered through Medicare Part B with very little to no copays.

One of the ways I have tried to improve access to these technologies is to offset the cost of a CGM with lower costs from medications. Patients with lower incomes may qualify for patient assistance programs, even if they have Medicare, and this is one way to “find” funds so that patients can afford to use a CGM. What are some other resources or tricks that you have used to help improve access and comfortability with these technologies?

Resources:
  1. Jimenez G, et al. The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review. J Med Internet Res 2021;23(1):e20195
  2. Pratley RE et al. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: A randomized clinical trial. JAMA 2020 Jun 16; 323:2397.
  3. Ruedy, et al. Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: Results From the DIAMOND Trial. J Diabetes Sci Technol. 2017 Nov;11(6):1138-1146. doi: 10.1177/1932296817704445. Epub 2017 Apr 28.
  4. Diabetes.org. 2022. New Medicare Coverage Requirements Make CGMs More Accessible | ADA. [online] Available at: <https://www.diabetes.org/tools-support/devices-technology/cgm-medicare-coverage-requirement-change-accessibility> [Accessed 11 March 2022].
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04-05-2022 20:45

Blake- great question.  At my practice site, we have a group called the Ambulatory Collaborative Care Team (ACCT) that I partner with to get patient assistance program applications completed.  Our social worker does a GREAT job of making sure that we have all of the correct documentation and signatures needed for the applications, which saves me tons of time.  

I definitely think it can be difficult to balance administrative time and clinical time, especially in a full time clinical specialist role.  One of the recent changes I have made in my clinic is cutting back one half-day of clinic appointments so that I can have a little more time to dedicate to things like paperwork and scheduling calls.

04-04-2022 21:55

Michelle, that's a really great idea to leverage reducing costs of other medications to bring CGM copay's within an affordable range. I feel we often have to be that trouble-shooter, problem-solver in clinic and this is a great suggestion! I know clinic resources are often stretched. Does your clinic have a dedicated team for medication assistance or does this fall back on the pharmacist? If it falls back on you, how do you balance the administrative work while still being productive with clinical work?