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Cost variances/Pump Interest

Discussion in 'General Discussion' started by RBYH20, Oct 17, 2013.

  1. RBYH20

    RBYH20 New Member

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    Hello, I am new to this site and also new to being a parent of a child with diabetes. My 9 year old son was recently diagnosed in July of this year with type 1 and his doctor at Childrens is pushing to get him started on a pump. He is not showing any interest due to the fact of having to carry it around and being all taped up. lol I have heard nothing but positive feedback but not sure how to get him interested. I am also a "single" parent and was wondering what the cost difference in supplies would be vs using the pen. I have heard that there are supplies needed as well with using the pump. Any advice you can give me would be so greatly appreciated. Thank you and God Bless.

    ~Rhonda~
     
  2. mamattorney

    mamattorney Approved members

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    I think it's great that his doctor is so encouraging of a pump, but if your child is not on board, then it will be a tough sell. I have nothing but positive things to say as well, but there are plenty of people who manage just fine on MDI and if my 10 year old daughter did not want to pump, she wouldn't be pumping, no matter the positives. That's why she doesn't have a cgm. I'd love it, but she's not ready, so therefore, there is no cgm in this house. That's just me though. To encourage him, I would point out the reduction in needles (one every two or three days vs. 5+ every day), ability to easily take seconds at dinner or "graze".

    As for cost, the easiest thing to do is call your insurance company and ask. For my daughter, it's actually cheaper for her to pump insulin than to use pens. But that may just be the way our insurance coverage breaks down.

    I did this comparison before I encouraged her to make the switch because I wanted to know the cost difference.

    Here's what you need to know when you call when getting pricing:

    On MDI, you have:

    - two prescription insulins: humalog/novalog/apidra and Lantus/Levemir
    - test strips
    - sharps (pen needles, syringes)
    - lancets

    I would figure out what this costs you out of pocket on an annual basis.

    When pumping, you have:

    - the pump (one purchase every four years) unless he chooses the omnipod

    recurring:
    - one prescription insulin: humalog/novalog/apidra
    - insulin cartridges/resevoirs (or pods if using omnipod)
    - infusion sets (none if using omnipod)
    - test strips
    - lancets

    You need to figure out the cheapest way to obtain the pumping supplies and to do that you will have to have a good understanding of your durable medical equipment benefit. How high is your deductible? What happens after the deductible is met? Is it 100% coverage, 80% coverage or something else?

    A tubed pump, infusion sets and cartridges are all durable medical equipment.

    Test strips and lancets, for us, are either prescription or durable medical equipment.

    Our policy has a pretty low deductible and once that's paid, everything else costs $0 out of pocket. As a result, it makes more sense for us that we order our test strips through durable medical equipment because we will reach our deductible after our first supply order of the year.

    For others with a high deductible or other constraints (maybe there is 80% coverage after the deductible is paid or something), it might be cheaper to pay for test strips through prescription coverage. You just need to work it out on paper.

    Anyway, just run the numbers and compare both methods on an annual basis.
     
  3. RBYH20

    RBYH20 New Member

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    Wow--Thank you so much! I didn't expect such a fast response and a PERFECT one at that! You helped calm my fears for sure and answered all my questions. Your reply was EXACTLY what I was looking for! Thanks again!! :D
     
  4. Johan'smom

    Johan'smom Approved members

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    Hi Rhonda - My son was diagnosed at 12 and showed no interest in the pump either...... until he went to Summer Diabetes Camp. He came home from camp that first summer and told me about all the new friends he met and how ALL of them (most of them...) were on a pump and he wanted one too. It turns out, our insurance covers the pump and all the supplies so the only thing we pay for the the $10 copay for Humalog every 3 months. It was actually a cost savings for us.
     
  5. missmakaliasmomma

    missmakaliasmomma Approved members

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    If your son doesn't want a pump, I wouldn't push it. We are one of the few people who did not like pumping. We had ALOT of issues within the 5 months. Most people really do love it but I was so happy when we stopped pumping. Everyone says it's so much easier, but I don't care what's easy, I care what my daughter wants and does better on and what suits us. MY daughter is much happier without something attached to her that she has to watch when she goes to the bathroom. She doesn't mind the shots at all, and since I've poked myself with her needles, I know that they don't hurt at all. I'm almost certain regular shots are cheaper than the pump supplies but how much cheaper (and if it really makes a big difference) I really don't know.
     
  6. Joretta

    Joretta Approved members

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    You can look online there are lots of photos of kids wearing various pumps.
     
  7. meganmac

    meganmac Approved members

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    Even though the original question was asked a few weeks ago I thought I would chime in about other cost associated with the pump that wasn't included.

    Batteries, battery camp replacement, cartridge cap replacement, iv-prep, uni-solve, skin-tac (or other tapes and things to keep the sites in place) and if your child is young like mine, several "pump packs" every year. All of these things can easily add up to another $100 every couple of months. As far as I know, insurance doesn't normally cover these extra things, but some people with excellent insurance can get them covered.

    For us, pumping is much more expensive than MDI, but worth it for our family. After 3.5 years, our pump started mal-functioning. It took 2 days to get a new one in the mail and we did 10+ shots. My son was not happy. Also, as they grow and need more insulin, we've found that a 8+unit shot can be painful. 1 or 2 units is nothing. On the pump, you can set it to bolus slowly, so it will push in the 8 units over a period of time instead of all at once.

    Just another opinion. I went into the pump without researching the costs and was shocked at how much it cost us. After large deductible, our insurance will sometimes cover 80%:mad:. If I have to order pump supplies in January before deductible is met (only made that mistake once) the bill can exceed $1000:eek:.
     
  8. meganmac

    meganmac Approved members

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    And I should add that you still have to buy long lasting insulin from time to time. You need to keep it on hand in the fridge in case the pump fails. We've probably purchased 2 vials of lantus every year, even though we're pumping.
     
  9. Don

    Don Approved members

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    It took me years to understand how insurance coverage works and I kept making errors in comparing the cost of MDI vs pumping. Insulin and needles are typically covered as a "pharmacy" benefit for which you pay a certain copay. Pumps and pump supplies are considered Durable Medical Equipment (DME) and you pay a DME copay which varies by plan (typically 20-50%). But you first pay 100% of DME charges in every calendar year until your deductible is met (typically $500-$1000). Of course, pumping will save you on the cost of needles and long-acting insulin, so you have to subtract.
     
  10. MomofSweetOne

    MomofSweetOne Approved members

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    We did MDI for a year because my daughter adamantly didn't want to be connected or taped to anything. She changed her mind when we started CGM shopping & our rep showed her the pump. Now she wouldn't switch back for anything given a choice. The pump makes life much more simple - the closest to life pre-D it can be at this point - but it has its own stresses that MDI doesn't. Trying to problem-solve what is causing a high now involves kinks or pulled out sites. The ability to temp basal higher or lower is something I wouldn't want to give up with puberty, though.

    There's not a right or wrong decision. The goal is good control & that can happen with either. I do believe with puberty, pumping and CGMing contribute best, but we've never manage to match our last A1C on MDI because one month later puberty hit with a vengeance.

    The pump companies are happy to do trials; it might be beneficial to talk to them and let your son try wearing one so that he knows and understands its potential. I think my daughter would have switched sooner if we'd done that, but I was being a very protective mama bear about respecting her choice.
     
  11. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

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    We've been pumping for about 8 years and I've never bought a battery cap or cartridge cap. If I needed one I called the pump company and they sent one. Baby oil works as well as anything to remove sites, alcohol preps as well as most folks need. In other words, you can spend a lot or a little on the extras. It needn't be much.
     

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