The dollars and sense of diabetes tech: How I talk with patients when tech cost is a barrier

I’m talking with a new patient: a woman with type 2 diabetes (T2D) who has recently started taking basal insulin. She’s detailing her daily grind as a working mom, and she strikes me as a possible candidate for a continuous glucose monitor (CGM). She’s clearly fed up with finger sticks.

I ask her what she knows about CGMs. She’s heard of them and she’s interested, but I hear hesitation in her voice. I suspect the conversation may soon pivot to money.

With diabetes tech, cost has to be part of the conversation. But I’ve done this long enough to know that if the financial commitment is a barrier, I want her to bring it up. We keep talking, and I ask questions inviting her to talk about what’s stopping her. 

Soon she raises her concern, but she doesn’t say, “I can’t afford it.” She asks, “Will it be worth the cost?” 

And now we’re having the conversation we both want to have.

Show patients what they’re getting for their money

I think for many patients, their financial concern comes from not realizing the value of using the tech. I try to give these individuals a glimpse of the information different diabetes tech may provide. 

Sometimes providing examples may be enough. For instance, I might

• Show my patients a graph of CGM data from a sample Ambulatory Glucose Profile (AGP) report¹
• Let them see the precision of a digital insulin dose log compared to a notebook²
• Pull up diabetes management apps on my smartphone and explain their features³

When discussing how much a patient is willing to spend on diabetes tech, help them see the value it may add to their self-management.

But my favorite way to open someone’s eyes to tech is to let them experience it. Fortunately, free trials may let them do that without spending a dime.

I worked with a middle-aged man with T2D, also on long-acting insulin, who was candid about his tight budget. He didn’t want to lay out money to get, as he said, “a bunch of numbers in my face.” To him, diabetes data seemed like a confusing, meaningless fog. Why would he spend his hard-earned money on that? I had to help him see the numbers as something meaningful. 

So we started talking about how and what he ate, and I gave him some examples of the “if you do this, then that” relationship between his basal insulin, his food, and his glucose levels. That made sense to him—he liked the idea of being able to see the cause and effect of his actions on his blood sugar.

When I told him that a CGM and a food tracking app might help him see it even more clearly—and when I assured him it wouldn’t cost him anything—he agreed to a 2-week trial of both.

After 14 days of logging his meals and looking at how his glucose levels responded, he came back with a completely different opinion of diabetes tech. The first thing he said was, “I had no idea I ate so much!” 

He promptly started cutting back his portions at meals, and he saw the difference it made in keeping his glucose levels in their target range. In the longer term, it helped his A1C as well. “Aren’t you impressed?” he said. “I learned something!”

Express empathy for people’s financial stress

There’s no getting around the fact that tech can be expensive. When suggesting tech, I think about facing the same challenges as my patients. I don’t have diabetes, but there have been times in my life when I’ve felt stressed about money. As a provider, I try to keep that feeling front of mind when we talk about making tough financial decisions.

I always remind myself to take their financial situation into account. I’ve had frustrated patients tell me their primary care providers don’t know what they go through with money. Patients facing financial challenges sometimes tell me that when providers talk about tech as if it’s free, or if they downplay the cost, they may lose trust or question whether the provider understands their needs. 

The flip side of that is when providers assume their patients can’t afford technology. They might not even recommend it, making people feel excluded from the decision-making process.⁴ Either way, I think it shows a lack of empathy from the providers. 

I believe we as providers need to show our patients the value of diabetes tech, but we also need to acknowledge the real financial impact it can have. When patients tell me about their financial concerns, I might reply by restating what they’ve said. I want them to know I’m listening and I’m on their side.

Crunch the numbers

I want to know what real dollar amounts mean to my patients. Can they afford $50 a month? What about $20? Or $10? What might they have to give up to make that copay fit their budget?

When we’re having these conversations, I think it’s important for me to tell them how much the tech may cost. I like to know the going rate for any tech I recommend, including any monthly supplies, and I try to keep current with options for less expensive pharmacies or supply vendors. 

Whenever possible, it helps to familiarize myself with each patient’s insurance coverage before meeting with them. I do my best to stay current with insurers’ typical coverage for diabetes devices—major commercial insurance providers, Medicaid in my state, and Medicare. There are too many different plans for me to learn them all, so I do my best to estimate general cost compared with cash pay prices. I also provide my patients with resources such as Medicare.gov/coverage to find out their coverage for CGMs.

And I’m always on the lookout for manufacturers’ savings offers, free trials, and rebates. The Association of Diabetes Care and Education Specialists (ADCES) maintains a list of cost-saving resources for diabetes tech that my patients find helpful. Any relief I can provide, even if it only saves them a few dollars, can help assure my patients that I’m taking their financial concerns seriously.

Savings offers, free trials, and shopping around for competitive prices may add up to meaningful savings on tech for people with diabetes.

Collaborate and problem solve your way to a plan

An endocrinologist referred a patient with T1D to me whom he felt was a good candidate for an automated insulin delivery system, or at least a CGM and insulin pump. But the patient refused to discuss it. He was 23 and had been using a glucose meter and injecting insulin since childhood. 

When I spoke with him, he pointed out that he wasn’t opposed to tech on principle. He simply said, “I’m not willing to shell out cash when what I’m already doing is working.” 

I believed him that he felt fine, but I wondered if he might be using the cost as a reason not to consider anything else. 

I asked him what price range would make him willing to try a CGM. He gave me a number, and we found a vendor where he could buy CGM sensors for less than that figure. He’s now using a CGM and making connections between his glucose levels and how he feels. 

When I asked him about an insulin pump, we went through the same discussion. The pump is a bigger initial investment, so he’s still debating whether he’ll move forward with it. He wants to see if he can be satisfied with the CGM and multiple daily injections. 

I see that as a win. He’s weighing the cost and benefits of each device, thinking critically. Money isn’t a total roadblock anymore. He’s figuring out what will work best for him, and the price is just one factor in his decision. 

Everyone has their own comfort level with change. One person may agree to try a device or an app for a specified period. Another may compromise by wearing a CGM intermittently rather than all the time. A third person might get creative with budgeting—finding a recreational activity they can cut back on or a monthly subscription they’re willing to cancel.

If I think a piece of tech may help someone, I’ll gladly work with any efforts they’re willing to make.

Balancing diabetes tech with cost for long-term stability

Money is a concern for many of my patients. The best way I know to help is to acknowledge those concerns up front, talk about what they can realistically afford, and help them identify tech that potentially offers the most value. 

The conversation we have today can help them balance their current priorities, and our ongoing relationship can help them work toward the long-term diabetes management goals they want to achieve.