Having diabetes not only comes with a diminished quality of life and social stigma, it can also be a heavy financial burden. And as any good financial advisor will tell you, wealth planning is not complete without health planning. According to the Ministry of Health (MOH), diabetes is the 2nd leading cause of death in Singapore. Last year, MOH declared a “war on diabetes“, and together with the Health Promotion Board (HPB), they’ve put programmes into place to make healthier food options and exercise more available and more affordable. They have also reduced the cost of diabetes screening and medications. In addition to these, here are some other ways for people with diabetes to control costs.
Diabetes Money Saving Tips
1. Lifestyle Modifications. By cutting out sweetened beverages, juices, and non-nutritious (or empty-calorie) foods, you not only save money (as these foods tend to be “expensive” relative to more nutritious foods), but you will prevent the onset or slow the progression of diabetes. When you’re outside your home, it’s useful to have your own reusable cup to fill with tap water. Many outside dining places will only have sugary drinks or bottled water for sale.
Exercising, maintaining a healthy BMI, and not smoking are other lifestyle modifications that can be both money-saving and better for your health. Join free HPB workouts, or visit subsidised ActiveSG gyms ($2.50 per entry, or free with ActiveSG credits). If you already have diabetes or any major risk factor for it, you can also visit Singapore Heart Foundation’s gym and get subsidised physiotherapy sessions.
2. Medications from a Public Facility. MOH provides subsidies for drugs at public hospitals, specialist outpatient clinics, and polyclinics. So just by going to one of these public institutions to get your medication, you will spend less than if you went to a private institution. But, in order to enjoy these subsidies, you must first consult with a doctor at these sites of service.
3. Medications from the MOH Subsidised Drug List. Often when doctors prescribe medications, cost isn’t their foremost concern. Many of them are unaware of the costs, and may not know if a specific drug is on any of the subsidised drug lists (this list is published on the MOH website). Many diabetes medications are on this list. And it will save you money if your doctor can safely swap a drug that is covered by this list for one that is not.
4. Medications from the Cheapest Pharmacy. Even if a medication is on a subsidised list and you are obtaining your medications from a public institution, the cost of that medication can still vary across different pharmacies. For example, the price at a SingHealth polyclinic pharmacy may not be the same as from a NHG hospital pharmacy. Currently, there are 6 regional public health systems in Singapore (which will combine to become 3 by next year). And even within the public system, there are differences in charges. It’s best to call around to different public institution pharmacies so that you can get the cheapest deal.
5. Medication Swaps for Diabetes. For many medications, a pill that is twice the prescribed strength might be just slightly more expensive than one that is half the strength. In these cases, it might make sense to buy a higher dose pill and split it into two doses. For example, if your doctor prescribes 5mg of Glipizide twice a day, you can ask your doctor to write 10mg on the script and then you can cut the pill in half.
Additionally, there is often a tradeoff between convenience and cost with medications. For example, taking an extended release version of a pill can easily double or triple its price. And if you are taking a combination pill (such as Metformin with Pioglitazone), it is often more expensive than taking two separate pills. This is especially the case if one or both of the medications are on the subsidised list. Combination pills are generally more expensive, less available, and you can’t independently adjust the dosages.
6. Medication Swaps within the Same Class. There is often wide variability in the drug cost across the same class of drugs. For example, one medication in the Sulfonylurea class can cost $0.10 per pill while another can cost $1 per pill (10 times more!) with both pills having the same effect.
7. Glucometer & Test Strips. While most people opt for a free or heavily-discounted glucometer kit, this can turn into the more expensive option in the long run because of the cost of the test strips, which are not universally exchangeable but proprietary and specific to the brand of glucometer. Choose a glucometer that uses test strips that are readily available and competitively priced. Like printers and mobile phones, the long-term cost of supplies/service can outweigh the upfront initial capital cost.
8. Make the Most of your Doctor Visit. Because another big expense for diabetics is the doctor’s visit, it is important to make the visit as productive as possible. This means you need to put effort into understanding your disease, ask questions, be prepared, and have an objective for the visit. For example, bring records of your glucose level checks or other quantified-self data and a list of questions to ask your doctor. Reference the MOH subsidised drug list, and ask your doctor if swaps are possible.
9. Pharmacy Consultation. Pharmacists can often help you and your doctor come up with less expensive but equally effective diabetic medications. Some public facilities offer free pharmacy consultations (by appointment) for this purpose. For these consultations, you’ll need to bring in all your prescription medications and even your non-prescription supplements with you. Sometimes making substitutions must be phased in, and the pharmacist and/or doctor will help you with that.
Health conditions can be financially devastating. Many people complain that Medisave funds cannot be used for anything outside of health care services. But we live in a time when health care spending is rising. For lifelong conditions, such as diabetes, saving a little here and there over an entire lifetime, really does add up. A small financial decision each time can lead up to bigger financial gains in the future. Lastly, if you are having financial difficulty with paying for medications or health care services, you might qualify for assistance programmes, such as CHAS.
[Note: An adapted version of this article was also featured on the Diabetes Council’s website, based in New York.]