Aetna Pharmacy makes me cry


#1

I had read with sympathy and concern the posts over the few weeks about people’s insulins not being covered anymore. I even got the new formulary in the mail and don’t remember being concerned by anything on it.

Last week or so, I realized/remembered that I was getting low on insulin and went onto the Aetna Pharmacy site, which showed that my prescription still had refills remaining and was in fact on autorefill. It seemed strange that I was running so low, especially since I go through my bottles so slowly now on low carb. So I manually hit the refill and everything processed through fine. Usually within 2-3 days the insulin is at my doorstep.

So today I realized I hadn’t received it and went onto the site to check the status. Since the site was being finicky, I called and spoke with a person…who informed me that my order had been cancelled. And that, well, they had tried to contact my doctor twice but didn’t hear back, and so they cancelled the order. But no, in those cases they don’t reach out to the patient to let them know. (Or maybe they would mail me a letter that the order was cancelled.)

Upon further probing, I learned that the issue was that Novolog was no longer allowed and I had to “try out” Humalog for a month before I’d be allowed to go back on Novolog. (Resolution Team rep gave me tips to share with my doctor to get approved to stay on Novolog, but of course it’s a 3 day weekend, so I need to be a little patient.)

So it only took a few minutes into the call for me to be audibly (and literally) crying in frustration, trying to articulate how irresponsible and dangerous it is not to alert the patient and how I could care less about, say, my birth control being held up (well, especially now that I’m pregnant), but…insulin? And did they realize this medication keeps me alive??

I’m not an emotional person, but if I ever need a good cry, all it takes is a prescription issue. A stupid, avoidable, communication issue about prescriptions.


#2

Hi Pipli,
I am sorry you are having to go through that. I know the frustration. I had to go through that twice last year for insulin.

Hang tough. You can probably get this overturned. And if you are pregnant, you should be able to appeal this as an emergency issue, and get a faster turnover.

But if they make you go through the month of Humalog first, make sure you keep records of every bad blood sugar, every itch or pain at the injection sight, everything. Highs or lows after meals, at night, every single thing!

Best of luck to you! Let us know how it goes.

If you need help with insurance letters, PM me, I have a bunch of them. You just change the name and insurance number and name of the insulin and send it to them! :wink:


#3

Funny how I had a similar situation with one of my husbands prescriptions through Aetna RX Home Delivery. And, FINALLY today it’s being shipped.


#4

I’ve only been using mail order pharmacies for about a year and have had a couple bad experiences with them for similar issues… I just always prepare for the worst and hope for the best when dealing with them… keep lots of extra insulin on hand… obviously they don’t grasp the sense of urgency


#5

Hi @Pipli - I am so sorry this affected you so much!

FYI, my son, in the past year, has already switched bolus insulin and basal insulin once each. There was, for him, no difference at all in the results. I know this is not true for everyone. But it may not be such a big deal, once you are actually able to GET the insulin!


#6

My insurance has switched several times between novolog and humalog, currently using novolog (and just verified it was still on formulary for this year on my plan!).

In my case, I found them both to work about the same, with the novolog kicking in slightly faster, but not much. Others have reported them very similar and a few saying more significant different for them, so it seems to vary.

I also learned that when I get my novolog from local CVS pharmacy, I can use the coupons offered on-line, that reduce my cost. But used to get it mail order, and they were not able to process the discounts.

You may want to check with your doctor if there are any potential warnings for novolog vs humalog for use during pregnancy. I don’t think so, but that could be a reason to stay on novolog.


#7

I dont think Huma or Novo are much different (for me anyway, but depends on the person). But during pregnancy, both the endo and OBGYN should write “change equals risk”!


#8

This is a key reason why you should not have to switch to their formulary for even one day! You’re pregnant. (Congrats, by the way.) The glucose standards for pregnancy with diabetes are very tight. There is no need to further complicate an already fundamentally more demanding situation. I think you have a persuasive case to stay on the insulin that you are familiar with and not experimenting with a new formulation while you’re growing a baby! Good luck.


#9

Thank you all so much! I’m confident my doctor will be as helpful as she can be to get this approved. I have less confidence in the office staff, since this is not the first time the office hasn’t responded to inquiries direct from Aetna Pharmacy. I’m feeling much calmer about this a day later. Situations like this remind me how ever present my diabetes is as an underlying stressor in my life. As long as things are moving along, it’s fine and I don’t realize it, but the minute it gets shook up, the stress boils over VERY quickly.

Once again, thanks to everyone. This community is consistently supportive and reassuring. :slight_smile:


#10

I have Aetna as well. Unfortunately Aetna uses Caremark as their mail order pharmacy and pharmacy benefits manager (PBM). Caremark made this change to the formulary moving Novolog to branded non-preferred. I suspect that while the mail order won’t fill it you probably can fill a prescription for Novolog locally, but it will be very expensive.

You may well do fine with Humalog, but switching insulin is a medical decision. Your doctor can write a letter of medical necessity and ask for an exception from Aetna/Caremark to get you coverage for Novolog. That can be quite a hassle, take some time and may just not be worth it.

In the meantime if you have an emergency you can go to your local pharmacy and ask for their assistance. Often they can intervene, get emergency approval from insurance and provide you with a temporary supply of insulin.


#11

make sure the letter uses these exact words, if you go this way.


#12

They must have different formularies within Caremark… my Caremark service only covers novolog as far as rapids go… both through their mail order and retail… I was able to get an additional option approved but that’s because my employers insurance plan itself wrote the pbm an individual override


#13

@Sam19, these formulary decisions are very insurance carrier specific. In my case, I have Aetna just like @Pipli and have experienced the same formulary change. CareMark as a whole has made a series of controversial coverage changes with insulin, including dropping Lantus in favor of the Basaglar. Your insurance also seems a bit unique. And it is true you can often get your plan administrator to intervene to negotiate some specific coverages in the formulary.


#14

Mine is a union health trust that contracts Caremark to play the pharmacy pbm role… my understanding is that the lantus / basaglar changes occurred to my plan as well …

Weird that Caremark would only cover humalog in one plan and only novolog in another, I would have thought the primary consideration on their end would be which one they can get cheaper… and that can’t be both at the same time i would have thought


#15

About formularies . . . you can’t always take them at face value. My old drug plan dropped one of my insulins so I enrolled in a new one that covers it (I thought). Soon I get this thick formulary book in the mail and the first thing I do is page through it painstakingly only to discover that two of my three insulins aren’t covered.

So I launch a concerned inquiry and get back an email saying that the book in my snailmailbox is only a partial formulary and the complete one, which covers both, is provided as an attachment to the email.

Moral: don’t take anything an insurance plan says at face value. Dig deeper. I know we all know that, but an occasional reminder does not come amiss.


#16

@Pipli, have you been able to get more insulin in?


#17

They are going to call Aetna tomorrow after speaking with my doctor. And then supposedly they will call and update me. I’m hopeful… it was reassuring to speak to a person.


#18

Humalog is 50% more concentrated than other insulin per unit. That is what dr. Bernstein says in his book. So one has to be careful not to give one a hypo. I did that a couple times


#19

To be precise, he says it’s 50% more potent that Regular ®. It’s approximately the same strength as other fast acting insulins, i.e., Novolog and Apidra. I have found this to be true in practice.


#20

Hopefully you were able to resolve this smoothly. I am sorry that it had to upset you at a time where upsets are more traumatic:(

Keeping our fingers crossed for you!