I use Novolog in an Omnipod pump. My endo talked to them and got turned down. I know this can be an involved process, but I also know that many people use Afrezza in conjunction with pumping. Any suggestions as to how to get this approved? I’m T2 for 20 years and just got a CGM. I went from 6.4 to 6.1 A1C after a month with the CGM and feel confident I’ll be in the 5’s at my next visit.
Did you doctor write a letter of medical necessity or did he just talk with them? A letter of medical necessity is the formal step. Often you can enlist the company (Sanofi) in helping to make sure that the crafting of the letter of medical necessity conforms to the peculiarities of the insurance company. Companies learn all the ways to get stuff approved by insurance, it makes a huge difference to their bottom line. Some googling can come up with how to enlist their help.
I’m not sure exactly what she did. We were texting back and forth. I’ll probably try to contact the company. Dexcom got me approved in a nanosecond.
Ask the doctor specifically for a “letter of medical necessity” - you must use those words.
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Don’t take no for an answer… Do whatever it takes. If all else fails they do have a patient discount card that will knock the cash price way way down… Merry Christmas
I’m hoping they cover it next year. They have a list for the year of what’s covered. Affreza wasn’t available last year so it couldn’t be included in this years formulary.
Thanks for the advice. I think we’ll get it sorted out. My endo is super helpful. She says sometimes the companies get stingy at the end of the year. But, she’ll do whatever it takes to make it work.
I paid cash. Next I’ll see an ENT (ear nose throat) specialist to discover my sinus problem. I coughed like crazy and more the longer I took it. But now I have sinus infection over a month ongoing. And eight years ago I had a cough that went on until steroidal inhalant. Just had a CT scan of sinus. I’ll see if still sick In four days and doctor will get me in with the ENT.
You have to ask for a letter of medical necessity. Chances are high you will be denied. You then must appeal and ask them to send you a letter on the grounds you were denied. Also ask, if Afrezza is covered by your insurance as a Tier 3 drug, on what grounds they will approve it. In our case, we are going to appeal. But our insurance company does not care if, for instance, our daughter is at college, has had many instances of hypoglycemia and we are worried about her overnight and want an insulin that does not stack, but is out of her system in 2 hours tops. They simply do not care and will not cover it on that grounds. So find out the grounds which your personal insurance will cover and hope you can meet their criteria. Our insurance covers if you are visually impaired which she is not. And there are a few other grounds. It is very possible you will be able to meet their criteria but first you must know the criteria. Each insurance company is different. I have just heard that Aetna may be listing Afrezza as Tier 2 next year. Any insurance company that lists Afrezza as Tier 2, you should be able to get.
I’ve heard about the visual impairment requirement by some plans before— how utterly stupid. You need to be visually impaired to use color coded cartridges of insulin instead of pens thatbl make an audible clicking noise for each unit? Brilliant plan…
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There are other criteria. And you may be able to qualify for another of their criteria. You have to get the list of on what basis they will cover from your insurance company. Each insurer is different. You may still be able to qualify.
Why am I not surprised to hear this?!?!?
Damned health insurance!
The insurance company is sending me a letter to appeal the denial of coverage. They said my policy does not include coverage of Alfrezza, and apparently that does not change in 2016. Of course, they are sending this letter via snail mail (really?). So, I guess we’ll see how the appeals process goes. In the meantime, I am getting a prescription for one month with the card, which says the first Rx is free and refills are no more than $30.
@Jim2 those amounts you cited for the insurance card are correct only if there is insurance coverage. If you’re paying cash it will reduce the price of one a month box by $150… At least that’s how they explained it to me…
Yikes, @Sam19! How much does that end up being, approximately?
Somewhere around $200 / box after the $150 discount where I live…(for the combo boxes that I get anyway)
It’s expensive stuff— for good reason…
I’m not sure if it might be a lot cheaper in other parts of the country or not