Hello all-
Just joined this group. My endo prescribed Victoza today, but the pharmacy told me my health insurance won’t cover it (Anthem Blue Cross of CA).
Anyone had any luck getting coverage for it yet?
Hi fgiraffe. I couldn’t take Byetta and its side effects and had to twist my Dr’s arm to prescribe Victoza.
I am getting really good results from it. My insurance wouldn’t cover it either so i had the Dr write a letter to the insurance company and they approved it. The cost difference to them vs Byetta is not that great in fact I think its a little less so its not like its super expensive. Normally if a Dr requests something not on the approved list it is approved so ask you Dr to contact the insurance company. In my case I worked with the chronic care nurse at my clinic and she ran all the interference to get it approved. My insurance said they would likely approve it anyway in about 3 months.
Optimum Choice had no problem covering it. However, it is Tier 3 and costs me the maximum co-pay of $50. Hope you can get approval. Victoza has done a great job with me (after my adjustment period).
Yea my insurance company at first balked. They called the doctor, (why?), and he confirmed that he ordered it. Anyway, after a day or two, its covered.
The pharmacy also had to call and verify with my doctor for some reason. They claimed it was a problem with the dosage amounts. It did take a couple of days.
I’ve been struggling with the decision on whether to start Victoza. I’ve been on Byetta for two years. As my control continues to degrade despite my endo suggested it at the last appointment. He had at the time about 80 patients who had started on it. I generally don’t like to be a guinea pig with new medications and when I checked, my insurance (Aetna) still classifies it as a tier 3 medication. This means that it is only covered 50%, a big difference. Byetta costs $40 for a 90 day supply, Victoza costs $180 for a three month supply.
In general, insurance cannot “deny” coverage for a medication that is prescribed by a doctor as treatment for a condition that is exactly what it is FDA approved for. But the insurance does not have to cover it fully, and that is what many insurance companies do, put it at the most expensive tier. Sometimes there is a delay between FDA approval and when is shows up on insurance formulaties.
I have United Health Care through my employer and they didn’t question it at all. It is a Teir III so it’s not cheap, about $100 bucks a month to be exact, but its better than the $500 a month price tag that it would be. My doctor also gave me a discount card for the first six fills I get $25 off, and apparently you can get this from their website as well.
I am not sure why Anthem won’t cover it, you may just need something from the doctor explaining what its for. I know United Health Care won’t cover it if it’s for weight loss, they only cover it for treatment of diabetes.
Hope this helps!
Just following up: my endo wrote Anthem, but they are still chewing on it.
I started using some samples, so far so good, mostly. It definitely lowered my sugars throughout the day, and it has had a profound effect on the amount of food I eat at meals. It seems like I get full faster, and stay feeling full longer. I’ve lost 10 lbs in 3 weeks (from 210 to 200). I’m sure this will taper off a bit after a while, but it was nice!
On the down side, it’s also given me an overnight hypo incident or two, but I use the Freestyle CGM so it wasn’t a big problem. And it did made me a little nauseous for a week after I started it and for a day or two every time I increased the dose. This seems to be fading.
FWIW, I tried Byetta for a month last fall and it did not do anything for me. No sugar effect, no side effects (pro or con).
It is odd that you had a hypo. Are you on insulin and/or a sulfonylurea? And how did you get a CGM? That’s what I want to know. I have Aetna, they’ll cover Victoza as a Tier III at 50%, but a CGM? I doubt Aetna would ever cover a pump or a CGM for a T2 without a knock down drag em out fight in court.
BSC I had a hypo one night and I am on Metformin with Victoza. It came about because I didn’t eat properly. It only happened once and I haven’t had one since. I was 75 but felt nauseous however after I ate something I was good as new.
I’m transitioning off basal insulin as I started the Victoza, and I’m on Glimepiride/Metformin. My endo said insulin+Vicotza has not been studied yet, so we’re tapering off off the insulin.
I forgot to mention the best part about Vicotza so far: my dawn phenomenon is finally under control. I was going to bed with fine numbers and waking up with a fasting BG over 180.
As for the CGM, don’t be too jealous! Anthem is only paying 25% and I have a huge deductible. It’s painfully expensive but it finally helped me shake off the denial I was in for years about my T2 diabetes.
Well, that explains it, Glimepride is a sulfonylurea and of course you can easily go hypo on insulin. I guess I feel better about the CGM, although I am sorry you had to put out that money. Perhaps in hindsight, if it turns your life around you will consider it a good investment.
Sorry, I don’t really consider a 75 a hypo, although anyone who actually throws up gets honorable mention in my book.
I had hypo just this last week, even after eating a pancake dinner, and a candy bar (the proper meal for a diabetic right?) I expected my levels to sky rocket instead at 11pm I woke up to 50mg/dl confused seeing spots, weak.
However they figured out it was the Glimepriride. Come to find out Glimepiride and Metformin together are famous for doing this, adding Victoza to the mix just upped the chances. They took me off the Glimepiride and I have been doing good so far the lowest I have been was 80 since then.
I have Anthem Blue Cross Blue Shield of VA, and they have covered my Victoza, but my co-pay was much higher than Byetta. It was $200 for a 3 month supply (9 pens). The interesting thing is that they required prior authorization for Byetta with a letter from my doctor, whereas with Victoza, there was no pre-authorization.
I have United Health Care through AO Smith. I covered a three months supply for the co pay of $30.00. I didn’t have any trouble at all. I was a former Byetta user, but I could not stand the constant nausea, but so far so good with victoza. I have recently lost over 50 pounds and am hoping to lose more. I have tried insulin but it made me gain weight and that was the last thing I want to do. I have the biggest problem with my fasting blood sugars in the mornings, does anyone have any pointers.?
Try needymeds.com to see if you qualify for free or drastically reduced medications (insulin too) I’m getting all my meds that aren’t on the $4 list at Wal-mart for FREE!
Good luck!
I don’t really understand why, but for some reason I was getting the Byetta, and now Victoza, at the generic price of $10/month through my pharmacy. Even the pharmacy staff have commented on the low price. According to my insurance formulary, Byetta should have been at the mid-price of $25/month, and Victoza isn’t even on the list yet. I work for a county government and we are “self-insured” and required to use BC/BS providers. Our prescriptions are covered through Walgreens Healthcare or something like that. But then, our prices were supposed to go up on January 1 from $7 to $10 for first tier, $20 to $25 for 2nd tier, and $40 to $50 for 3rd tier. I went for a good 3-4 months paying the 2009 co-pays at the pharmacy. I did ask a couple of times and was told they paid for it so no problem. I finally decided it wasn’t my problem. Anyway, from what I’m hearing, I’m definitely not complaining about my co-pays.
I have UnitedHealth, they pay everything except 30 dollars every three months. I had no problem with them at all.
Hey fgiraffe
My doctor was giving me sample pens for awhile, and when it became evident that Victoza was cutting my high blood sugar numbers more than in half, he gave me a prescription. I sent it to my mail in pharmacy but they couldn’t cover it. Then I took it to my regular pharmacy and the insurance (County plan since I work for a county agency) wouldn’t pay for it and wanted me on Byetta. I read so many bad things about Byetta side effects I didn’t want to try it. So my doctor did a preauthorization letter for me, and now my insurance pays, even though I have a higher copay of $95 for three pens. Upshot is that you can go to Victoza’s website and call them and get 12 $25 discounts, so you save $300 the first year.
Hope this helps!
John
My bad, I should have followed up on this thread months ago.
Anthem BC of CA is covering my Victoza. There was a recurring foul up every time I tried to refill my scrip, but I never did sort out whether it was the fault of my local Walgreens or Anthem BC. But they were only giving me 2 pens for 30 days, which at my dosage level of 1.8u/day was only a 20 day supply. We went round and round on this every refill for 4 months before it got sorted out. My endo mentioned that there might have been an error in the dosing info with Anthem BC.
So if your scrip is for Victoza at 1.8u/day, make sure you are getting one pen for every 10 days!
Victoza is still working out well for me.