I recently switched companies at work and the new company has us signing up for insurance through healthcare.gov. I went with Horizon BCBS NJ Advantage EPO Silver Plan. Went I to the pharmacy and filled my prescription for Humulin R U-500, it came out to $450. I have been trying to call Horizon BCBS NJ and MYPrime to see if I could get a price for the Humulin if I switch to the Advance or Advantage EPO Gold Plan. Would any Horizon BCBS NJ Advance/Advantage EPO Gold Plan members be nice enough to do a search for Humulin R U-500 on the MyPrime.com website and tell me how much it would cost to see if it is worth switching to any of these plans? Any help would be much appreciated. Thank you
First, since you are pumping many insurance policies consider insulin prescribed for use in a pump to be Durable Medical Equipment (DME) and it is often covered differently than pharmacy, often with lower or no deductible and just a co-pay. Check to see if things got messed up and you didn't properly get the insulin prescribed for use in the pump and billed as DME. You may also find that you need to fill DME prescriptions differently, possibly through some "preferred" provider.
And before you freak about the cost also check to see what your own policy says about pharmacy coverage. You likely have a deductible and probably a pretty high one. So when you start coverage under the policy you will pay for the prescriptions until you reach the deductible at which point you will only pay a co-pay. Make sure you figure out yearly costs, for young people with few healthcare costs the low cost plans with high deductibles make sense. For those of us with heavy expenses paying extra per month to get the lower deductible can make a lot of sense.
ps. U-500 is expensive, actually $450 for a vial is considered a steal on the open market these days.
Mine's just the opposite (not BCBS). High deductible on DME which includes pump supplies :-(, before they start paying their 80%, but insulin is covered as an Rx w/ just a $40 co-pay.
I know this is an old discussion but figured I would give a reply.
I was recently, March 31, laid off and had no insurance. I was prescribed U500 in October of the previous year and didn’t have any stored or extras so in April I went to get it refilled and was told it would be 1450.00 without insurance. Crazy expensive as it was a 30 day supply only. I promptly applied for the medicaid and received it under that for a huge discount.
While I was without though I was researching and attempting to locate it anyway I could. Sadly I was unable to locate any U500 without spending an arm and a leg. Instead I found many people selling U100 on CraigsList. I know, I know, its shady but I ended up paying 25 dollars per bottle of U100 which was quite a bit cheaper than the U500 from the pharmacy. Worked for me in a pinch.
You can get Regular U-100 over the counter in the majority of the states in the US for $25 at Walmart.
I thought you still needed a prescription… I don’t think anyone distributes it without one.
In all states, newer analog insulins like Lantus and Humalog require a prescription. However only Alaska and Virginia appear to have any limitations on the sale of Regular and NPH (Humulin and Novolin). I know in my case I was able to obtain vials readily over the counter at Walmart although I was required to show my license in order to get syringes. I suspect in NJ you will find the same thing. In my case a 30 day prescription of Regular or NPH will have a $20 co-pay if I run it through insurance so it almost doesn’t even make sense to get a prescription and file insurance.
I was unaware of that. I will keep that in mind if I find myself without again.