Anybody know if there are any particularly expensive type II meds (other than insulin)?
Wondering what variables might lead to a type II becoming expensive in the next 12 months .
This is a homework exercise that I picked because I thought I might have some good intuition about it. However, as a type II, all I have come up with is if a type II is like an expensive type I and uses insulin or nondurable medical devices. I need some more type II specific factors. Drawing a blank…
Anybody know if there are any particularly expensive type II meds (other than insulin)?
Are there any non insulin injectables for type 2 only? Is this what you are looking for? What about checking the FDA web site for trials? Not sure about other ideas.Nancy
Not sure :
The FDA has approved of AstraZeneca’s Bydureon BCise (exenetide extended-release) injectable drug for type 2 diabetes.
Bydureon BCise is a new formulation of Bydureon–this one is a once-weekly, single-dose auto injector device intended for adults with type 2 diabetes whose blood sugar levels are still not well managed when taking one or more oral medications in addition to diet and exercise.
Bydureon BCise is a glucagon-like-peptide-1 (GLP-1) receptor agonist with a continuous-release microsphere delivery system which is meant to dose consistent levels of exenatide to help manage blood sugar levels.nancy
Consider co-morbidities, like dyslipidemia . Though statins are fairly inexpensive to lower cholesterol, guidelines calling for 'lower is better" may result in more people taking more expensive meds like Zetia or PCSK9 inhibitors.
I’m not sure I understand the question. Do you want expensive medications? Just ask for the latest before insurance covers them. You could spend $K per month. Can you help with what exactly you are asking about?
A co-worker uses Bydureon & Lantus pens. Before she had insurance, the cash price for both would’ve been $1100 per month at our local pharmacy.
I take Onglyza. This med is subject to deductible so this year 570 then free. But since I sign up for insurance through the marketplace in past years it would have cost 6000.
And since the ACA is government assistance I can’t obtain a discount card from the manufacturer. I already told the doc if I end up with a high deductible in 18 I can’t take it.
It already is expensive. Many insurance companies simply don’t cover things for Type 2’s that they would for Type 1’s. I spend over $5k a year on my CGM and pump. I have to pay cash, and none of it applies to my deductible or out-of-pocket.
@McChesney this is an interesting comment. The co-worker I mentioned above buys her health insurance through the marketplace & receives a subsidy to help pay for it. She uses a copay discount card for her Lantus. I know this because I found the card for her.
My daughter’s plan is also through the marketplace but without a subsidy. We use discount cards for her Novolog & test strips.
The ACA is a law. It is not considered a government health insurance & the subsidies are not considered government assistance. Someone is giving you inaccurate information.
That someone was a pharmacist. You are right though I am sure.
I am hoping Ambetter offers the same plan in 2018. 570 deductible is not bad since once paid it gives me free meds for the rest of the year, and I take a lot of meds. They covered a scan too this year.
With the canceling of cost sharing my subsidy might even go up.
Those are all really valuable comments. Thanks sooo much.
Type II’s can use sensors and omnipods, if they are insulin dependent, on medicare/medicaid now? Or just type I’s can get coverage on non Durable medical devices?
Note that Medicare does not cover Omnipods. I’ve been working for 3 weeks now to get my first insulin Rx through Medicare for my Omnipod. CGS the Medicare contractor who processes claims has refused to cover the insulin. A Medicare rep told me to “talk to my doctor about getting another insulin” right after he read me their policy that “Medicare does not dictate brands”. What a crock! Has cost me hours on the phone to get nowhere. As a type 2, my insurance denied CGM. I believe I could get it via Medicare now but frankly, I don’t have the energy for the fight at this time. I’ll be happy with just covering test strips and my pump insulin under Part B as Medicare policy dictates. I’m on a pump because I asked my Doc for it after not getting my A1C lower than 8.5 even after sticking with a pretty good plan. Since being diagosed in 1997, I’ve never had a medical pro suggest a pump. Yet post-pump, my last A1C is 5.5. My personal belief is that the Type 2 community is ignored as candidates for today’s treatment technologies. We aren’t the “right” category so getting access to the technology is potentially a fight with whoever (insurance or govt program) is making the decision that it’s “medically necessary” for you. That decision maker is not solely your Doctor. So what is a low A1C and good control WORTH?? Is it worth same worth in a Type 1 vs Type 2 vs a Type 1.5 vs a yet to be defined Type X?? (I fear I’ve digressed off your original question…)
As others have said, any new drug is going to be expensive over the tried and tried generic Metformin for Type 2s and some of the co-drugs like statins are expensive. Another hidden expense is that you simply have to eat better and give up the junk food, fast food, easy to buy stuff. Access to fresh quality foods is a problem in poorer urban and rural areas. Kudos to my next door county Health Dept who is offering free classes to reach out to the Type 2 and pre-diabetic community with quality, practical education.
I would guess if it were studied, the cost in yr 1 vs yr 10 for a type 2 is significantly higher. With Type1 you are forced to take care of yourself. If you stay in denial, you’re headed to dead PDQ so you have a get a good plan in action right away. With type 2 you can go undiagnosed or live in denial with poor control for many years and be silently killing off your body’s systems a few cells at a time without being really aware of it.
With Type 1 I’m guessing that your overall treatment plan is pretty well set from diagnosis day 1 and except for insulin, test technology, and insulin delivery improvements, you are on insulin for the rest of your life… period… Now don’t start throwing rotten eggs at me for this as I know I’m oversimplifying!! The point I’m trying to make is that as a Type 2, you are much more subject to the influence of the latest sales rep who last talked to your Doc about the latest new drug. Or if you move, new Dr X will migrate you to their pet program vs what your prior Dr Y preferred. So meds and subsequently costs, will vary quite a bit through the years. You may or may not see better results from that. Eventually you get enough street knowledge to do a better job of working with your doc in influencing your treatment. IMHO the “military industrial complex” of the 1960’s has morphed in the “health care/insurance/drug company lobby” of today. Drug companies see big $$ in developing the new drugs for Type 2 population. Yes, many of these are showing better results but it’s costly.
Kicker for everyone is insurance. When I was uninsured for a few years, my insulin cash price was over $2000 for 90 day supply.
So, mohe0001, you posed an interesting, complex question… As I reread my post, I can’t stand myself sounding so cynical and morose so it’s time to get off this laptop and out into the sunshine as it’s a gorgeous day on the Florida panhandle!!
Thats a bummer, obxidiva, but thanks for the input. Perhaps the nondurable devices will become more accepted after Dex ‘breaks in,’ the insurers.
Medicare will cover CGM whether you are type 1 or 2 as long as you meet their other criteria such as needing finger sticks four or more times a day and using that information to adjust insulin dosage. You must be on multiple daily insulin injections or a pump. So far only the Dexcom G5 is approved
Success at last!!! Medicare finally covered my not-officially-approved-for-Omnipod insulin for my not-covered-by-Medicare pump. Took almost 4 weeks to get through the system. Appears that my local CVS personnel were simply not getting ALL of the correct data into CGS, the Medicare claims contractor, for a Part B claim. My calls to 800-MEDICARE were pretty useless except for one rep. Was told everything from “change to a different insulin”, “if CGS denied it, file an appeal”, “it’s only covered under Part D” to finally getting to a Medicare rep who took the time to add my CVS in a three way call and give them the number to CGS to work on the detailed reasons for the denial. Bless her!! So if you enter Medicare with a pump, suggest you keep persisting with your pharmacy if you are denied as insulin for a pump, any insulin, is covered under Part B.
Once and a while, you can outplay the gov and the insurance co. Impressed by your success and its a huge accomplishment. Much like the occasional Bob Dylan song, none of this makes sense. Good job breaking through it! https://www.youtube.com/watch?v=MGxjIBEZvx0