Just received notice that FIASP will be excluded from the Tricare formulary starting 1 Jul. I"ll transition of Medicare/Tricare for Life in just under a year. Does anyone have experience with how/whether TFL pays the Medicare Part B copays/deductibles associated with insulin used in a pump.
The letter says review determined FIASP has little to no clinical benefit. Probably fixated on HbA1C. And they probably won’t care about twice as many and more severe hypos if I switched back to Novolog. Last refill plus a trip to Canada and I can get FIASP under Medicare.
While I don’t have any Medicare/Tricare for Life experience to offer, I detest “non-medical switching.” The people who make these policies don’t care about you or me; they only care about the bottom line. Glucose variability and quality of life issues don’t seem to factor into their decisions. We live with a broken health care system in the US.
Well stated: My BS of California Medicare Supplement just changed their formulary from Novolog to Humalog as of April 1, and all I can think is: “Who got rich over that change?”
They (insurance companies) all say that when they exclude something. You ask a really good question about whether Tricare for Life picks up what Medicare does not. You may have to submit for reimbursement yourself. I’m assuming that it would still go under the prescription benefit (even though it goes through Medicare Part B for pump). I will say that it is possible that Fiasp formulary status may change again by next year.
You are completely correct, but perhaps overly diplomatic. My grown daughter has had the same experience with insurance changing formulary from Novolog to Humalog. Decisions made by idiots who are decades behind and claim all insulins in a class are the same. If insulins are all the same, then why aren’t the copays at generic rates? Oh yes, $$$.
Moobm - Tricare for Life (TFL) acts as a supplement to Medicare Parts A and B. I also have the Tricare Formulary, that is pharmacies at military installations and Express Scripts mail order. FIASP will be excluded from formulary, but TFL pays (or reimburses) for Medicare Part B copays. Insulin for pumps is covered under Part B, but that is useless if no pharmacy will fill an Rx and bill to Medicare Part B. Part D specifically negates TFL reimbursement for medications.
I just turned 65, transitioning to Medicare and TRICARE for Life. Also, had just switched to Fiasp in my Medtronic 670 pump with good BG results. I received the TFL/Express Scripts letter Fiasp exclusion letter - and based on guidance on this site, worked a solution. Just yesterday, I received my 3 month Fiasp order at Walgreens. Medicare covered it under Part B, and TFL picked up the co-pay. Great support from the pharmacist, it can be done.
I really appreciate the response and am reassured I’ll be able to get FIASP after transitioning to Medicare. I’ll be getting all my other diabetes care from VA as long as I’m not assigned to a hypo-phobic endo. I contacted Medicare concerning requirements for provider enrollment and quarterly Endo visits. The phone rep advised that for insulin, only the Pharmacy has to accept Medicare/be enrolled; VA Endo might be contacted only for verification.
