Fighting with Prescription Insurance

I started pumping about ten days ago. For whatever reason, my insurance company is being really stingy with my new prescriptions. I have 60 units/day of Humalog (1800 units/month) and 6 tests strips a day (180 strips/month), but they'll only give me one bottle of insulin at a time and 100 strips at a time. The strips are especially annoying because I have no copay on them and because the bottles come in 25 strips/bottle, so they could easily let me have, say, 150 at a time. With my previous brand of strips, I got 200 at once with no issues. They're not actually restricting my use of these drugs since I can get a refill every 19 days, but I don't want to be at the pharmacist that often. Not to mention paying two copays a month for insulin.

Have you ever successfully gotten an insurance company to give you more supplies at at time? Any recommendations for how to go about fighting them?

I always recommend that you have your doctor intervene. Have them write that you need "up to" 80 units/day (2400 units/month) and that you should test up to 10 times/day. Then you can argue that "absolutely" you need two vials of insulin and three orders of strips at a time.

I don't mess with the insurance company, they are a mindless penny pinching company. The will cover the "minimum" required, but when your doctor writes you a prescription and carefully plans for the "minimum," then you will get what you need.

When I ran into this, I had a 4 way call w/ my doc, Walgreens and BlueCross. I called Blue Cross first, to make them wait, then Walgreens then the doc, who I felt fortunate to catch. I was like "I need more strips than 7/ day" BCBS said "how many does the doctor say you need?" The doc said "how many do you want?" I said "I think like 12/ day" the Doc suprised me and said "ok, 12 seems reasonable..." and Blue Cross punted so I let the doc go and asked Walgreens when they'd be ready.

My insurance allows 90 day supply of all meds if I go through their contracted pharmacy's mail order plan, but only 30 day supply otherwise-- not sure if yours might offer any similar options, might be worth looking into

I got it, if you have no co pays, find one of those mail order outfits that do direct billing. Then, have them order bill and ship you strips every 19 days. you wont run out and actually you will build up a reserve. you can do the same for the insulin but I doubt you can get away with not paying copay every time. My insurance allows me 30 days of insulin, but my doctor prescribes double what I need so I only have to go every 60 days. everything else my pump supplies and strips are mailed to me

We tried this and the pharmacy "lost" the prescription. I got a hardcopy, and I'm going back there with it.

I have a similar problem. Now that I have a cgm, my insurance company will only cover half of the amount of strips that I previously had. And yes, I also asked my MD to write my Humalog pump prescription for more than what I used just so I could have a couple of extra vials around in case. The insurance companies don't want to hear about bad vials, or emergencies or diminished potency after the bottle has been opened. You have to play the game and unfortunately, it means sometimes lying and manipulation, just because we want and need to take care of ourselves. I have very often gotten the line from providers and insurers about how they have other diabetics who don't need or don't use the amount of supplies I ask for. They don't get it... we are all different! And, if I want or need those supplies to help prevent possible future complications,I should have them. Complications which will cost the insurance companies much much more than a few test strips and vials of insulin, its ridiculous. These insurance people can't even see the big picture, no common sense! It's totally frustrating.

I had a problem with the mail order place a while back. Suddenly, they decided they were sending too many pump and CGM supplies every 90 days. This really irratated me because I only order what I need. They told me it was "my insurance."

So I called BCBS and Tri-Care and had nothing to do with this change. They suggested that the company might be recieving unused expired supplies and were trying to cut those numbers. I let BCBS handle the whole thing and they did a great job of it.

I started having this problem 2 months ago and I don't pump. Insurance will pay for 100 strips every 17 days, same with pen needles. It didn't matter what my doctor wrote. I'm still battling multi drug resistant UTI so don't have energy to take on the insurance co. Some people have recommended 90 day mail order. I just worry about my supplies sitting outside all day while I'm at work.

Kathyann, The two mail order companies I have used (Medco and Caremark) have always done well with insulated insulin and other meds that need to be cool. Pills are OK for a few hours in the mail box. Many Texans and Floridians have also indicated no problem with mail order insulin. If you are really concerned, can you get it delivered at work? That is, if you have a reliable mail system at work.

First of all, congratulations on beginning to pump. I hope it will be a good experience for you. Many with whom I have talked agree with me, that we will not ever happily return to shots.

It is not fair. nor is it right that we have to depend upon the edict of an insurance company in order to receive the medicines that we need, as diabetics, for life.

I had a similar situation and I asked my CDE and endo to revise my prescriptions to reflect my needs for insulin and test strips. They gladly did it and I no longer have to pay full price out of pocket for the 50 test strips each month that I was short, or the vial of Apidra the I found myself short about every three months. I am sure that your endo or CDE will do the same thing for you.

Be well.

Brian Wittman

Check to see if your insurance company can give you more flexibility if you go through a mailorder pharmacy. Also, have your endo write the prescriptions for more than you actually need. I have always done this both to not run into this issue AND to have some back-up supplies if anything happens. Currently, my endo writes my insulin Rx for about double what I actually need.

Check out one of those mail order pharms they will often send three months at a time if your ins will pay and they usually will because those pharms charge less money.
I agree with the doc intervention. All I had to do was threaten my insurance when they refused to pay for more test strips, I said "My doc prescribed this and if you prefer we could discuss this with a judge." That was the last time they gave me any problems.
Your situation is not how much but how often. Again, be aggressive, use implications that make them nervous like legal action. They are not doctors (hoping your not in an HMO program) and though they like to play tough their bark is worse than their bite and they don't like bad publicity.