Getting Insulin covered via a letter of medical necessity -- "on the formulary"

I wonder if anyone has any experience with being on Medicare and also being in a prescription drug plan where it first says that Insulin is NOT covered, but then you get your endo to write a letter of medical necessity so the insulin becomes “on the formulary”…

If so, does that mean that the insulin would be 100% covered, or might you still have a significant proportion of the insulin to pay?

I just went through the process of my doctor filling out a letter of medical necessity so that I can qualify for insurance coverage of an “off-formulary” insulin. I have a long-documented allergy to the formulary insulin. I get raised red welts at a pump infusion site when I use Novolog insulin.

That likely depends on your drug coverage plan. I get my insulin covered under Medicare Part B since I use a pump. I carry a Medicare Supplement plan so that my insulin is paid for without cost to me. I’m not sure if all plans (like Medicare Part D) work the same way.

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Part D requires co-pays + very expensive premiums for insulin coverage. Better off taking cheap $14/month Part D and then import insulin from Canada at 90% discount from US list price

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Hey – thanks for responding, and I’m glad you’ve found a coverage plan that’s apparently working for you!

If you don’t mind my asking…

I carry a Medicare Supplement plan so that my insulin is paid for without cost to me.

Which plan is that ?

Thanks -

Well that’s pretty astonishing that the % diff could be that much.
I mean… it’s not that I don’t believe you - just that, I guess, this is all new to me so I’m pretty surprised. I’ll certainly look into it. Thanks!

I use a United Healthcare AARP Plan G to supplement my traditional Medicare Parts A&B.

You may want to delete the personal info you inadvertently included in your emailed comment to me. (Admins took care of this.)

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If you physically buy your insulin in Canada including Humalog and Lantus the cost is almost exactly 10% of the US list price. If you order it by mail from Canada the discount is not as great because the Canada pharmacies take pretty high margins on the insulins they ship by mail to the US. My Insulin Humalog cartridges cost $48 for a pack of 5 in Canada and Humalog prefilled pens are about $10 more for a pack of 5, If you need any advice on importation from Canada, just let me know.

We also only live 60 miles apart so may want to talk about joint cost saving options as well sometime

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Admin has deleted it from the message.


Stick around for a Wile. Wile still new myself in the beginning I had no idea. Thought my Lantus was $320 because it was a very expensive process .

LANTUS is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli (K12) as the production organism. …

I guess thats why its $300, sounds like quite a process,


They are like intestinal parasites. Our wallets are the host organism.

While I don’t have Medicare, I do have a prescription insurance plan that lets you get things off formulary (with Dr’s instructions). The hitch is the co-pay is $100 plus any increase in list price between the formulary/non-formulary medication. So for me the ‘floor’ price is $100 for a 90-day supply no matter what. That’s not bad because I can have my doctor write a script for 10-vials per 90 days (roughly 3x what I actually use). So if the price is the same, it’s $10/vial assuming no difference in list price. I haven’t had to order Fiasp (non formulary) because my CDE is giving it to me from her pharma-rep sample supply.

Under insurance not medicare
Like @Paytone I pay a $100 for a 90 day supply no matter what too. The doctor sends in a request for my preferred kind, I’m not sure what she would write but my insurance covered novolog at the time and I liked humalog, for me it worked better. And my old endo would write it so I had plenty under any worse case scenario. But she was a type 1 too.

I now have a new endo and she just messed up the prescription so I got half of what I actually need and they wanted to just straighten it out the next prescription. Uh no please, as it would cost me an extra $100 for no reason. So hopefully it’s getting straightened out! That reminds me I need to call!!