Seems like novolog is really expensive. Insurance said no more humalog only novolog. Now it says I’ve spent too much in the year on novolog. I find out when I go in for refill that I need preauthorization.
Have you over used the number of vials prescribed? For example, I have 4 vials prescribed for 90 days. If I used more, I would need authorization from my doc.
We have had to have a preauth for every plan we’ve had since my daughter’s dx. We get 3 vials/month. The same applies to test strips. When we switch plans, the first thing I do is find out the requirements under the plan & get the required form to the endo.
That works out at 3000 units or 100 per day. Even allowing for wastage it seems an awful lot of insulin.
I routinely ask that critical supplies like insulin and test strips be prescribed to cover worst case. If you don’t have a hefty buffer than a single bad vial or an unexpected week of being sick can cause an end of the month desperate effort to negotiate more supplies. I’ve had too much nickle and diming from insurance companies to trust them. If your doctor prescribes 2999 units per month, they they will typically only cover two vials. I routinely round up and add one.
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Nope. That’s my TDD.
And it’s not even that much… many T1s use more than 100/ day
At one time 100u/day wasnt enough. We were fortunate to be able to make arrangements with friends who made up the difference. 100u/day is not much at all for a pubertal female with T1. Now that she’s older & the worst of puberty has passed, we have a nice safety net for when shes sick, or insurance decides to limit supplies. I’m not a hoarder by nature, but when it comes to keeping enough of what my daughter needs on
hand, I will proudly stockpile everything I can.
ETA:. Another reason to have excess supplies. My daughter had surgery in Nov so we had to reschedule her endo appt (not up to the long drive 3 days post surgery). Unfortunately, the earliest we could reschedule was late March. I called last week to get a new Rx for her insulin. Nope. Not until she sees the endo. In March. Because a T1 can either ration insulin or totally do without? Really really grateful for our hoarded supplies right now.
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My mistake. I was under the mistaken impression that your daughter was a young child.
I agree it is a good idea to have a spare vial or two. I get four vials prescribed - this usually lasts a bit over two months and I re-order when I get about half way through the third vial. There is no strict limit - if I dropped or lost some vials, I could just order some more. Because it is all done through the NHS over here, I just telephone my local Health Centre (GP) and request a prescription re-fill . It is ready to collect a couple of days later from a pharmacy that I pass on my way home from work.
Thanks all for commenting. I sometimes feel alone in the struggle. People die in America trying to get refills. Insurance here is bizarrely random. Someone in an accounting office set a yearly limit this year. They make rules to save money. I can only guess how this new rule works. My union just switched from blue cross to navartis as the rule maker. This rule is new to me. Do they think I’ve used too much fast acting insulin because they assume the use of long acting insulin? Did my pump use record not get seen? Is there a financial limit on every medicine?
Hi Aaron10
you are NOT alone. I jumped through hurdles to get my insulin approved - I had to suffer with numbers sooo high because we had to ‘try’ approved insulin first. Finally, we got it approved and my numbers are in line…BUT NOW we are switching companies next year and we confirmed that THEY will require a ‘step approval’…and they don’t accept the prior results…I’m paying a lot of money in premiums to essentially allow them to be fat and happy as I get sicker…it will backfire, if I can’t work and pay the premiums then they loose my $$$$$
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And don’t forget, a dropped vial is a broken vial. If a vial is exposed to extreme ytemperatures it goes bad. And there is always the zombie apocalypse!
Generally it is an issue of prescribed quantity and timelines within the rules of the plan more so than an actual limit on the quantity (in my experience anyway) They may have some issue with how the script was written given the parameters of the plan… of course trying to figure out what the problem is can be painstakingly difficult and monumentally frustrating when dealing with insurers.
Just for example they may require you to fill 90 day prescriptions but your script is written for 30 day supplies-- so instead of actually fixing the problem they just give you 30 days worth and call it a 90 day supply and give you no indication whatsoever what the problem is and no avenue to figuring it out… again that’s just an example of the kind of silly issues that I’ve usually seen and hear from my wife, who manages patients’ prescriptions for a living…
Sometimes you can have a better understanding of what is going on with your insurance by asking your pharmacist. My pharmacist at Target has always been very proactive if there has ever been any issues with my insurance and covering my insulin…knock on wood, I haven’t had any issues with any of my carriers covering what I need and the quantities. The one time I did have some issue was Lantus when I was still doing MDI was not the preferred long acting basal insulin, and I had to use Levemir…which I absolutely hated, but by the time i gave it a try…there had been changes in the formulary and Lantus was then covered with no step-edits. Of course it wasn’t long after that I went on a pump.
You are NOT alone! I am fighting with my insurance now. It labels any medicine that costs $16.66 & over a day, or $500 a month, a “speciality” medicine, and requires a copay of 20% instead of only $80-something per 90-day supply. Problem is my 30-day script is just under the threshold but they treat it as a 28 day script so the calculated daily need is just over the $16.66 threshold. In my case, I worked really hard by using metformin and losing weight & continue to work hard to keep healthier to get TDD into the 60s rather than in the 100s. Not be rewarded for THAT anymore!
I am extremely angry with my insurance. At the same time I realize that these insurance companies are getting squeezed by Big Pharma companies who jack up the price of things like daily life sustaining insulin & epipens though the drugs have been around MANY years because they figure someone will pay for it – insurance or the patient --in order to keep the patient alive. Well, I guess I should consider myself lucky that my insurance just demands 20% copay rather than cutting me off after so many dollars. And to hear insurance companies demand proof that you need so much insulin by having high A1Cs with less is scary. I’s like they hope you’ll just die from DKK during the proof phase & they will be free of you and your many expensive bills.
Anyway … I wonder if with high insulin needs around puberty if something like metformin would help even healthy weight T1 teens need less insulin. It works by stopping the liver from releasing so much glucogon & thereby your body has less glucose in circulation. Perhaps something to investigate …
Another thought for anyone getting charged $100s a month because they reach some magically insulin limit, maybe that Big Pharma company will help or an indigent Rx card, for those poor but not at medicaid levels will reduce the costs. When I was at 100 TDD, my Rite Aid pharmacy noticed the copays on my insulin & just added such a card without my knowledge to my account just for the insulin. I felt bad I needed it but it was just the way it was. It can make 30-day Rxs from local pharmacies cheaper than 90-day Rx from one’s insurance mail order because to my knowledge, the mail order places do not take those special pharmacy cards.