How on earth did my novolog copay end up so high

my boyfriend went to the drug store for me to pick up my novolog prescription. he tells me its 300 and something dollars! its suppose to go through medicare then through medicaid. so how on earth is that possible! it was covered in january when i last refilled. what on earth are these ins companies doing??? they dont seem to care. the copay once it goes through the ins its about 3.65. has anyone else in the states have this issue? im doing to have to go to the drug store and find out what on earth happened and why didnt they call me. oy vey. not what i needed today.

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I can’t tell you from a Medicare perspective, but my HMO threw Novolog on Tier III and I had to go to a grievance board to get the price down. I have a Humalog allergy, so there was no other option than me getting my Novolog. I won. Thankfully. You will have to find out where the increase is coming from, and get things looked at asap. Best wishes.

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Do you have access to website for the pharmacy coverage? For example mine is Caremark. I can check online for my meds to see what tier they are in or get estimated cost for specific drug and quantity… For years, my plan has flip flopped between Novolog and Humalog, depending on which company gives a better deal.

I had the same issue with Medicare this year. Last year, it was covered as a Tier I drug, and this year it moved to tier 3. Humalog is a Tier 4, and all the other types of insulin are at least tier 3. I went into the prescription “donut hole” in April. For me, I use a Medicare advantage plan with Aetna, so for them I have to pay 40% of the cost of the drug every month until next year. That comes out to about $350 per month for Novolog. I filed a grievance with Medicare, but it didn’t go in my favor. I’m going to try since they charge $150 for 3 vials of Humalog, which I prefer anyway.

I believe there are multiple possibilities for this.

I have had similar happen to me. IMHO the place to start is by asking the pharmacist why the copay is what it is. If you do not get an UNDERSTANDABLE answer (regardless of whether you like it or not) then ask to speak with the pharmacy manager and if that is ineffective (or often times you already were speaking with the pharmacy manager) then ask to speak with the store manager.

Based on what you learn will often times dictate what your next course of action will be.

I recall once it turned out that all I had to do was wait 2 days and come back. It was simply a timing issue where the script had been refilled 2 days prior to when the insurance would pay for it. Not saying this is what you have encountered just that the possibility exists it could be a minor issue. Sometimes you get lucky.

went to the drug store to find out what on earth happened. it turned out they somehow forgot to put it through medicaid. how on earth do you forget to put it through my secondary insurance. so it worked out and has been fixed. but why medicare didnt do their part in covering it, beats me. at least i know medicaid covers it. thank god because i have no money to be paying out of pocket for anything.


Glad that’s resolved happily!

i told the person who helped me thank you so much as i just dont have that kind of money and insulin is one of those medication i cant skip

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This is an interesting issue. One needs to turn back the calendar to find out what is going on. Medicare has a bidding process for insulin and ONLY one insulin is selected. Generally the three choices are Humalog, Novolog, and Apidra. The one with the lowest cost to Medicare is selected. Now, the Medicare health care plan with a relationship to Medicare need to change their formulary list. Ask your doctor, endo, etc., if they know which one was selected for 2018 ( ask this in 2017). For 2017 the Medicare choice was Novolog. For 2018 it is Humalog. Now, for pump users, are you ready to change your insulin pump insulin each and every year!!!##@$^&.

Next plan, in late 2017, if the Medicare choice for 2018 is not the insulin that you use, your physician needs to prepare an appeal. IMPORTANT. This physician appeal should be sent in at the earliest date in 2018. One needs to wait for a successful answer. A successful answer means that one will pay more than the Humalog amount for 2018 but less than the cost without the successful appeal. Your Doctor can still request this insulin appeal during the entire year. Hope this helps.

im glad that my medicaid program covered it…i cant use humalog through my pump…it burns and causes huge bruises. and i mean huge. the novolog is better. doesnt burn or cause any bruises. but for medicare not to even cover it, seems ridiculous. at least il have enough insulin now to cover me for a while. i get like 6 to 8 vials of it.

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It really sounds like your drug store dropped the ball on submitting your order for payment. Thru Fed.Blue Cross I get 6 pens at a time for $45.00.
I can say that when I was on Bietta the CO Pay went up to $300.00 forgone month when it was $45.00 this was because after 5 years it became a Teir one dry. So now on Trulicty for 125 for 3 months.

sorry for late response. once i got there and found out what happened i was relieved that it was fixed. i wouldnt of been able to pay the money that it cost. and insulin is an important drug obviously