Humana Medicare

Diabetes Advocacy Self Advocacy
1

To make this as short as possible here goes. I'm on Humana medicare insurance end of February I fell into the doughnut whole where they'll no longer cover my insulin .

I'm a severe diabetic and take 4 injections a day of HumlinR U-500 because I'm insulin resistant.
Regular insulin burns at the injection site and it takes 5x as much insulin as the U-500 does. So by taking U-500 I take 4 injections of 40cc daily instead of 8 injection daily of regular insulin.

By using the U-500 I can keep my blood sugars manageable.

Problem is now my prescription for 1 month of 2 vials is $1400 which is more then I make on SS.

Humana has been no help at all. We've talked with over 20 representatives. I was supposed to be on a special needs program for diabetics which covered insulin even thru the gap. Now they tell me they eliminated that program this year after I signed up.

Last year I went over 90 days without my prescribed insulin before they agreed they would pay for it. They assured me everything was ok for this year.

I'm down to half a vial only taking 1 injection per day now. Not eating but 1 small meal a day usually soup or salad. Blood sugars are in the upper 200 range.

Their answer was pay $4000 out of pocket for medication then they'll pick up 75&.

Have my doctors provide me with free samples (U-500 is not provided as a sample) How ever doctors will give me any free samples they can. But that's now going to be 8 injections daily and double the amount of syringes plus I'm allergic and get the terrible burning and can only use it a short time.

Another answer if I get on a pump they'll cover it. Doctors say pump is no good as I take to high a dosage and U-500 not readily available for pods or pumps.

Another, call manufacturer which I did but Lilly only supplies one free vial per calendar year, Unfortunately had to go that route last April can't use again till May.

Another apply for state Medicaid , Which we did but my wife works and makes $200 a month to much for us to get any prescription help.

Ok the last one was the best and suggested by more then one Humana representative .

My wife should divorce me and have the state put me in a rest home and take over my medical care.

That or go to the ER 4 times a day for injections and pay my $75 copay.

They will how ever have someone come care for me while my wife is at work or also pay for a gym and dietitian program.

As you can see I'm lost at what to do now. Has anyone gone thru this before?

I have little to no insulin left. I'm just looking for some guidance .

Thank you.
Brian Childs
Pensacola , Florida

2

Sometimes your pharmacist can help, sometimes not. Maybe call the governor's office, or check local health department(some have sliding scale). You'd definitely be better if you're wife stopped working, then you'd qualify for the Medicaid drug program which makes scripts 2.35 or 6.xx something a pop copay(not always the best solution, I know). My grandmother had Medically Needy share-of-cost Medicaid(I think she still does) as well as the drug assistance program, which both go based on income. How Medically Needy works, it's usually based on your income, you have to accrue X amount in medical bills for the month, then everything's paid by Medicaid. Regardless of whether you paid the bills, they just need to be submitted to Medicaid, from an ER visit or even from a pharmacist(cost of all meds), showing you have X in medical bills for that month. With all of the Medicaid reform in FL, I'm not sure if Medically Needy is still available to seniors on Medicare, but it might be worth it to see if you have it, call the Medicaid call center(nightmare, I know).

Have you tried any of the newer insulins? Like Apidra, Humalog, Novolog coupled with a 24 hour insulin like Levemir or Lantus? With a pump, it's recommended you use one of the rapids(Humalog, Novolog, Apidra) opposed to any type of R(some do use the different Rs anyway, due to allergy or whatever reason). Usually insulin requirements actually drop from the use of the pump even with high resistance(MDI I'm double what I am on the pump). The U-100 R might just burn because of the sheer volume you take, especially if it's with the newer shorter needles. The only difference between the U-100 and the U-500 should be the amount of actual insulin dissolved into the suspension liquid that makes it injectable. Sometimes changing type of insulin reduces resistance, too. There are bigger syringes available to accommodate the higher dose of U-100 R, so cost can be cut, but the bigger the dose the more it might burn. Walmart is the best place to get syringes I've found cost wise. Winn-Dixie use to carry a decent one, at a good price, but I think they've been discontinued now. Wal-mart has a low cost R insulin, too(around $25 a bottle I think).

With your resistance have you tried combining Metformin to reduce your resistance and maybe drop your dose? It's a $4 script and it's gotten me through some tough times money wise stretching what insulin I had when I was without coverage.

3

This may be of no help at all., But im going to throw it out anyway. I can easily take 8 injections a day. My basic regime is 6 shots a day of both long and short acting insulins. If I have to correct a couple of times, there’s the 8. I reuse syringes and pen needles, have been for years. It has never caused me any trouble. I saved money and waste. As long as you keep your different insulins and their respective needles separate, and never allow the needle to touch anything but you and the vial, you should be okay.

Again this may be of no real help to you but it has worked for me.

P.S. I also get a burn under the skin when I inject but it only lasts about 30 seconds and then quickly goes away. Good luck getting your insulin.

4

Thanks for the reply back. Unfortunately we wouldn't be able to keep the household together without my wife working. With rent & utilizes we'd be homeless with in a year.
Medicaid told her to quit her work but it's just not an option .

I take 2000mg of metformin 3 times a day. They've tried lantus, novalog and it won't get my blood sugar lower then upper 200 no matter what they do.
They thought my diet might be the problem and hospitalized me for 2 weeks and put me on a diet and tried 3 different insulin's the only one to lower my blood sugars to the mid 100s was the U-500.

The burning from the regular insulin lasts about 30 seconds but does occasionally blister my skin. By taking the U-500 at 40cc each injection is really equivalent to 200cc. You can get syringes that handle 100cc so that's 2 injections each time instead of one and I'm still not going to bring my blood sugars down enough .

Target pharmacy has bent over backwards trying to help even calling area doctors trying to get any free samples of insulin they might have on hand.

Unfortunately my body isn't handling the limited insulin I'm on.
I'm getting shakes bad and dizziness and blurred vision, very unsteady on legs. I spend most of my time in bed while my wife is working. She goes in at 7am and not home till 6pm or so. She comes in gets me into the living room makes a salad or some soup. I eat get into the shower with her help , Then back to bed.

I use to be able to get up and do some lite house work and maybe sit outside awhile. Unfortunately now without proper medication I'm stuck in bed.

5

Thanks for replying ,As stated above 8 injections still won't lower my blood sugars to the optimal range. Also as you stated burn lasts only 30 seconds but when it blisters the skin doctors said it was to dangerous as it takes a week or so to heal. They have me doing injections in my stomach . They've tried novalog pens on me but they don't put out enough dosage either and redialing while its in you isn't to comfortable and that was one of the insulin's that burned & blistered the most.

6

1. I wonder if you have tried calling your House Representative? Reps have to get re-elected more often than Senators and they usually do help out with their "people" in trouble. This would be my next step if you haven't tried it. Try first sending a letter asking for help, making the same points you made here, but no longer than one page. If your wife can drop off the letter at his office, all the better. I got this off of Jeff Miller's website:
Pensacola Office
4300 Bayou Blvd., Suite 13
Pensacola, Florida 32503
Phone: 850-479-1183
Fax: 850-479-9394

2. Do you have a social worker? That person usually knows organizational resources for free assistance. If they are good and not too overworked to help, that is. A good social worker should be able to help you deal with that $200 issue. There must be a way to deal with that. Surely the cost of your insulin eats that up quickly.

I know there are organizations that help with free insulin (don't know about the 500 unit size) but someone else on here will have to provide that info as I don't recall the resources.

7

Thank you for the information , We'll look into it. Unfortunately I feel I'm losing this battle quickly.

The only social worker we had was thru Humana and they were no help at all. Last year a worker from Stonebridge came by but he couldn't accomplish anything. You could tell it was just a paycheck .

We talked with Medicaid over the phone and they flat out said they couldn't help as long as my wife worked full time.

As stated before we need her income to stay afloat.

Before I started medicare insurance I was covered on my wife's work insurance and we never had a problem getting medication.

Unfortunately we moved from Connecticut to Florida 2 years ago to be closer to my wife's kids & grand kids . She also lived here over 40yrs before marring me. Doctors told me it be better for me down here away from the cold.

Started on medicare before moving and have had nothing but problems getting medication.

Tried to purchase a backup prescription policy to help cover medication when I go into the gap every February but was told no such policy exists .

I've unfortunately come to the realization diabetes will take my life. Not because I didn't diet right or do what the doctors told me to do. But because I can't afford the medication I need.

I know I've a lot of other health issues and do take a lot of other medication that we can afford . But it seems like the insurance companies see me as a minus value. They actually pay out more for prescription and since they have to provide the service free to the government they do only a limited amount then write you off.

Although I may not be actually paying the insurance company for my coverage I do in fact pay about $150 a month out of my SS to the government for the process of having Medicare .

I'd much rather pay a $200-$300 fee to an insurance company and be covered with no gap in prescriptions.

Feels like I have an expiration date stamped on my foot and the time is near.

8

You might be out of options insurance wise until open enrollment and you can change your plan. See if you can get a credit card or loan and make monthly payments.

9

Just a thought...I am not sure if this is correct or not...but if you were to convert over to a pump, isn't insulin used the in the pump covered at a DME (Durable medical equipment) cost. Thought I read that somewhere on here that insulin is included with pump costs (if that is something you would be willing to do)....Or I could be making this all up...Swear my mind is swiss cheese and the holes get bigger and bigger :)

10

Sorry....just re-read your post on the pump....sorry :) Seee ...Swiss cheese :)

11

Unfortunately with me being disabled for over 8 years our credit rating isn't good enough.

12

As stated pump isn't an option due to the amount of insulin used daily. But thanks for the suggestions .

13

I understand the insulin resistant part, I have that as well. But since I switched to a insulin pump....my needs have been almost cut in half of the ant I had to inject vs continuous infusion. I know of pumpers using u500 in their pumps....just curious if you would still need that much if you gave it through a different delivery system?

14

I'll have to ask my endocrinologist . He was pretty adamant before about the pumps or pods not delivering enough insulin.

I've talked with the Omni Pod representative and he states they are working on higher dosage delivery system but have to get Lilly to make a dispenser to fit the pods. Then get Food & drug to except their system. Then get the insurance companies to accept it on their durable medical equipment plan. They state it's on the table but no idea if & when they'd get the ok.

15

you can pump U500 how ever if you are needing 2 vials a month you might be changing even the largest reservoirs ever other day or more. Pump supplies do add up. Are you on any meds to lower your insulin resistance?

16

Sometimes the only thing that works is to talk to the news media. You have a compelling case; embarrassment and bad publicity can sometimes get exceptions made to the rules.

Another possibility is to contact state and/or federal representatives and senators. The possibility of looking like a hero and the attendant good publicity will sometimes draw them like a moth to a flame.

17

They doctors figured I'd be changing after each day, And say it would be to costly. They have me on metformin. Not sure what other insurance approved medication would lower insulin resistance .

18

I'm not big into trusting political staff. They usually either promise you help then walk away or use your plight to better their agendas.

Your either sweeped into the cracks or exploited the hell out of.

I'm running out of time an answers , I did receive some free sample insulin and am using it but it's painful and already has blistered my stomach, It keeps my blood sugars in the upper 200 range.

I find myself asking is it even worth all this. I'm stuck in bed most of the time and sleep all day and in pain all night. Maybe things won't change for the better.

19

• Are you quite sure that you're T1? If so, I hope you're checking for ketones. >> http://www.aafp.org/afp/2005/0501/p1705.html

• I'm befuddled. You said "…Lilly only supplies one free vial per calendar year, Unfortunately had to go that route last April can't use again till May." Yet the Lilly TruAssist website states "A 90-day supply of medicine will be shipped to your home via mail order pharmacy. Prescription refills will be available during your 1-year enrollment period....You will remain enrolled in the program for up to 1 year. To continue receiving free Lilly medicines, you must reapply each year." >> http://www.lillytruassist.com/

• You mentioned that you take other medications… Many medications cause hyperglycemia. >> http://www.diabetesincontrol.com/tools/tools-for-your-practice/9625-drugs-that-can-affect-blood-glucose-level

• What is your metformin dosage? Also, many patients have reported problems with some generic versions. >> http://diabetesupdate.blogspot.com/2011/02/differing-brands-of-generic-metformin.html

• Here's a list of medications which might help you reduce your insulin dosage. >> http://www.diabetesnet.com/about-diabetes/diabetes-medications/insulin-with-meds?

• Are you rotating sites and splitting your injections to facilitate absorption? >> https://www.bd.com/us/diabetes/hcp/main.aspx?cat=3065&id=63271

• Have you read "Dr. Bernstein's Diabetes Solution"? Here's a link to excerpts from the previous edition. » http://www.diabetes-book.com/readit.shtml

20

Yes Lilly will indeed provide more insulin @ the pharmacy cost of $1400. They provide 1 free vial per calendar year. We've worked extensively with lilly in the past trying to find an alternative.

Endocrinologist sends me monthly for both blood & urine tests to keep up on my condition .

I take 2 2000mg of metformin three times a day and have been told by the endocrinologist that is the maximum dosage he will prescribe.

All injections are done in the stomach areas, rotation sides and sections each injection. While using U-500. But when using other samples of insulin because of blistering and irritation stomach , thighs, arms and butt are all used for injection sites. Also since 2 injections are needed with sample insulin 200cc rotation is performed each injection.

I've used both short & long needles with no difference in irrational or pain.

Now insurance now states I'm over using needles and don't want to cover the cost of 8 needles per day. They are so messed up. They are questioning why I went from 4 injections daily to 8. Endocrinologist chewed them out but they still being A-holes.

I've been thru programs The renown Joslin diabetes center in both Boston Massachusetts , & was a patient at their New Britain Connecticut center for many
years before moving to Florida . They performed numerous tests and tried many new medications on me before deciding HumilinR U-500 was the best medication for me.

While on my regular dosages of U-500 I have no problems keep blood sugars in the mid 100 range, I'm able to move around normally with less neuropathy pain. I do have to admit my vision was starting to get blurred but is a lot worst now.

I've done what my endocrinologist , primary , and cardiologist have told me to. I make sure they all know what medication they each have me on and if one doctor does blood work I make sure that each gets a copy of the results.

The only negative in my health program is an insurance company that has no regards for it's clients.