In December, 2012,I was told by my insurance company , Medical Mutual, that they will no longer be covering Apidra, but that all I need to do is get a basic prior authorization from my dr and all would be ok. Wow, was that ever an understatement.
I Had a little less than 1 bottle left over at the end of the year, so I went to try to get a refill around January 5. No go. I went to my Endo to ask for a prior authorization.: The PA who handles such requests was not their and the woman who took her place seemed to not understand what I meant. I even had a rejection printout from the pharmacy and the number to call my insurance company to make the authorization, which I confirmed with a presentation of my insurance card. She said she would check it out and get back to me. The next week, I would soon be running out of Apidra, so I I went back to the dr's office, as they had called me in after my numeorus phone queries to them . I had contacted my insurance carrier, Medical Mutual, who said thast Apidra wasd not longer on their formulary and that they were hot sure if a prior authorization would help. I called the insurance company the next day the customer service woman who answered their phone this time said that they would cover it if my Dr. Sent in a prior auth. The next morning, I went back to the dr.s office and got a no copay cared from the PA and I tried to explain to her that that would not help me. She said that the Apidra rep told her it would take the palace of a prior auth. ARgghh I felt like I was talking to a brick. It was late in the day; I came back a third time, two days later, and reiterated my predicament to the receptionist, and received two bottles of Humalog "to use while we work this out." She did say that the new PA was not familiar with prior auths. and that I would have to talk to "C", the more experienced NP (whom I have worked with in the past, as she has been with this practice, like me for years) to get the prior auth. the receptionist said I had been to thre doctor's office so many times ( Phone calls do not work with them, and there is no way toi e-mail the office., just fax or smail mail), that she would get she would ask "C" to do it.
Meanwhile I have been in contact with Sanofi-Aventis,the Apidra manufacturer and they told me that there was a coding error with Apidra where it was inadvertently not covered for some Medicare recipients, and many insurance companies followed suit and refused to cover it in 2013. Supposedly, this discrepancy will be taken care of in the next few weeks. I realy like Apidra and do not want to fontinue using the Humalog I have been given. The tail is too long and I cannot get the quick corrections that I am accusotmed to. Plus, I am a pre-65 retiree and my Humalog, before my high yearly deductible, would be 143 a bttle and I use about 2 bottles a month.m Pretty pricey!!!I could get , after the No copay card is used, thr apidra at $60 for the two bottles as sasnofi -Aventis would tkae care of the $50 copay per bottle with the savings card. Quite a savings, but I believer I will be forced to go to Humalog, unless my dr's come uo with the info I nned to go back to Apidra.
today ( Sunday 2/11) I went to the CVS oharmacy I usually get my preceriptionsion filled thass has the apidra script on file.we ran the script again and it was rejected. The phramacist siad to do whatever I need to do to get a prior auth. from my doctor.
I really like my endo, but his office is undrestaffed and many are not trained well. Will I have to write the pre-auth and just let my doc sign it? What do I have to do to prove that i get better control with the insulin that I have used for the past 8 years? I have only been on Humalog for about 3 weeks SO FAR, in 2013, but I am seeing a difference. I have to wait 3-4 hours for a full correction to take, unless I almost double the cotrrection suggested by the bolus wizard. This throws my day off and makes me want to "rage bolus" to get a high down quickly so I can go about eating and taking part in a regular day. Have had really crappy blood sugar swings from overbolussing to avoid 3-4 hours of highs. OF COURSE i get a resultant, realtant low, and many times a rebound high. Viscious cycle. I just prefer a low to a high, any day. ( like 314 to 37 in the spacee of 7 hours. Not fun.
I had some roller coaster highs when was on Apidra, some due to user error, but I did not find I had to double the correction factor with Apidra. I want to keep using it, but I cannot afford it striaght out of pocket, neither thr Humalog at this time. I did not pay for Apdira at all last year, even prior to meeting my deductible. nIt went through nwith no-copay ane no price as covered by my insurance. Now I am bein gtold they do not Cover it at all. BIG CHANGE
Should I just go and sit at my dr's office and demand a prior auth? What info should I ask from my insurance company prior to going for my 'sit-in"/ I do not plan to be evil and nasty, that is not my style. I will be sweet and persistent and will sit there for several hours, or all day if I have to.
I will post this on the regular type one forum as well, to see if anyone has run into similar Apidra and doctor office problems/ Perhaps those there who work for insurance companies may be able to help.
Thanks for taking the time to read this, Tufamily, mi familia