Insurance changes affect insulin coverage

Hi everyone, I just got a letter from my insurance company (Keystone East, which is a subsidiary of BCBS in eastern PA) informing me that as of April 1st they will no longer cover Humalog Insulin. They sent me this long letter “proving” that Novolog works just as well. The problem is I was on Novolog about 10 years ago and every shot I took ended up swelling up around the injection site. My doctor at the time decided it must be an allergic reaction and took me off of the Novolog and put me on Humalog. I’m a bit scared that if I go back to Novalog now that I’m on my Omnipod I’m going to have serious problems after three days of allergic reaction at each site. Does anyone have any experience with fighting this type of insurance decision? Or any suggestion as to other options? According to the insurance I can still receive Humalog (at twice the price) until June but then would need prior authorization and would have to pay even more. I can’t afford that. Does anyone know any other options?

Do they provide coverage for Apidra? I prefer it to Novolog and Humalog.

No, Apidra’s never been covered by them. Before I could choose either Humalog or Novolog, now it’s like they’ve got some sort of contract with NovoNordisk or something, there is no choice at all. It’s either a Novo product or going completely off the formulary chart.

Wow! That’s horrible. Is it an employer-sponsored plan? If so, it might be beneficial to contact your HR department and let them know what’s going on. They can usually put a little pressure on the insurer to make an exception.

I do get the plan from my employer. I’ll talk to our HR person. Problem is I work at a small office for a big company so I don’t know how much sway our HR person would have. But it’s definitely something I’ll try!

My insurance is a pain in the butt, but they do cave under pressure…They initially wouldn’t cover the Freestyle test strips for the OmniPod, but they WOULD cover the OmniPod itself…
after a few letters from your doctor and your employer explaining that you are unable to take Novolog, they might let you stay.
It seems like they wouldn’t force you to take penicillin if you were allergic to it…
Honestly I wouldn’t even let them know that Novolog would work at all. If you can get your Endo to let them know that not all fast-acting insulins are the same and that Humalog is the only medically sound option for you, they may make an exception.

Also the pharmaceutical company sometimes can put the screws/push on a company pulling this kind of BS…
After talking with your doctor, you should try calling Lilys customer service dept.

I would certainly ask your endo to write you a letter making the case for why you need to continue with Humalog. A little pushback goes a long way with insurers. I’m sure they’re just trying to save a buck.

Why are you not wanting to get prior authorization? I did that when my insurer was pushing me to move to One Touch or AccuCheck strips over Freestyle and when they wanted me to use Humalog instead of Apidra. It was just a case of one being in the cheaper, preferred drug tier. The price difference was maybe $20-30 more per month to buy out of the higher tier for me, I want to say. Maybe I’m wrong though. It was a while back.

My price difference is $50 a month. I work for a church and my finances are stretched super thin as is… I’m sure I could get the prior authorization, I’m just equally sure that I can’t afford the insulin. I’m stuck in a really awful place right now. The only reason I’ve never tried Apidra is 'cause I couldn’t afford to go up to that price tier. I’m really frustrated that my insurance is giving Novo a monopoly on semi-reasonably priced insulin. It’s bad enough that we can’t get a generic insulin but now I can’t even afford to get normal insulin that I’m not allergic to. Still trying to get in touch with my doctor… hopefully she’ll have a suggestion.