Insurance charges triple the usual 30-day copay if quantity exceeds 31 days

My Levemir prescription is for 12 units morning and evening, for a total of 24 units per day, or 720-744 units for 30-31 days. A vial of insulin is 1000 units, which is enough for about 42 days. That means that my prescription costs $105 instead of $35. If I get a "90-day" supply, which I cannot afford on top of everything else, I pay the same $105 for 2 vials (which lasts only 83 days), and then I have to worry about my stupid refrigerator (which I cannot afford to replace) freezing my extra bottle. I might as well pay for "90 days" and get two vials, but then I have to cut back on my food budget--really, there is no other place to economize. Why is it impossible to buy smaller quantities of insulin. The 3 mL insulin pens would be a good solution if you could buy them individually, but they are only available in boxes of 5! I doubt that most type 1 diabetics use more than 750 units of basal insulin per month. Do others run into the same insurance situation?

If your doctors are decent, just call them and cite insurance issues and have them issue a new script for the closest unit per day that gives a full vial over 31 days. I've done it a couple times, once with pens and once when I started pumping.

I agree>ask your doc to write a script to accomodate your concerns.

God bless,

Yes just get your doctor to write a new script that says you need 35 units per day. You will not run out, and you will be within the 30 day limit.

I routinely request that my doctor prescribe enough insulin to cover my "range" of needs. After all, you can waste a bunch of insulin priming and stuff. You should ask your doctor to write a prescription up to 30-40 units/day and then problem solved.

Also, you can appropriately argue that a vial of levemir is only good for 28 days once it is opened, so a 90 day supply must be 3 vials. Your insurance surely can't be suggested that you use "expired" insulin.

Good luck.

There is also the Lantus insert that says that a bottle is only good for 28 days. So if they want to play the stupid "30-day magic number" game, they have to get you two vials every 30 days.


The key is in what the prescription says as written by the doctor. There is no reasoning with the pharmacy on how much to dispense (especially when the insurance company is involved).

Orbiter7 - As others have said - get your doc to re-write the prescription.

To prevent your insulin from freezing in an unreliable refrigerator, try the following:

1 - Keep the insulin as far away from the freezer area as possible.
2 - Keep the insulin in a larger plastic container (air can be an insulator)
3 - Get a gel freezer pack (preferably two). Leave one out to warm in room temperature and wrap your insulin in it every morning. Put it back in the fridge - repeat daily.
4 - Alternatively, get a cooler and keep your insulin in the cooler in the plastic box. Put some ice in the cooler periodically and keep the cooler in a cool, dark place in your home (basement?).

Insulin kept in a relatively stable temperature environment that isn't above 80 degrees F or below 32F is surprisingly stable.

I thought about the 30-day/throw-away rule, but apparently it varies according to the type of insulin you use. Levemir is supposed to be good for 42 days, so that doesn't help me. I had the doc write another script for the pens, 17 u twice a day, which is 3060 units for 90 days. I got 2 boxes of pens, which come 5 to a box, 3 mL per pen, for a total of 30 mL or 3000 units insulin. Not quite 90 days, but close enough for government work. If I want pens for 30 days, though, I would have to get a script for 50 units per day, which I suspect might be too far off the rails for my doc to play along with. What would be his position if I were taken unconscious to the hospital and his prescriptions were called for? Can doctors be held liable in any way for intentionally writing to the insurance plan rather than to the patient? I am grateful to him for helping me in this way, but I can't understand why we can't buy smaller vials or fewer pens. Strip quantities cause similar problems. I can't afford to pay $443 (soon to be $461) per month plus $2200 deductible, plus $35/month copays (or $105/90 days)for two types of insulin, test strips, needles, etc. I need to be able to at least get close to getting 90 days worth for a 90 day copay. As it turned out, they would only give me 400 pen needles (instead of the 600 called for). Now I have to fight them over that. Is it possible that they consider the pen needles for the Levemir as somehow separate from the pen needles for the Novolog pens? I am tired.

No, Tim. Even if I were taking Lantus, with the 28-day rule (instead of the 42-day Levemir), they apparently don't HAVE to give you enough for 30 days (at least, not for the 30-day copay of $35). The rule is not that you get enough for 30 days for a 30-day copay. The rule is that if the packaging of what you need for 30 days causes you to have enough for even a fraction of a day over 31 days, then they get to charge you 3 times as much ($105). It is especially frustrating if you want the insulin pens because they can only be bought in increments of 5 pens (total 15 mL). There is no way to get a 30-day supply of Levemir for a 30-day copay, at least not at the dose I take, in either vial or pen. Assuming I can swing $105 at the time, I can buy a 90-day supply by going to one of the few (and inconveniently far away) "retail 90" pharmacies on the network's pharmacy list. Of course 90 days does not equal 90 days. Two vials or 3 boxes of pens is enough for only 84 days, but you can't get more because that would be enough for more than 90 days! No matter what you do, you end up paying what amounts to 13 copays per year. If you have a disease requiring pills, you can get exactly what is prescribed for a given period of time. Just one more way the system takes advantage of the poor type 1 diabetic, who can only cough up the dollars if they have them or suffer the consequences of inadequate diabetic control if they don't. I think the drug companies should make available smaller vials, allow purchase of individual pens (or at least boxes of 2 or 3 instead of 5), and make test strips available in increments of 25 or perhaps 30. Of course that is not going to happen, because they have it worked out with the insurance companies to maximize profits, IMHO. Aargh!

Insurance companies have started trying to "crack down" on "waste". It happened to me recently.
The first step, as others have suggested, is to get a new prescription written. I would suggest telling your doctor the issues that you've been having with your insurance, and asking them to write the prescription as "One bottle for every 30 days, inject as directed". This gets around the insurance company's fuzzy math policies and gives you what you need.

I have had the best luck with Wal-mart pharmacy on this issue. Other pharmacists have had less favorable policies (toward me, that is), but my Wal-Mart pharmacy has been willing to go back and forth between my doctor and running insulin through insurance to see what is the most insurance will pay for. I assume this is why they are such a big retailer now.