Insurance Co. is forcing me to not use Tresiba

I am on Medicare, but also have a supplemental Blue Cross insurance plan.
Our prescription plan is not under Medicare.

First I suddenly had to start paying about 10 times the amount I was originally paying for Tresiba and now I received a letter telling me that they are no longer carrying it.

These are the choices that they are giving me instead.

BASAGLAR
NOVOLOG
FIASP
HUMALOG
ADMELOG

GENERIC INSULIN LISPRO

I love Tresiba and am unhappy about this, but because I have been ill for months and research health matters almost everyday, I don’t have a lot of energy left for this too.
Do any of you use the basal insulins listed here?

I know some of the choices listed here are ridiculous. Some of the insulins I am not familiar with.

Before Tresiba I used Levimer. I love Tresiba but Levimer was fine.

Oh another note, I questioned my cardiologist about the location of a test he had ordered and he dropped me as a patient yesterday. I am beginning to think I am living in The Twilight Zone.

TIA
Marilyn
Type 1 dx 1959

Tresiba is a long acting insulin? Humalog, Generic insulin lispro, Fiasp, Admelog and Novolog are fast acting insulins. Basaglar is the only one that’s long acting?

You can usually get around the you can only take what we tell you by your doctor submitting a letter saying you need to be on a certain one. They usually then approve (in the past for me anyway they have) But you do end up paying more for it because it’s not on their formulary list. The other thing that can happen is you have to “try” the new insulin to prove it doesn’t work as well.

You can tell the doctor you have to try the new insulin and if it doesn’t work can he submit paperwork requesting Tresiba. I think Tresiba is supposed to be better at not having lows. As soon as you decide you don’t like it, call your doctor to tell them and ask if they can submit a request. It’s possible that with you being sick he can submit something now about Tresiba helping stop lows but I am unsure if that will work.

Tresiba has a button for a savings card on their site. I have no idea what it entails.
https://www.tresiba.com/taking-tresiba/what-to-know.html?campaign=000732302&utm_source=bing&utm_medium=cpc&utm_term=tresiba%20insulin&utm_campaign=1_Exact_Brand_Tresiba_Branded_Core%20Brand&utm_content=zjzruyAY-dc_pcrid_74079806190937_pkw_tresiba%20insulin_pmt_be_slid__

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Thanks Marie, when I called the makers of Tresiba I was told that they do not give coupons etc to people on Medicare or who have private insurance plans.

Yes, I thought all the other choices were probably short acting. That just makes no sense whatsoever.

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Do you have drug coverage through retirement benefits and that precludes you from changing drug plans? I definitely choose my drug plan based on what the formulary is, but for sure insulin is hugely expensive through Medicare Part D plans. As a pumper I get my insulin through Part B which is a great deal with Medicare paying 80% and my supplemental paying 20%.

Hope you get it figured out and are able to keep using Tresiba.

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How awful! I’m sending you lots of hugs, good thoughts, and prayers @Marilyn6.

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I was just thinking about you today.

What the hell? Why is this stuff happening to diabetics?

What is happening in this world?

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This stuff is happening to everyone and not only to diabetics. It is because we, the people, have allowed for profit corporations to take over the direction of our lives.

Like Laddie, I opted to get a pump through Medicare and my supplementary insurance. They are now paying for my insulin and supplies through Medicare Part B.

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Hi Willow. What brand of pump?

I agree. I too suffer from the chronic condition of Rheumatoid Arthritis a painful auto immune disorder.

I inject myself once per week. Medicare does not cover that drug. A drug that works really well for me. Fortunately I have secondary private insurance and for both my husband and I we pay with Medicare 1400 dollars per month. If I had a supplementary Medicare plan Enbrel would not be covered. I would have to go to the hospital for infusions of another RA drug and it may not even work.

I just chose to concentrate on my comment about diabetics.

Though my disorder is painful and complicated I just don’t, at this point feel it is as trying as what I see many diabetics go thru with all the change ups that seem to go on. It’s happened to us.

I was one of those caught in the Animas/Medtronic trap. Second Animas Ping for me. Now I have a Tandem t.slim x2 and am awaiting the Dexcom g6. Medicare did not pay for the Tandem but does continue to pay for insulin as well as supplies. It is also paying for the Dexcom and supplies.

I commiserate on the Rheumatoid Arthritis. I know several who have RA, also an autoimmune condition that sometimes goes hand in hand with T1, Hashimoto’s Thyroiditis and several other conditions such as MS. One with RA is my 21-year-old grandson, dx’d almost 2 years ago. A very active young man, he feels it hampers his life. While his activities have not been totally curtailed, RA has limited him in what he can do. It can be very painful to live with and, like T1, there is no cure.

Sally, first of all thanks so much for thinking of me.

I think it all comes down to money and greed.

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Are you able to consider ordering Tresiba from Canada?

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I’m sorry you’re going through this @Marilyn6. My plan is changing their formulary in January. My insulin options are different than yours, but the long-acting insulin I currently use is not on the new formulary. I am okay with switching to Basaglar because I’ve read a lot of posts about how it is very similar to Lantus (which I currently use). Hopefully Basaglar does work the same for me.

I’m currently going through a prior approval request for Afrezza, and it has been quite frustrating - as expected. In 2019, Afrezza was covered for me, but in 2020 I’ll need prior approval. Just getting the request for prior approval submitted has been an undertaking…

Have you used Lantus before?

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I have no idea.

Thank you. Good info.

RA is painful but with the right meds and continuing to do what one can things are ok. One day at a time.

My very best wishes to you.

I suppose I am ok with switching to Basaglar since I used Lantus for years, I just really liked the convenience of Tresiba, and I don’t like that I no longer have the choice of taking it.

I called Blue Cross and complained just for my own peace of mind. The woman I spoke to didn’t really understand or care. I tried to be very nice to her since it certainly isn’t her fault.

I have some extra Tresiba on hand and maybe I won’t have to make the switch until I am feeling better.

Why in the world would your insurance company make you jump through more hoops? I find that heartless and ridiculous.

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It’s all about the money.
Always about the money.
Caring is out the window and the people you talk to via phone at insurance complains etc. are caught in between unawares, some, the rest must have to steel themselves and the others…just a job. They have home and hearth they must maintain also.

Glad you are ok, Marilyn.

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Meaning can you afford to purchase on your own?
It’s substantially less in Canada.

I completely understand. This kind of thing frustrates me as well. Perhaps Basaglar will be the same as Lantus… but wouldn’t it be nice if I didn’t have to find out? It’d be great if I could simply keep doing what I know works.

It’s unlikely that their steps are directed at me specifically. Afrezza is quite expensive, but there are other name brand drugs that are probably even more expensive. My plan had a non-formulary name brand drug benefit in 2019. They still have that benefit in 2020, but I guess those drugs now have to undergo some sort of prior approval process. They probably figure that by making people jump through hoops, fewer people will try to use the drugs that aren’t on the formulary which will cut costs so that they can keep the premiums low. My insurance is a union plan, so the only company really making money under this scenario is CVS and whatever drug rebates they can slide under the table in the backroom.

Suffice it to say that if I can get the prior approval then I’ll end up paying $3,000 less per year. If I can’t, then I have to switch plans and pay out. I don’t think I’m willing to give up Afrezza even if I have to cut costs elsewhere in my life. The prior approval process is pretty annoying though.

We’ll see what happens.

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Basaglar is the same as Lantus, it should be a suitable alternative.

As somebody else said the rest are all fast acting if you do not have good results with basaglar you could try having your doctor document that and writing a letter of medical necessity for tresiba.

It’s not the end of the world… give basaglar a go and let us know how it works

The reason that insurance companies do this is because Eli Lilly offered them a larger secret rebate than novo nordisk did, so at the end of the day they’ll be more profitable to distribute Lilly than novo. It’s a corrupt system but that’s what happens when we have career politicians in congress.

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They are not allowed to give coupons or discounts to people on Medicare… go figure… there’s that congress looking out for us again