I’ve been on a pump for a few years and from time to time I like to give myself a break and switch back to MDI… And I’m using Lantus/Novolog… This last doctor’s visit I asked about tresiba and my doctor wrote me a prescription for it. Now when I went to our employee pharmacy to pickup my prescription I found out that our insurance doesn’t cover tresiba unless I will try and use lantus first.! I told the pharmacist that Im using lantus when I’m on MDI and he said that I last refilled my lantus 6 months ago and that insurance wants it to be within 3 months and then after I try lantus and don’t like it then I can try tresiba.! Anyone had this experience? And what did you do to get your tresiba covered? Looking forward on reading your replies:)
It just reeks of “Try brussels sprouts again. I know you didn’t like them last time sweetie, but maybe you’ll like them this time now that you’re older.”
Well you’re still gonna have to jump through the hoops to get insurance coverage. If all they’re asking is that you’ve tried their preferred lately, consider yourself lucky…
Usually they’d want to pester you or doctors office for documentation about why the preferred alternative wasn’t acceptable a handful of times until your doctors office just gives up, then everyone would be disappointed and you’d still not have it… So if all they’re asking is for you to have filled a lantus rx more recently, it’s about as good as you can hope for
It is termed step coverage and yes it is customary in about of all health insurance plans these days. Usually, (not always) there is a pressure valve wherein the doctor can justify the different prescription based on the expected effectiveness and piror resuts of required medications. To pursue this option you will need to contact the doctor and ask them to make an appeal. Such an appeal is often granted less than 50% of the first time on average.
Tresiba is still new. Many insurance plans take a year or two before they will cover new drugs as preferred or at all. Often the way that they cover new medications but limit use is by either making it “non-preferred” or by requiring “step therapy.” Apparently your insurance requires step therapy. You basically have three general options. Go back to using Lantus to satisfy the step therapy requirement and then attempt to refill the prescription. Or you can have your doctor write a letter of medical necessity and say that you already tried Lantus on MDI and failed and that the 3 month rule should be waived. The third option is to use the Tresiba savings card to pay for the prescription.
