My health insurance has classified my current insulin Novolog as a drug that requires their “step therapy”, a.k.a., - use generic or their preferred brand-named drug. Otherwise I pay unless I get my doctor to submit a pre-authorization. Many reasons why this is in the wrong direction-
this will absolutely not save ME money! My insurance’s only claim for change.
it is so unreasonable to have me the patient & insurer to interrupt, bother and harass my doctors to call & answer questions to insurance personal instead of being doctors to me (and others).
if a pre-authorization is approved, it may be for a short length of time (in my case 1 year). So I have to ask my doctor to repeat the process all over again!
I’ve been on Novolog for 13 years and after many pump parameter adjustments my A1C is finally under 7%. I don’t want to be forced to change my insulin nor feel pressured to bother my Endocrinologist to call my health insurance when my diabetes is in control and I am in a state of being healthy!
This doesn’t make sense to me. Thoughts from others?
If you’ve been able to go 13 years on one insulin without having been forced to change by your insurance previously, consider yourself indeed fortunate. In my first five years I’ve been forced to change three times.
Most people seem to find Novolog and Humalog very similar, though there are exceptions. In my case, Novolog went a little further than Humalog, i.e. 1:8 versus 1:7 I:C ratio. In rare cases someone might be allergic to one or the other.
I agree, it is a pain in the derriere to have insurance calling the shots in what insulin or other meds one can have. It’s a pain for both the doctors and the patients. Unfortunately, in the US that seems to be the way it works these days.
I’ve been down this road - yearly in fact - though I use Apidra, rather than Novolog. In my case, I DO have a bad reaction to Humalog, so ought to be left alone, but it hasn’t helped. As @Uff_Da said, doctors have gotten used to the process, so call the endo and discuss the issue with them. This last time, it took all of one hour for my Apidra script to be approved, once the Prior Authorization paperwork was submitted.
My HMO threw Novolog to tier 3 and wants $200 for two vials a month. I was unable to get this changed, and even though I have a severe allergy to Humalog (was one of the first people in the US to be allowed to try Novolog), no one cares.
I used the card from the Novo site, and am able to have one vial per month for $25 for one year at minimum. Two vials was a bit higher. My CDE writes for two, but I didnt want to lose this deal so I went with one. You can check on their site for their discount card. I am still really upset by the whole thing, because there is no way I can afford to pay that much money. Some folks may be able to get a tier lowering but Optum RX told me no. Oh and last time I checked their site, they had that my two vials would be $300 a month.
Changing basal insulins for people still on MDI would likely have a much bigger impact. Levemir, Lantus, and Tresiba all work so differently. Humalog and Novolog are very, very similar.
As long as you don’t have an allergic reaction, you may not even notice much of a change. Maybe just a few small adjustments to your basal rates?
It’ll likely be less of a headache to make those adjustments than to pursue pre-authorization. Maybe give it a try and see what happens?
Thanks everyone. I agree, it’s the way the US health system is and will be in the future. I guess I should just go with the flow as in two years I’m looking at Medicare
for diabetes health support!
BTW: I did discuss this with my Endo; he said the two insulins were pharmacologically similar and his team sometimes needs to carefully choose their “battles” with insurance companies. I couldn’t disagree with him. He has successful fought on my behalf before.
I’ll switch- just wanted others experiences.
@CH_BOS, as @Laura_S suggested, you might look into the copay card for Novolog. My insurance prefers Humalog, it’s a Tier2 medication, my cost is $70/month. Novolog is a Tier3 medication with a monthly cost of $110. With the copay card I pay less than Tier1 generic prices (usually $25/month). Financially I would rather get the higher Tier medication because it will cost me less per month than the preferred insulin. I am always ok with saving a few dollars.
Just keep tabs when you switch. They are not totally identical and not everyone gets the same results from them. There is a difference, though most people dont have issues.
Very little if any difference for most people. I switched from novolog to humalog a few years ago for a discount… at the time due to the placebo/nocebo effect I had convinced myself that it didn’t work as well… here a few years later when novolog is again cheaper, I tried humalog again just because I had it laying around and was curious and now I’ve managed to convince myself that it works better… grass is always greener on the other side but for most people in most cases it’s interchangable
With my current insurance, something is weird… Humalog is the “preferred” insulin and only one that’s “covered” by the plan; however, when my endo filed for a prior authorization (due to me allergy to Humalog), they approved Apidra for me. Here’s the weirdness: The 90-day copay for Humalog was going to be $150, yet the PA’d Apidra is only costing me $90 for 90 days!??
I find no difference between the two. In the 30+ years on a pump I have switched back & forth several times. If you have problems staying below 7% A1C then the problem are the carbs. Go to a very low carb diet and everything is easier.
I’ve been on Humalog since my Whippple surgery 09/02/2016. I just saw my endocringolist this past week and ask him about Novolog he said that in most cases it takes more Novolog than Humalog. So, don’t get too bent out of shape, this just might be good.
