My insurance is a high-deductible plan. This means every January, I have to pay full price until I pay down the deductible. I love having my pharmacist look at me with pure pity when they ring me up (and sometimes try to run the insurance card again, thinking it didn’t work) each January and into February. That $1200 just for insulin is painful.
The first year I worked here, I had to get a payday loan. Not even kidding. Since then, I’ve been able to set aside some money to make sure I was covered for my deductible. I now use one of those health savings account (HSA) cards. My employer contributes some seed money to it each year, but not enough to cover the whole deductible. I contribute enough to make up the difference.
Last year, I went to fill my Novolog insulin prescription in April. The bill was, again, over $1000. I flipped out and waited, because I thought maybe I was filling too soon. The next day, I received a letter in the mail telling me that I had to switch to Humalog, because insurance wasn’t covering Novolog anymore. No real reason WHY, just “switch now.” The letter was dated April 5 or something like that. The coverage change was effective April 1. So they notified us that we needed new insulin after they stopped covering our old insulin.
Thankfully, I already had an appointment lined up with my doctor, before my existing supply ran out. I got a new prescription while I was there, with about 2 days of insulin left. Needless to say, I wasn’t happy.
I’ve also had no end of trouble getting authorized for insulin pumps over the years…
Can’t your doc GIVE you your insulin? My doc gives me all the insulin I ask for, at each visit. Doesn’t matter if it’s vials or pens–he provides all of it. I haven’t bought insulin in so long, I cant remember the last time, but it’s been quite a few years
I think you likely have a very compassionate and forward thinking doctor, but this (free meds for the asking) is a highly unusual circumstance, at least in the US. I used to occasionally get samples from my physician, but a regular prescription would only be filled at a pharmacy.
Perhaps you guys with difficulty paying for insulin need to call around to other endos. Granted, my doc is very helpful, but I can’t believe he is the only one out there. What is it going to hurt to call around?
Insurance companies are the bane of our existence! Everything is a battle! And I am so sorry for you. I hate paying for my insulin. It is my most expensive prescription and I have good coverage. I have never asked about sample of insulin but have been given samples for new things I wanted to try and not pay for because it might not work like Symlin and Victoza and of course free meters are always available.
That being said, I got the same thing with the change in approved test strips. Last year I had to go from Contour (my favorite) to One Touch not as accurate. Now i’m Being told I have to switch to Trividia Metrix test strips. Never heard of this company or meter but what I can find is I am going down in the accuracy rates. So tomorrow I start the battle! Why would they go backwards! And the funny thing is the Contour strips are the cheapest of the 3! Oh the joys of diabetes and insurance companies. Mine is nothing like your problem. I hope you can find a helpful doctor who might be able to help. Good luck and keep fighting the fight that we all must fight!
@CaM2 have you tried using a co-pay card for the insulin? You have insurance, so you should be eligible and it might significantly reduce your cost in the beginning of the year. Novo-Nordisk has one currently that pays for up to 2 years. When I was purchasing Tresiba my bill went from $1800 to $100 with the co-pay card every 3 months. Lilly also has a program, but it is tied to household income and has upper threshold income limits.
For me, Humalog is a tier2 med (of 5 tiers), and Novolog is a tier 3. The difference in cost/month is more than double between those 2 tiers. I use the Novo Nordisk co-pay card to lower my Novolog cost to less than half of the monthly Humalog cost . It’s a game and i don’t shed a “tear” that i am using the system against them.
This sounds awful. I’m sorry. I’ve found that some insurance plans give you discounts if you order through mail-order. Also, some insurance plans have diabetes programs. Sometimes those programs are a hassle, and sometimes they’re super helpful. I came across one awhile back that covered ALL insulin and test strips, regardless of whether the deductible had been met (this was also a high deductible health plan).
Your plan doesn’t sound as fabulous, but if you can get a copy of your policy and read through it, sometimes you’ll find gems you don’t expect.
Also, @El_Ver is an excellent resource for getting good deals on diabetes supplies. I’d recommend looking into the co-pay card program described in the post above.
Optum RX via my HMO took Novolog off formulary this year. However, they did not post the change online where they had other such situations posted and the web site diabetes/asthma back page did not show the change until after the health exchange enrollment period was over. I have a huge severe allergy to Humalog, and Apidra is not on the formulary so I am trying to get a grievance board to hear my case. They already said no once. The price is down some, but still too high for me. And the Novo discount card got me one vial for $25, on January 26. They now say that was a fluke. I wrote the state insurance board, and sent another letter to the grievance board suggeting they must want me to set aside my pump and move to Regular and NPH insulin. I have pretty much had it.
Novo card will no longer work for me. Worked one time, and HMO changed what they were willing to pay and tossed the card out of the system as “Rejected.” disgusting.
@Laura_S I understand what you are going through. I have had to fight insurance companies for almost everything in my care, and have always had to appeal the initial decisions -sometimes 2 or 3 times. I think the insurance companies hope that if they reject you outright, you will just drop the matter. If you fight it and have a Dr that can wordsmith a great Medical Necessity letter your chances of success are greatly increased (based on my experiences only).
I hope you win your appeal and get your Insulin. Maybe if you demonstrate the costs due to ER visits and such vs the cost of off-formulary insulin they might reconsider. Money talks, yes?
Also, I would call the Novo co-pay card phone #. My old Insurance drug plan paid bupkes for meds. Novo & Abbott paid almost everything thanks to the cards. The HMO doesn’t determine what Novo will cover unless I am greatly mistaken (which definitely does happen - somehow…).
I am very lucky right now. I’m getting all my diabetes supplies for no copay through my work health insurance and OptumRX. I just got set up on this back in the fall. Prior to that I was drowning in a sea of copays. I had heard about this through my employer but never acted on it for years until all the copays went up. It was a hassle to set it up and there will be hoops to jump through every year to keep it going but it will be worth it.
I haven’t always had this nice set up available to me. I have had to beg, borrow and steal before to get what I needed just to stay alive. And, have paid and paid and paid until there was nothing left.
It’s very sad for some folks, and I may be in that situation again some day. Doesn’t the JDRF have a lobbyist that can go to bat for us to get the costs under control?
In my second appeal to the board, I mentioned that since there are only three products approved for pumps, I guess they want me to toss the pump they purchased for me and they want me to go back on NPH and Regular…
They will not accept the card and say they made a mistake in January when they did. The Novo discount card.
Sorry, I think I misunderstood. Are you saying the pharmacy won’t take the
copay card? If that is the case, you can still get the rebate on
applicable Novo Nordic products. I have a pharmacy that absolutely will
not take the card. I file by mail after filling out a form online. The
website says McKesson, but they handle the Novo Nordisk rebates by mail.
The form can be found at
Every rebate I have filed by mail takes approximately 3 weeks to receive
the check.
You can buy contour next strips off ebay for 24 dollars a hundred and even cheaper - and no they are not knockoffs or from China - they test right on the money every time with the test solution - they always have good dates (at least a year) I have also tested them side by side to the ones from the pharmacy -
Also cheap on amazon - 22 bucks for a hundred and free shipping
I dont have the income to put out money ahead. My pharmacy got me one vial in Jan. for $25 but now the HMO changed what they would pay and want $100 per vial. Hubby has new medical issues and life is creating lots of debt lately unfortunately…
Liking is not right—just the only option to say “I get it”…Jeeze…$100 per vial. It seems self-defeating for the insurance creeps. You might try pointing out to them that if you die due to these idiotic policies, they will lose you as a source of income!..Bah Humbug!
