I started with a new insurance January 1. I went to get my insulin filled at the pharmacy today, and they informed me that it would cost $225 for 5 vials. I was in TOTAL shock. I think the most i have ever paid was $35 for all. Is this unheard of? apparently my new insurance is garbage. I called my insurance company and after 45 minutes of being on the phone, I found out that a 90 day supply of insulin would cost the same as a 30 day supply. Has anyone ever heard of this? That seems ludacris to me but I will take it if that is the case!
It is always important to understand deductibles. Often at the beginning of the year, you have to satisfy deductibles. This can often be shock. We often overlook how much we are ripped off by medications. Check with your insurance and make sure you understand your deductible and co-pay. You may find that once you satisfy your deductible your medication out of pockets go down significantly.
My insurance offers mail order 90 day supply at same cost as retail 30 day supply. I agree with Brian, you may also have a deductible that applies to scrips.
Are you on a HDHP (High Deductible Healthcare Plan)?
I am on one, and what it means is that you pay 100% until you meet your deductible.
So yes I have heard of this. Diabetes is expensive for me Jan-Apr. Once I get to Apr, or so, then the deductible is met, and I pay 10% until the out of pocket limit then I pay 0%.
So in Jan & Apr I should be paying:
$600 for 3 months of strips
$500 for 3 months of Humalog Pens
$360 for 3 months of Lantus
$75 for 3 months of Pen needles
$20 for 3 months of Syringes
$1555 for each refill.
After that it becomes reasonable again, and I don't pay for the insurance from my paycheck. So it saved me 1000's to do it this way.
i do not have a high deductible insurance. I have an 80/20 plan. my deductible is $100 for major medical or hospitalizations. I didn't realized 5 vials of insulin costs $1000 i guess. insurances are very confusing. Im so frustrated because i opted out of mine to go on my husbands because after research it seemed like the better choice! has anyone gotten a 90 day supply of insulin through the mail? I heard CVS does 90 day supplies so i guess that is where i will start.
I would check with the insurance company to see which mail order pharmacy is allowed.
I use mail order from Express Scripts. It is required by the plan.
It works ok even in Phoenix summers.
yes, I receive a 90 day supply by overnight shipment and have for years. Never had a problem no matter the season.
My insurance only allows local 30-day supply of prescription for non-routine medications. Once you get the 30-day amount of any single prescription three times, my plan will not pay for any additional medication unless it is ordered through the mail-order plan. My mail order plan is through Express Scripts and I get a 90-day supply of insulin through them. I've been getting a 90-day insulin supply via mail order for over 20 years.
My annual deductible is $250, so if I filled a 30-day supply of insulin locally in January, I would pay $250 + 20% of the amount between $250 and the total cost. If your plan works like mine then I don't think the amount you paid, although painful, is unusual.
You may want to ask if your 90-day mail order plan combines insulin plus test strips into a single copay. Mine does.
Sadly not unusual!
Every year I have to do the "insulin refill dance" with my mail order pharmacy benefits manager.
First, I have to get a new prescription that the mail order pharmacy decides can't be filled as written. After a few back and forths between the pharmacy and my doctor we finally figure that the pharmacy can't understand 30 units/day via pump, so it gets written for 50 units ONCE PER DAY.
Next, I have to revalidate my credit card so they can charge me $900+.
I generally receive an email after all this that says my prescription will be filled in 10 - 17 business days (!) after the pharmacy receives my prescription (note this is a department within the pharmacy benefits manager company). Then, I must call to ensure that the pharmacy actually has the prescription and I tell the CSR that I am ready to authorize (again!) the charge against my credit card. "You don't need to do that, sir. We already have your authorization on file," is the response I always get. I then sigh ...
In excess of 17 business days I call back and ask where my prescription is. The CSR then says, "Because the amount is so high, we are waiting on you to provide us with an authorization to charge your card."
Then somewhere between 9 - 18 months, I receive a call from a pharmacist asking why I haven't been ordering insulin every 90 days. "Are you still taking insulin", they ask?
The dance continues ... sigh!
It sounds to me that they have made a mistake if there is no deductible, you should be paying 20% which can't be that much? I get my D stuff through express scripts and the copay is $20 for all 90 day D supplies, no matter what amount I get I believe, i.e.: more or less test strips still have the same copay. I can no longer get any rx except for a 20 day supply or for emergency maybe more I think at local pharmacies. I think they may have changed this slightly now and there are some local pharmacies where I can fill some meds. It sounds like they're charging you for the retail cost almost maybe? I'm not sure. But I would definitely call them to find out. There are programs to help you pay with Sanofi and various companies also. I got back $80 of my copays last year through a program like this.
thank you for your response. The cost of the insulin is $1000 for 5 vials, so 20% is $200. It is so ridiculous. My husband and i both work, so i will find a way to pay this amount. I would hate to take from funds that others may really need. I am going to ask my doctor to write a script for 90 days. $200 for 90 days seems way more reasonable!
the "dance" is ridiculous to me. My personal insurance states "all diabetic supplies covered at 100%". well that is a joke. so far from the truth. I just wish they made things easier. i have private insurance for a reason…..I don't want to have to spend all this time on getting medicine that i need to function. thank you for your response
I have caramark, but i am a little confused on what you mean about fill 30 day supply twice = 90 day supply. they told me that the 30 day supply is the same price as a 90 day supply?
I have a $1,000 pharmacy copay which i am not used to because i have never had one before. once i meet that copay, i have to pay 20% out of pocket which makes no sense to me because I pay 20% out of pocket until i meet that copay? i feel like i am spinning in circles. maybe i need to call back to speak to someone else. Thanks for your response!
Maybe vials are more expensive than pens I guess. I wouldn't worry about taking funds from other people, many of these are offers have no financial requirement and they're offered by the companies who are making tons of money off of insulin and other medications. No one will be turned down for this due to you getting it. You never know what expenses you may have as a pwd or for other health condition so I would try to get some money back from programs like this, especially since your insurance doesn't seem to cover very well. Any medical expense out of your pocket is also a tax deduction as I'm sure you probably know.
SO that means you have a 30 day supply for 3. Meaning you can get 3 months on mail order for the same price as you get one month at the pharmacy. It is well worth getting the insulin mail order. The plan is pushing mail order insulin and it is likely because the mail order price is perceived as being so much less than the window price for the local pharmacy.
Insurance is made deliberately confusing. If you could easily see which was the best deal then you would get the best deal and you wouldn't be ripped off so much. The insurance and pharma wants it to be confusing.
My insurance has a separate deductible for pharmacy benefits, I have to pay this amount before insurance kicks in. The medical and hospitalization deductible in my case is a separate deductible. Once you meet the deductible, you will pay your co-pay (20%). I also get a benefit from a 90 day mail order. It is fulfilled by CVS Caremark on behalf of my insurance (Aetna). It is more affordable and I have never had a problem. You also need to check your insurance "formulary." Often you will have different tiers of medication and Novolog may be a preferred brand and offer a much cheaper copay than Humalog.