Is their Help out there even with Insurance?

Our New Insurance kicked in, I was so shocked when I went to pick up my son's Insulin and they told me it was $1400.00 for a 3 month supply, I almost fell over.... I paid $70.00 before, it seems that I now have a $5000.00 deductable on my insurance, does anyone know how to get insulin for his pump at a lower cost? I have been told that I make too much money to get any assistance, but for the life of me I have no idea how I can afford this along with all his pump supplies as well? Anyone have any thoughts? Thanks for listening. Cheryl

I know some have mentioned that there is help if you buy Apidra, you can search for discussions on that or contact the company. Apidra is a rapid acting insulin, similar to Humalog and Novolog, and many use it in their pumps. $1400 sounds outrageous for 3 months - how many bottles was that ? You might want to challenge if it was charged correctly.

You should also check your insurance plan. It may be that you no longer are paying premiums (or lower premiums) if this is an Employer plan. Often those types of plans allow you to set aside pre-tax dollars in a fund, and then you pay for your Rx, etc, from that fund, using 'pre tax' dollars, so there is some savings there.

For some, the reduction in premiums somewhat matches what they have as deductible, so instead of paying 5000 from your paycheck throughout the year, you get hit with it right up front. Hopefully once met, your costs will go way down.

That would have been 12 Vials, I actually had them re-check it and the price was correct. I also contacted my insurance company to see if I did mail order would I save there, and no the price was actually the same. I am doing the Flex Program as well, but that is barely covering the office visits at 300.00 a visit and his pump supplies, eye doctor and dentist.. Sadly the changes to the plan consider's the pump supplies Durable Medical and the only allocate 1000.00 per year on those supplies, and the deductable doesn't apply towards those supplies. I will contact his doctor in the am and see about Apidra, thank you for the info. Cheryl


The good news is that it is likely once you complete the $5,000, everything will be at no charge or at a significantly reduced cost. You can set aside $2,500 in a tax saver benefit, still your money, but tax free money. You can do that usually in the last quarter of the year for each employed person and you can claim it as soon as you have expenses in 2014.

Look at your policy for what happens after you reach your $5,000 deductible. You might be surprised at the benefits or your plan. Check at your business personnel office.

Cheryl - yes, for 12 bottles that would be about right for 'full' price prior to deductible being met. It may go down to 0, or 10-20% of that after deductible, so check your plan. Many people with plans like this have 0% after deductible, and 'stock up' at year end. Then their flex-acct can build up in the early months of new year and then available when time to hit the deductible again.

Another option might be to consider using Regular, but this is a much slower insulin than the current rapid insulins, but costs only $25/bottle.
Your doctor may be able to provide samples of Apidra, or other insulins.

5000 deductible is part of being underinsured. I hope your doctor or drug company can help you out.

5000 is a stiff deductable. Does your insurance offer a 2500 deductable or potentially an HMO option? Will not help you this year, but maybe next year.

Just a note, the $5,000 deductible will be fairly common the marketplace in years to come. Many plans are moving to the high dollar deductible in order to dissuade first dollar usage. This year I know of six plans that when with the $5,000 deducible. Now all of those were 0 / 0 meaning no copays, no deductibles after the $5,000 is met in all categories. But it does get ones attention quickly if you do not knwo what is coming.

These plans cost about half of the normal deductible plans because frankly very few poepl spend more than $5,000 per year on health insurance covered items. Do pay attention during renewal and open enrollment to use your benefits wisely. With regard to buying late to stock up. Yes that is one option but presumably that is only for one year. The plan administrators knwo if you have high dollar medical bills you will spend this year in year out. There is jsut no certain way to get around it.

Apidra is made by Sanofi they have a patient assistance program but having insurance could get in the way