I read that article a few weeks ago and it started my thinking about my insurance company and the coverage provided for insulin and test strips. You get lower copays (but NOT the lowest generic tier copay) for using insulin and glucose monitors and supplies from certain manufacturers.
My insurance company is Coventry of Kansas and they “encourage” the use of insulin from Eli Lily and the OneTouch meters and supplies. By encourage, I mean that you are perfectly free to use whatever brand you want, but if it is not one of the “preferred” brands, your copay is $25 higher per month on each item. That adds up to $300 a year, for me anyway, since I found I have to use Novalog in my pump as opposed to Humalog.
The biggest issue I have is that it seems there must be some type of agreement in place. What is the difference between what Bayer did and what Coventry and Eli Lily are doing? Diabetes seems to be the only condition with this type restriction. Most medication copays are set by the relative cost of the medication, or so Coventry says.
Except for these… the copays for these drugs seem to be based upon the condition of the patient. Coventry’s position is that they have found diabetes drugs from these manufacturers to be less costly. Then why can’t we get the $10 generic copay on them as opposed the $30 mid-tier?
Novalog and Humalog are almost identically priced, so the lower cost argument does not hold water. I went and looked at my prescription history. Novalog comes in at $91.52/vial ($55 copay) and Humalog comes in at a shockingly low $91.05/vial ($30 copay).
Why is this type of behavior on the part of manufacturers and insurance companies legal? How does it differ from what Bayer was doing? I feel this is very similar to the horror stories you used to hear about. Where a treatment for a condition isn’t even mentioned if the patients insurance wouldn’t cover it. I just can’t see the difference.
Now, I suppose I have made some rather strong accusations in this. This is my opinion and I have documentation to back up my numbers.