MDI is freedom from physician and insurance oversight and manipulation


#1

Recently, I’ve had lots of issues with insurance denying the fast-acting insulin I use and my pharmacy cutting back long-acting insulin to bare bones. When I was on a pump my endo could record exactly how much insulin I used and that information dictated the insulin rx. Being on MDI there is no way for my endo to see exactly how much insulin I use. I cannot allow my insulin stock to run as tight as only a few days remaining as the pharmacy is currently insisting. Is it wrong to inflate the amount of insulin I use in order to increase the script? It is terrifying to have only a few days supply on hand when something always goes wrong with insurance or the pharmacy when filling a script.


#2

WRONG??? Hell no!! My endo always inflates what I get (back when I was buying it at the pharmacy.) I’m on a pump and he would simply calculate a large enough quantity that I’d never come close to running out. He gives me insulin at each visit, saving a trip to the pharmacy. Your endo should be your advocate!


#3

Most of us have a supply stockpile that we’ve accumulated over the years.

You could call your strategy “inflation” but others call it “under-dosing”.

If you are recently diagnosed you may not have had time to build up a stockpile. Don’t feel bad about not having one yet, you can do it.

Yes some endo office staff “rounds down” and others “round up”. Sometimes I hit the jackpot and other times I come up short. When I hit the jackpot I build up the stockpile, when I come up short I can sometimes complain about the math and get it corrected. A lot of the office staff are NOT rocket scientists when it comes to math.

My particular mail-order pharmacy gives me 90 day supply 4 times a year which is only 360 out of the 365 days. So even if I never broke a vial and never had to take a correction, I would end up without enough insulin. So don’t feel bad about goosing the numbers when you can, to make it work out.


#4

I am also on MDI and buy my insulin in Canada to save 90% from US retail price so in order to make as few trips as possible up north, I take my highest daily dose and multiply x 3 x 90 days, then add for priming needles, bent needles, etc. and give total units for endo to write prescription accordingly. Canada is OTC so do not need prescription, but having a valid US prescription is a requirement customs may ask for re-entering US from Canada. They have never asked me for it but I carry it with me just in case. Does not sound like you are looking to be that aggressive in overwriting your prescription but remember, your days will vary so you really have no idea exactly how much you will use each day and therefore “inflating” really just means you estimated a little high.


#5

@Lauri may Endo always rounds up approx 20% on insulin and test strip Rx’s so I can have an “Oh ****!” stockpile. It also helps for formulary and insurance transitions as I am not desperate to make changes and can wait to see what will be best for me financially and health-wise.


#6

My GP asks how much I use and adds 20-30% so I have enough. Nothing wrong with that.


#7

Illness increases insulin needs. Vials of insulin can be bad or go bad. You may even occasionally eat something different that requires you to use more insulin. Insulin is not like pills, where it is easy to predict exactly how many you will take per week, month, year. Rounding up and accumulating a stockpile is an essential strategy, not just reasonable.


#8

No, I don’t think it’s wrong to increase your insulin quantity to comfortably cover your supply needs. Glucose management alone adds extra and often unavoidable stresss to our lives. As you well know, stress complicates our effort to manage blood glucose.

I derive tangible comfort with a few extra vials of insulin in the fridge. This may be hard to understand from a gluco-normal’s perspective. But we see insulin in stark life and death terms. Running low on insulin is an existential threat and there’s no reason to continue to allow that to happen.

The insurance companies and other payers do not care about us. They are profit seeking organizations. They play their role to enhance their goals. We need to play our role and do whatever it takes to ensure a sufficient supply that can easily survive unplanned circumstances like loss of access to insurance or a natural disaster.

If you do what most commenters in this thread recommend, will you feel morally compromised? If so, you may want to talk with a trusted spiritual counselor and see what s/he thinks.


#10

@Sam19 that is fantastic!


#11

I was dx three years ago, so not squeeky new to T1D. Building a stockpile are one of the things I’ve been learning, and I do have a stockpile of short-acting insulin that I won’t reveal to anyone outside of this community. I was foolishly negligent in refilling my long-acting insulin because I always got an ample supply. It caught me off guard when the pharmacy actually counted out the units and gave me only a 75 day supply because one more pen would have put me over 90 days and “that’s insurance fraud”. Now my long-acting insulin supply is low. I feel like Scrooge counting money when I lay out my insulin supply and count out the days. Such a feeling of security to have more than enough, but terror to see maybe not enough…


#12

I like that… spiritual counselor… it just seems like I shouldn’t have to lie to get enough insulin to be secure. I haven’t seen my endo for 8 or so months but see her next month. Let’s see how she fills the script for long-acting insulin and if I need to nudge her. I just so want the stars to align and to not have to struggle for every diabetes management drug/device for which I pay so dang much. The time investment these last three months has been nearly a full time job!

My spiritual counselor is the woods but the snow is up to my waist. It’s a good work out and soul soothing even if I don’t get too far!


#13

Oh i don’t, and wouldn’t lie. I say “I use about 20 units per day of basal and 20 per bolus but I’d like to have more than that prescribed for a safety net”

He says “oh of course I always do.” And prescribes about twice what the minimum amount I absolutely need is… I mean it’s not like I’m selling it on eBay. He even puts “internal notes” in my chart that only he and other hospital staff can see that tells how much I actually typically use vs how much he prescribes.

He is the doctor, how much he chooses to prescribe is his prerogative. It doesn’t have to be the exact amount I take every day…

All other doctors I’ve seen handled it the same way, I guess I’ve just always assumed that is the standard…


#14

Wow. Your doctor writes the script based on what you report. I’m slowly catching on to the “game” of managing diabetes supplies. My pharmacy and insurance are treating insulin like a pill for high blood pressure. You take “x” amount a day so you get “x” pills a month. I hate to play games with idiots but the battle is more then I can manage. I’ll have to conform and play with the idiots but say I take 20 units/day when I actually take 10.


#15

Now I’m worried. My long-acting insulin rx is for “exactly” the number of units I used per day when I last saw my endo. There isn’t even excess written in for the 2 unit pen prime.


#16

Just call the office and tell them you’d like to increase your prescription to X units + 10 per day or whatever.

If you’re taking 20 just say “can you please bump my rx up to 30” in a message… it’s not like it’s some clandestine operation. This is common sense to them just as much as it is to us…

If they gave me the slightest ration of bs about it I’d quickly be finding a new doctor


#17

When I saw my endo last she filled my test strip rx for 10/day and commented that that was probably as high as she could go. I didn’t really understand her reservation and gave her a sharp look that she acknowledged but we didn’t talk about it. I’m pretty naive about the workings of health care so that was my first “alert” that my endo is not the one in control. She certainly has never “rounded up” on my long acting insulin.


#18

Again I don’t recommend actually lying or telling them you take more than you do. That could be dangerous if you’re ever incapacitated and they’re dosing your insulin based on your medical records. Just ask them to rx how much you want. They’re not going to bat an eye if it’s reasonable. It’s not like they’re the insulin police. They’re on your side and are your advocate.

She probably meant that 10/ day test strips is all your insurance would pay for and they’re available otc so there’s no point of writing it any higher as it’d just create a run around. The same does not apply to how many units of insulin she prescribes toy per day.


#19

The last thing your endo wants you to worry about is having sufficient insulin. Tell your endo you get really stressed about this so need a much larger amount. Life happens. Just think if you just won a 2 month dream vacation all expenses right now, You would have to give it up because you don’t have sufficient insulin to carry you through. Circumstances change, diets change, eventually we all hit medicare that changes the game as well. Just a little advance planning allows insulin stress free transitions as life changes happen.


#20

@Lauri Insurers are auditing pharmacies and Drs alike for over supplying/over-prescribing test strips (as evidenced on Amazon and EBay). I have found that 6-8 strips a day is relatively easy to get (200/30 days), but 10-13/day (350-400) is tough. Generally you have to be on a pump or MDI and poorly controlled to get away with that many. I personally am not looking for a non-compliant/poorly controlled diagnosis as insurance companies start withholding all sorts of stuff then.


#21

Being audited is the excuse my pharmacy used for breaking open the box of pens and sending me enough insulin for only 75 of the 90 day rx.

I am on MDI but also use a CGM. I think I can get the 10/day test strips because there is documentation of CGM reading inaccuracies, ie, CGM showing 200 when strips showed 40. Medical records show that it isn’t safe for me to dose insulin using the CGM reading. Otherwise my records acknowledge that I have good control and my hA1c is pretty good… usually under 6 since using Afrezza.