Offense or defense?

Type 1 and LADA
21

There might be more than one problem occurring simultaneously.
I went to two Walgreens locations this morning and was able to fill one prescription that I’ve been working on since Christmas.

But this was at the first Walgreens that I visited.

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Spontaneous closures have been a problem all over town. Short staffed. There is definitely something awry at Walgreens. Some rumors all that they are going out of business. Some people say they are intentionally short staffing them due to retail pressure. One pharmacist tech today says that ALL retail pharmacies are under huge pressure, Walgreens is only really closing pharmacies in the southern US, and that staff are leaving for clinical practices where conditions are better. But she says its all retail pharmacies, including CVS. Of course, the independent pharmacies say that the CVS and UHG PBMs are shutting them all down due to unfair market practices. They shuttering every day. There are barley any independent pharmacies left. Things might be worse than I imagined.

The pharmacy lobbyists say that every CVS eventually turns into a Dollar General. That does seem to be happening in my neighborhood.

22

I can tell that you all don’t like my new scheme. But its kinda great. I do pretty well on a split dose of NPH. I don’t need any RX, really, because R and NPH are over the counter at Walmart. BS strips are over the counter at Walmart. The only prescription that I would DEFINITLEY require is one for syringes. Good luck finding an excuse not to authorize a diabetic script for those. I recognize it’s unconventional. But its kinda a great idea, right? It allows total freedom from any bureaucratic difficulties. I don’t think its so bad, given the circumstances. I may never have to negotiate with a Dr or an insurance company or a pharmacy again. Total freedom. https://www.youtube.com/watch?v=N6uEMOeDZsA

Maybe I could even return to managing diabetes, instead of JUST babysitting the system that distributes supplies all the time.

23

Going back to eat or die sounds like a terrible plan. But for planning ICE google says MN pharmacies can sell syringes without a script, up to them. It varies by state. and year? My state has gone from anyone can buy to keep a log to ID required to know need is legit (didn’t last long) to script and back to anyone can buy.

Also, your health plan says everyone in MN should be tested for syphilis!?! No wonder they can’t keep the pharmacies open.

Wags pharmacy employees commenting on last years news
https://www.reddit.com/r/WalgreensRx/comments/1g46pdb/walgreens_says_it_will_close_1200_stores_by_2027/
https://www.reddit.com/r/WalgreensRx/comments/1f2k0cg/stock_price_just_broke_10/

Pharmacy fun https://www.reddit.com/r/CVSvoicemails/

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24

Score!!! They have to sell me (or exchange used syringes) if I say that I am an IV drug user.

I think this is coming in from Canada…like the wild boars.

I mean…the pharmacy lobbyists have been telling me this for a long time…that Walgreens staff were on their knees. I guess I just never saw it manifest into a full blown inability to get my prescriptions until recently. Walgreens can’t order Dash pods. I was able to buy them once I had the information about two Walgreens that actually had them, physically, in stock.

I’m guessing this is more of a Walgreens “on its knees” issue in combination with the fact that there aren’t many dash users out there and thus perhaps not many dash pods available.

25

She’s listed on the formulary.
This is also how it shows up inside the Walgreens computer system because I hear them use this “gen4” terminology. That’s how I talk to them now in order to be perfectly clear.

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Walgreens will perform an automated refill process. That takes four days. Once that fails, you can ask them to execute a manual refill process. That might take 6 days. After 10 days, you KNOW that the business process has failed. That is the process that is failing at Walgreens, I believe…for Dash pods. They have it shipped in to the store from a warehouse, but it never arrives.

Insurance will only allow you to place the order so far in advance. So, a few 6-10 day failures results in no access to supplies. It’s a bad point of failure.

I’ll try moving it to a different pharmacy.

26

Please forgive the stupid questions but is that from the 2025 formulary? None of the commercial plan formularies on their public pages list omnipods and they aren’t in the “Commercial diabetic drug list” aka diabetic supply list.

I was typing a reply that said buy from a DME company based on this 2020 formulary update https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/entry_217867.pdf showing they changed Omnipod to DME and this DME list from their provider site Coverage criteria | HealthPartners A9274 is the CPT code usually used for Omnipods.

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Ooooh. Good question. My blood sugar is super low, but I will try to find out.

Yup. 2025. Here’s the link. See page 108. https://healthpartners.adaptiverx.com/web/pdf?key=8F02B26A288102C27BAC82D14C006C6FC54D480F80409B687A5928A9EF400B98

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I am on Omnipod 5. It’s the only pump I have ever tried and I absolutely love it!

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29

Okay, I did hours of reading and learned nothing from your health plan. I get the confusion now.

First the good news: Minnesota passed regulations limiting the cost sharing for insulin to $25/drug/month and $50/month for all diabetes supplies that went into effect Jan 1 2025.
Press release Rep. Michael Howard - Release: Rep. Howard highlights new Co-Pay Cap on Life-Saving Medications taking effect in January.
Law Sec. 62Q.481 MN Statutes
Send that man a cake. And clear off the couch, I’m moving in.

Here’s an explanation of what Wags means by “closed out” from reddit. There’s a possibility someone was being Minnesota nice by closing the script. More likely they heard that you drove all the way to their store to get a partial fill. In Wags world once you get a partial you have to get the rest from the same store. So they closed the script and I’m hoping asked you to get a new one from your doc sent to the location of your choice.

For what originally happened to cause the problem sounds like Wags couldn’t get Dash pods delivered to your store from their distribution center. I don’t think there’s anything the store can do or even see inventory at the distribution center to be able to tell you its not available. Wags can’t move their distribution center inventory very well, or at all, to cover shortages. Dunno if you were being literal about going to the same store multiple times in a day, that doesn’t help. Ask when the delivery normally comes in and how many hours they need to process it so you know when to check in. Only one store can have your script in a queue to be filled and Dash pods aren’t going to be a stock item in any retail pharmacy unless they get stuck with them.

Have you tried contacting your doc and asking for a new script without having an appointment? If they will just do that. Also ask for script that says change every 2 or 2.5 days so you have spares. I’m guessing insurance told you to see the doc because that is their default answer to get a new prescription. The formulary doesn’t say a PA is needed and no QL. Even if its wrong the pharmacy PA form from HealthPartners doesn’t ask for a last seen date.

The generic process for pharmacy rx processing that I’ve learned from dealing with Optum and

  1. Doc sends script
  2. Script is keyed or reviewed by someone under the supervision of a pharmacist. Even at giants like Optum. Days supply gets calculated and entered.
  3. Refills start here
  4. Script is checked against insurance. At retail they’ll modify the script to make it process. Optum mostly throws it back to the doc.
  5. if a PA is needed the pharmacy notifies the doc. The doc then deals with the insurance, in my experience the PBM has been contacted to handle this for insurance. Pharmacy doesn’t move forward unless the PA gets approved* and attached or the customer says they’ll pay cash
  6. Then the script goes in the queue to get filled. In the case of your Dash pods assume they have to be ordered.
  7. Pods or whatever arrives (unless you use Wags) and the script gets filled and checked by a pharmacist.
  8. In my experience script gets billed to insurance as soon as its been filled. Some companies could do it differently
  9. Pay your copay and pick up the script.

*Step 6 could take days. By the time the PA comes back its going to have different start and end dates than the script.

Kids at the cash register have no idea about any of this. Don’t believe anything they say. Try to know the formulary rules for your drugs/devices. Review the process with them step by step. I’ve drug Optum all the way back to lookin at the the image of a script. Didn’t match the typed version. Have the doc send a new one they say. Don’t waste my docs time, fix it I so informed them thusly. In the days of fixed copays we could check for coverage problems or shenanigans but that’s mostly gone with % copays.

Or blame Canada (nsfw) Hope something here helps a tiny bit. Thanks for letting my try.

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30

is THAT what’s happening?!?!? I thought it was this settlement from the original 2018 lawsuit settlement w/ the insulin manufacturers taking effect. But that wouldn’t explain the decrease in pump supply prices. Minnesota AG Reaches Another Insulin Price Cap Settlement | Twin Cities Business

You are correct. That’s what is happening.

I have a Doc appointment this morning.

Part of where this gets worse is that I have a “closed”/expired script in my walgreens account for an Omnipod 5, and a valid Omnipod Dash script. For some reason, the techs always focus in on the 5 because that is the more common model that they recognize. So, they will try to fill that on accident if they are moving fast and in a hurry. I always attempt to fill the Dash, and then drive to a different Walgreens that isn’t super busy and verify the correct model was filled by asking them an open ended question about what was filled. Otherwise they call the PC that accidently wrote a script for the 5, several years ago, and attempt to refill that script, instead of filling the correct one. That holds up the whole process for 2 weeks.

The computer system might be running thru its automated process to refill the Omnipod 5, over and over again. I might not actually be able to delete that script from the records entirely.

I’ve been trying to delete the RX for the Omnipod 5 script, but last time, the tech accidentally deleted the Dash RX. They were in a hurry and made a boo boo. So, I wanted to fill before attempting that again. Part of what I’m doing, when I go to Walgreens to Walgreens is: 1.) Trying to find a Walgreens that is open; 2.) Trying to find a tech that isn’t too overwhelmed to focus on the details I am giving them. When I went in to try last time, both RX were closed and I was totally confused.

Super helpful information. I need to read through it again before my appointment.

Thanks sooo much. Talking through this really helps. It helps clarify what’s going on and maybe I will be able to explain it all to the Doc. I found additional land mines yesterday when I went in to talk with a new pharmacy for him to send scripts to. There’s an unused, expired Omnipod 5 script sitting in an account there, under my name, that I have never used. :grimacing:

I’m calling the insurer now to verify which pharmacy can fill a Dash, per our work yesterday.

31

@spdif – Although I haven’t been through the hyper-fastidious Rx hell like @mohe0001, I have been surprised and pleased to see both your deep knowledge and willingness to share it here. Bravo!

Of course, the bureaucracy is needlessly slanted in favor of Big Pharma (PBMs, etc.), yet detailed knowledge is definitely a way to beat them at their own game. It’s much more effective than throwing your hands up in frustration and premature unconditional surrender as I am apt to do!

Thank-you for taking the time to help.

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32

The pharmacies are crumbing for some reason. It’s the markets. No legislation has even gone thru yet…probably in the Spring, as part of the giant “reconciliation bill.” What if this gets worse before it gets better? Be prepared with backup supplies.

33

Doc says that all the pharmacies are in a bad state and changing to a different one might not help. I’m gonna upgrade to Omnipod 5, and keep an active Dexcom 6 RX incase I need to fall back on manual injection. Doc says Omnipod 5 is significantly easier to fill than Dash. But he anticipates g6 to end soon in favor of g8.

I will soon be able to operate any model of omnipod insulin pump ever manufactured at the drop of a hat…if a pharmacy can fill a script for the pods.

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34

Educate me, I thought the only reason to stay on Eros then Dash was to loop which can’t work with the Omnipod 5. I’m planning to ask for a script for O5 this month but plan to only use manual mode. Is there an advantage to the Dash?

Thanks for the update, sounds like you are making progress. Have you considered checking with the mail order pharmacy (welldyne?) to see if they sell pods? Or if you can get them through a not terrible DME company like Edwards?

35

Eros were the old model of pod that ran on the classic omnipod insulin pump. You could loop. I actually would have stayed on classic omnipod forever if they hadn’t finally forced me to upgrade because they quit manufacturing it.

Classic ran on radio Frequency (RF) communications.
Dash runs on Bluetooth.

I can’t name many advantages of remaining on Dash over omnipod 5, other than I got to upgrade to that model for free because the upgrade was forced (they stopped manufacturing on classic). I’m not under contract because it was a forced upgrade. That always left me with an opportunity to upgrade, again, into Omnipod 5. That means that I have all three hardware models of pump that are potentially operational.

I don’t think anybody ever really liked dash much, so many people encouraged me to jump from classic → 5. Now the downsides of my decision have been revealed to me.

I also plan to run manual in 5, but the Doc doesn’t like to hear that so I don’t say it anymore directly. One thing that I don’t love about the 5 is that it is a single point of failure for both the pump and the Dexcom. Right now, I have a separate, independent Dexcom that I can still run if I fall back on manual injection.

I have maximum flexibility for how I want to operate the system because I own every model of hardware this way. But, flexibility comes with additional complexity/complications.

Given the option, I would just run Dash because I don’t have any desire to run another APS system at this time. Upgrading to 5 is simply a means to receive reliable pod access.

I spoke with HP and they were unable to produce a list of pharmacies that they have an agreement with to supply Dash pods. I think this stuff has been reclassified as Non-durable medical equipment (starting with the Dash receiver) about a year ago, and thus gets billed as “pharmacy benefit.” I don’t know if you can bill it any other way, but it’s definitely cheaper as pharmacy benefit. I’ve been told by distributors that they simply aren’t supplying them anymore. I don’t know if mail order is very practical in MN where temps are so cold that the hardware will likely suffer damage sitting out on the front step. But mail order might be possible.

Lets ask Brad if he has had any trouble getting pods. He’s still a looper. @BradP, have you have any trouble getting shipments of Dash pods? What are you gonna do when they stop manufacturing those? My Doc said that might be coming. He also thinks they will stop producing Dexcom 6 soon. Any word on this?

Also, I have discovered where the pharmacists congregate on their internet forums. We can ask them questions directly there, maybe. These guys (https://www.truthrx.org/) have a secret internet forum here: https://www.truthrx.org/forum?feedType=all-posts
They want to be friends with the diabetics because of our mutual interest in sports like in PBM hunting.

36

I tried the omnipod five and absolutely hated it because of the way that there is zero control of the automation when you Run in closed loop mode. You give the PDM you’re starting point numbers but it’s supposed to learn you and adjust things automatically, but it takes months for it to learn you.

If you have the dash in the G7, then you can either use loop or trio and have a lot more control of the automated loop. – Is very much still around and should be just as easily available as the omnipod five.

I can get mine either at the pharmacy or through mail order and have no problems getting either.

Hope this helps

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37

Was the Dexcom built into the 5 or were they two separate devices and just the data was integrated? If I got the 5, could I fall back on manual injection and still have a dex?

I just don’t see me using the commercial APS system at all. I don’t love the idea of getting locked into a contract with them. I’d rather be a forced upgrade. I prefer the old equipment and it keeps me out of any contracts.

38

Depends on your insurance. On mine the omnipod 5 and dash both go though prescription side as does the Dexcom G7 so if it is prescription side then no contracts.

The omnipod 5 was made to be a commercial closed loop system but can run manually if you have to.

The dash is not closed loop by itself but you can use loop or trio to diy the closed loop like I do.

39

So, if I’m on a 5, I could run the Dex without the pump? I could run the pump without a Dex?

You’re right. There might not even be 5-year contracts anymore.
OMG. Everything has changed so much.
spdif figured out that I only get charged $50 max for any hardware picked up at the pharmacy. New state law. Kinda changes how I ought to think about everything.

40

Thanks @mohe0001 and @BradP

https://www.omnipod.com/sites/default/files/Omnipod-5_User-guide.pdf Page 46 (PDF page 55)

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Mail order can ship in the cold, an insulated box and a thawed ice pack can keep the contents above freezing.