I try to offer help, suggestions and encouraging words to people here who encounter craziness at the pharmacy. I talk a good game. Today I was beaten by the crazies. I thought it was only fair to share.
I ended up at the local mom and pop pharmacy to get a box of Lantus. The prescription was for one box, 30u once a day, 30 day supply. My health plan says $20 for a 30 days supply. There’s no shenanagans in my plan with charging more even though the box has 5 pens. The pharmacy insisted on charging $70. At some point I saw their screen, the software was showing a response from the PBM that the charge was $70. I waited for the other pharmacist to show up to see if they would enter the days supply as 30. Instead they sold me 3 pens for $20.
Providing the whole box of pens when you only needed 3 or 4 used to be the accepted way to build up a supply of spares. Or two vials when you only needed 1100 units a month. I saw plans change a few years ago to make this impossible. That nutty US AG that went after pharmacies changing medicare “for only 30 days” changed how pharmacies operate without changing the medicare regs. How do ya’ll handle this particular craziness? Are your doctors writing prescriptions with dosing instructions that add up to whole vials or boxes of pens every month then telling you to do something different?
I’m on Part D now for one year. My CDE simply writes for more and always has. We’re in a world of earthquakes, hurricanes, other things. We have to have spare stuff. I was in a dispute with I think Optum a few years back where the rep said you never need spares. Boy I let her have it.
“never need spares” Ha! Tell me another fairy tale. =)
Is your CDE good at keeping track of what they prescribed vs. what you actually take? In appts with my last two endo they always start with “so you’re taking a day” and every time I say “no, i’m taking exactly what you told me, x units”. Than again, maybe this is just a MDI problem.
I do recall this being a problem back when I was on MDI. Easy to build up a security cushion with bolus insulin because TDD varies widely day to day, but Lantus is pretty much a fixed amount–not so much wiggle room. I don’t see any way around these idiot restrictions other than getting a script for a higher DD than you’re actually using. It’s not like we take this stuff for fun.
My doctor knows I spend part of the year in Florida (where ANYTHING can go wrong weather-wise), so he always just prescribes me more than I need. Good Endos know that you need a “stash” to stay safe. I don’t abuse the system by not always buying if I get too far ahead, but I like to keep a cushion of at least 2 months in reserve.
Well, that is probably true of most everyone on this forum, but there are people who seek to make money off their diabetes. Before CGMs, my Endo would write scripts for meter strips, 5 tests per day. But when I got sick, I sometimes had to test more often of course, and I was running out. Found a listing on eBay for strips for my meter and the seller happened to be nearby, so we arranged to meet… I gently asked how she happened to be selling the strips. She said her son had diabetes but did not test much, so they sold the strips to make money.
OK, insulin might be harder to sell that way, but my point is not everyone out there is above trying to make money from scripts that exceed what they actually use.
Still, I completely agree we all should build up an inventory as fallback if there were supply problems for any reason. I have a good endo and try to be honest about my current doses. I would rather not lie about what I am taking just to get her to write scripts to build up that stash. It is a real problem.
