Hallelujah! I just got my latest 90-day insulin refill via Humana, and thanks to the guvmint, my cost, still under Medicare, Part B, I presume, has dropped from the former 20% of $1,236 for four vials to $105. Your mileage may vary but it’s a big help for me, and I hope for other senior pump users insulin buyers as well.
5 Likes
Same here. I was paying close to $600 every three months under Part B. (I use a lot of insulin) Last order I paid $105. Yea!! (This is under a Medicare Advantage Plan)
3 Likes
I have regular Medicare and a pumper. I pay ZERO for my insulin used in my pump - under Part B. The prescription is required to be stated “used by an insulin pump.”
2 Likes
It’s great to read that your insulin out of pocket cost has shrunk to a more reasonable amount! I think government has an important role to limit the greedy over-the-top instincts of corporations. Not obliterate the important role of the private economy; just to brings some balance with the needs of common citizens.
I think it’s important to note to more casual readers of this that many senior pump-using diabetics use traditional Medicare under Part B paired with a privately purchased Supplement plan to totally avoid any out of pocket ongoing insulin expense.
I only bring this up since this choice of coverage is time limited and once the window closes, the decision is irreversible. If you are nearing the all important age 65 time frame, pay attention and get educated! The short term appeal of a Medicare Advantage plan can easily become overwhelmed with serious long term health conditions.
For people who miss that chance or find that choice unaffordable, this moderating of insulin costs that @Tom_in_SC writes about is a breath of fresh air.
For what it’s worth, I moved to New Zealand a year ago. All prescription medications, including insulin pump supplies (which you get through the local pharmacy) are completely free. There’s one exception in my case, in that my jardiance (empagliflozin) does not qualify for public “funding” as I am a type 1, and it’s intended for type 2. That means I have to pay the full cost myself, which is $83/month. My insurance in the USA was paying about $800/month for the exact same medication.
There are downsides, for example Dexcom is still not “funded” so I have to pay out of pocket, about $1,200 NZD (about $700 USD) every 90 days which includes transmitters and sensors. From what I hear, the agency that determines what meds and devices are funded (PHARMAC) is currently accepting proposals from Dexcom, libre, etc to consider making them publicly funded devices.
The only other significant costs here are that GP (primary care) doctor visits cost $60 (free for all children under 14) but anything the GP refers you to, like endocrinologist, blood tests, radiology, etc is completely free. Also, unless I happen to have a consultation, every 90 days I have to pay my GP $17 to call in my prescriptions.
There are no premiums, deductibles, out of pocket maximums, etc. Everything is paid for via one chunk of payroll taxes (called PAYE), with tax rates almost the same as in the US… But with no expensive insurance premiums and line items like state tax, social security tax, etc coming out of each check we actually keep more out of every paycheck, and get universal cover.
Other downsides are that some meds are just not available here at all. PHARMAC has a pie of public funds to divide up each year in order to maximize public good. That means if you get a weird, rare disease there may not be any effective free meds available to you, or perhaps only older less effective meds are available. You can get private health insurance however, and this fills in those gaps, paying for non-pharmac funded meds, expanding cancer care, and giving you access to private doctors outside the public system which can reduce waiting.
Overall I think this system is much more fair. I had a friend here who suddenly had intense abdominal pain from a ruptured infected ovarian cyst and had to spend 3 weeks at hospital and have 2 surgeries. She never received a bill. Sadly, her inbusiness went insolvent as a result of the lost income. But at least she didn’t end up also with tens of thousands of dollars in medical debt also.
1 Like
“Medicare Advantage” often gives no advantage to a patient – it puts an insurance company between the patient and his/her/their healthcare program. And insurance companies may be inclined to make money by denying claims or limiting care to doctors you might not otherwise choose. I have a number of friends whose care is being delayed because of the added hoops they have to jump through to satisfy their insurance company’s Advantage plan.
And, the government’s mandated reduction of the cost of insulin is also available through regular Medicare.
Just saying …
1 Like
Details on Medicare insulin costs.
For those not on Medicare, there are cash pay discounts.
I get 3 vials of Novolog or Tresiba for $99 using this offer.
1 Like
Congratulations! I’m so happy for ya!!!
