I used to pay $120 for a 90 supply of Novolog last year thru Aetna mail order. My policy is the same HMO only change is that it now meets the Obamacare version. I went to reorder the same prescription and now they are quoting me $1,013! I went from an annual cost of $400 to $4000! Can anyone recommend any outlets to try and get this for cheaper?
Is it possible they changed their formulary list and another fast acting insulin is now preferred?
That's a shock! We need insulin to live.
Have you posed this question to Aetna? Insurance companies change their formulary and certain medications receive a "preferred" price and their competitors are outrageously priced. What are their prices for an equal supply of Apidra or Humalog? Some insurance companies will allow to appeal to retain your current insulin at the preferred price providing the doctor writes a letter of medical necessity.
All the modern rapid acting insulin analogs are priced very high (too high, in my opinion). It's only insurance coverage that makes it affordable to working people. If you are willing to accept an older formulation, I understand Walmart has inexpensive insulin.
You might look into any programs that Novo-Nordisk sponsors to help people get their insulin at a reasonable price.
The Affordable Care Act is the result of the legislation bending over backwards to not disrupt the role that insurance companies play in our health care system. A Medicare-for-all, single-payer system, would have made access to health care less expensive and more equitable.
I'm sorry for the stress this causes you. I would feel outraged, too! I wish you luck in finding an affordable source of insulin.
Also, have you check to see if there is a waiver program? More and more insurance are requiring to particpate in a "wellness" program for chonic diseases in order to qualify for these waivers. Sad, but true…at least in my case.
Thanks I will look into that. My One Touch Ultra test strips went from $120 to $350 with the required deductible. I came across a new product that is a generic test strip for One Touch "unistrip" that hit the market last year. My insurance quoted me $300. I bought the same product on Amazon for $100.00! I can't wait for generics to hit the market for novolog.
In Germany there is a federal law that no prescription medication can be marked up more than 2000%. So a vial of insulin that costs the manufacturer maybe $1.50 to produce cannot be sold for more than $30, under any circumstances. Here, that same vial might cost you $150, or worse.
Our medical care system is broken, full stop. Unfortunately, the ACA is not fixing what's wrong.
P.S. You might also check out the resources on this page.
Also check to see if your insurance/pharmacy will accept a coupon for Novolog. You should be able to get one from their web site. With coupons your often better off changing your prescription to a 30 day supply and getting the insulin at your local pharmacy.
Insurances occasionally change their formularies, it's likely they've negotiated a cheaper deal on Humalog and are trying to switch you to that by no longer covering Novolog (I think you're seeing the full cost of the Novolog). A responsible company would send you a letter information you of the change and your options, but it's not surprising that they might not. Correlation is not causation, I think it's a stretch to pin this on Obamacare.
"with the required deductible." Those evil words. One of the emerging trends related to health care reform is the movement to high deductible consumer oriented plans. Did your plan this year by any chance move to a high deductible plan? Is the high cost your plan coverage for prescriptions or does it include the deductible.
I always hate the beginning of the year but in terms of costs it is important to consider all the costs over the entire year.
In general insurers will treat insulin as a prescription item and will have a fixed prescription co-pay for prescription items. I don't know if this is an absolute requirement for a marketplace plan to meet the Obamacare requirements, but I think it might be.
Most plans *do* charge full price for out-of-network/non-preferred items. I use Humalog/Lantus and I see co-pays of $10 for a month supply of the humalog and $30 for the lantus on my plan ($10 means 'generic', $30 means 'preferred'). It may be that my insurer doesn't cover Novolog though; then I would see a similar price to you.
So what seems to have happened is nothing to do with Obamacare; your insurer has decided that Novolog is no longer a "preferred" brand. They should be able to provide the facts to you, but some insurers seem to regard it as preferable to blame someone else. They should be able to tell you what the "preferred" brand is; it is probably Humalog. If not then the simple question "how much would Humalog cost", followed by "how much would Apidra cost", should make things abundantly clear.
I think, since you mention Aetna, that you are on an employer plan. If not then I believe you have a short window of opportunity to get a different marketplace plan; one of the other providers will work (i.e. have Novolog as a preferred brand.) Depending on your employer the insurance plan may not actually have to conform to the Obamacare requirements. There is mounting evidence from tudiabetes that some employer insurance providers are using the lack of a compliance requirement to cherry pick aspects of Obamacare to maximize profits over this year (i.e. until 1/1/2016, when, currently, they have to start really complying.)
I'd be very interested to here what your insurer (Aetna?) answers about the prices for Novolog, Humalog and Apidra. Very, very interested.
John Bowler
Well, there's a law in the US that MediCare won't pay more than 6% above the wholesale price.
We live in a Capitalism, Germany is Social Democracy. Germany has laws that reflect that (employee representation is required on the board of a company for example), we have laws that reflect our Capitalism and then some that don't.
For example Medicare (the CMS; the part of the government that administers Medicare and the ACA) is not permitted to negotiate the price it pays.
So we've shot ourselves in the feet (the phrase "shot ourselves in the foot" isn't adequate to describe the damage) and we live in a ridiculously distorted market where health products have massive wholesale prices and massive rebates that discount the wholesale prices for everyone except us, the people.
John Bowler
Some years ago I gave up using my insurer (BCBSO's) 'preferred' test strip. I discovered that a wide variety of test strips that were very much less expensive than the BS's copay were readily available.
These days I use a particular, expensive, brand because my insulin pump controller supports it and, anyway, using an Omnipod (and having the right insurance policy) I always meet by deductible.
Meanwhile generic test strips are available over the counter from credible US pharmacists (I bought the last lot, for extra-pump emergencies, from Walgreens) and, ironically, we see the saps who administer tudiabetes falling for the used-test-strip-salesman pitch that "US test strips are better", so we had better campaign for really expensive test strips. Duh.
John Bowler
High deductible plans (using the established definition of this phrase) are not permitted in the ACA marketplace.
That's because the ACA requires an OOPMax ("Out Of Pocket Maximum" - total cost including everything except the insurance premium) that is set to about the level of the "high deductible".
Some plans exist where the deductible and the OOPMax are the same, they're set to about $6500; you end up paying $6500 in addition to the insurance premiums before the policy starts paying everything.
In the past I and my wife used a high deductible policy for my wife; we chose the maximum deductible ($10,000) because, except in emergency, my wife would never meet even the smallest deductible (about $500) and, in emergency, we could pay the $30,000 that the insurance policy required before it paid everything.
With the ACA everything is much clearer; all our up-front payments except the policy payments, however weaselly worded the description of them is, count toward the deductible and the OOPMax really is a simple numerical maximum (but you must stay 'in-network') rather than an extraordinarily complex calculation.
So on my ('gold') policy I pay $1500 up front then the post deductible rules kick in.
In the context of the original question I still get to pay only the co-pay on 'generic' or 'preferred' prescription items, but most of my expense (the insulin pump supplies) is not a prescription item so I still meet the deductible. For those of us doing MDI the co-pays are what counts, insulin and test strips, and the questions to ask are now obvious and the math is easy.
John Bowler
That's not all that Medicare does. It steadily reduces what it will pay. We have a state law that requires municipalities to provide ambulance service. They can either operate it themselves, or contract it out, but they must do it. Our ambulance service used to break even. Medicare, however, has steadily reduced the amount they will pay for transport and it is now down to somewhere around fifty cents on the dollar (I haven't checked recently). So the city now subsidizes the ambulance service from its general fund, and the subsidy grows larger every year. That means every year there is less left to repair streets, hire police officers, etc., etc.
Sorry for the rant -- you touched a nerve, I'm sure without meaning to.
Interesting. My employer dropped Aetna in December for a variety of reasons, that being one.
I went to my doctor today, he wanted me to take off my shoes and socks and he touched my toes, he meant to do this. He touched a nerve, I'm happy to do so too; otherwise how do we really know we feel?
I choose not to blame Medicare: it's a law, not a corporation, not a person; the things that have standing in our society.
Understand my rants, even if you don't forgive them, just as I understand yours.
Yes, Medicare is a law, but it is not the law that keeps scaling back reimbursements each year. It's the unelected bureaucrats who administer the law. 'Nuff said.
Thanks for the clarification. My point was that this could really be an issue with meeting a deductible at the beginning of the year. We also attribute a lot of things to "Obamacare" that are not part of ACA. My office introduced a "high deductible" plan with a $2,500 deductible combined with an HSA. If you are on one of these plans it is easy to see how you can pay "truly disturbing money" at the begining of the year before insurance kicks in.
But still as you note figuring out the actual math can be a nightmare between medical, pharmacy and DME coverage combined with at times several different deductibles.
Which is what you get with the public sector. Period.
I am really, completely dumbfounded that so many people seem to think a single-payer system would be the one thing that would be "different".
Hey Canadian brothers and sisters, when did you get the Omnipod? Yo, my brit friends: How's that Dexcom G4 working for you?
If a tone of bitterness is heard in this posting, you're "hearing" is working well. Getting something for free is tempting. So much so that people will pull a three-monkeys and ignore the major downsides to having politicians in control of your health care AVAILABILITY.
No count of paragraph after paragraph explaining how its now so much clearer and easy to understand why one's HC is now costing so much more than before the ACA makes it go down any easier.
The ACA is an unmitigated disaster for millions. For those, they legitimately question: Was it necessary to screw them in order to address the problem of the uninsured?
Of course not.