Shortcut to insulin prescription renewal?

T1 for 42 years. My current endo is basically out of business as of last month. I have several expired prescriptions - most notably Humalog, Tresiba, and Dexcom G6 sensors.

I have a new endo lined up but my first visit is not until mid-June.

I have some insulin stockpile in the fridge but it’ll b running very thin by June.

More abruptly I’m out of Dexcom sensors in a couple weeks.

My PCP in the past has refused to write me an insulin prescription during past endo transitions. Says that’s an endo-only thing as far as his practice is concerned. I haven’t actually asked yet but I’ll assume the answer is going to be no. And I know for sure my PCP is not set up to do the authorization paperwork for Dexcom sensors.

Any advice on how to get a short-term Humalog prescription? I can bring in an old insulin box with prescription sticker attached, or an old printout from a past doctor’s visit listing my prescriptions.

Wal-Mart brand insulin available OTC of course with no insurance coverage and the price isn’t ridiculous. I did R and N for decades and wouldn’t feel too uncomfortable falling back on that.

I certainly have never had a PCP refuse to write an insulin prescription for me. I don’t use endos. I find this very odd. My internist also does the Dexcom paperwork for me. Have you thought about finding a PCP who treats diabetics? My internist realizes that I know more about my diabetes then he does, so he just writes prescriptions for whatever I want.
I doubt that he could help someone on a pump but I can’t imagine that he would refuse to write prescriptions.

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You could go to your new PCP office in person and explain your problem. They might write a one-time scrip to cover your needs. You might ask if they have a waiting list to upgrade appointments.

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My endo also just left to another job. Hoping if I need RX that PAs could do that, or they might get new endo by the time I need refills.

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The Walmart Relion insulin is garbage in my view. I tried it and it never worked for me. Plus it causes a lot of weight gain.
You can use Push Health and get prescription for insulin online. Look into using a discount card from Novo Nordisk or Eli Lilly. I was paying $35 for Levemir. I am switching to Tresiba and using the discount card.

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Lucky you. I have had doctors refuse to give me more than one refill for insulin or outright refuse unless I make an appointment for an office visit. Oddly, many doctors think it is a controlled substance. The pharmacist at a Walgreens I used to go to thought the same. weirdos

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My PCP has made it clear that he doesn’t get paid enough as a non-specialist visit to take on the liability risk of renewing my insulin prescriptions.

I will agree things were a little different in past decades.

In any event I will be able to limp along without CGM and Humalog for 4 months, by buying test strips and Walmart R OTC.

@Tim12 Walmart R and NPH and OTC test strips is a solid plan F. I have a couple of ideas for plans C-E.

Was your previous endo part of a medical group or office with multiple doctors? If so ask them for assistance with renewing your prescriptions. Any chance your new endo is part of the same group? If they can access your chart they should be willing to prescribe the medicine you need to stay alive before your appointment.

If your new endo is with a different group call them up and ask if there is a 10-minute appointment available sooner they you can bring a copy of your records to so the endo can write you a prescription then in June do the usual new patent onboarding appointment. Another possibility is check if your state has any laws on how fast you have to be seen. Here’s an example from California I’ve used the “if you are accepting new patients you have to be able schedule my appointment before…” line a couple of times.

Last idea, if your PCP fails to provide you with healthcare, find a new PCP. Unless there’s a Dr. McDreamy kind of big deal reason… Again, are they part of a medical group? A manager or CMO might have a different perspective.

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The whole endocrinologist environment is going through a shock in my region. This was one of the largest endo practices shutting down - they had 7 endos a year ago, then dropped down a couple last fall due to retirements, then announced a month ago they were completely shutting down. Even though they’re nominally still in business I’ve been unable to get any prescription renewals because there is no longer any office staff and many of the endos have moved out of area to find new jobs.

I was lucky to get wind of the shut-down early in February and find a new endo appointment in June - but it’s a 50 mile drive. 4- or 5-month wait to get an endo appoiontment has been entirely the norm here for past decade.

PCP’s are even tougher - so many have shut down or gone concierge-only. I’m lucky I still have a PCP at all. I’m unwilling to pay concierge prices for a PCP that I might only see once a year and won’t even renew an insulin script.

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This might be no help, but some chain pharmacies have clinics where there’s a doctor or there are all those urgent care places. One of those doctors might write you an insulin prescription. It’s just insulin after all. I have no idea what your PCP thinks is the “liability” involved in prescribing insulin to a diabetic. His refusal strikes me as bizarre and inhuman, but perhaps it’s more common than I think.

As far as CGM goes, buying through GoodRx is not cheap but comparatively affordable. You still need a prescription, but the doctor giving it does not need to fill out any extra insurance stuff. It’s just a regular script that a doctor at a pharmacy or an urgent care might write.

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I’m sorry, that is a terrible situation to be in. @Tnyc might be on to something, CVS for example offers clinics in some locations that can also do a one off prescription for insulin. MinuteClinic I dunno about the other chains. Some Walmarts and Targets have clinics that can do the same.
The bottom of this page Get Urgent Insulin Support - Get Insulin mentions some states allow pharmacists to refill an expired prescription but then the question is will medicare pay for it?
This isn’t a serious suggestion but are you mobile and retired? Take a 3 month vacation somewhere cheap and with plentiful healthcare. California, Florida, and Texas all have places with beaches and doctors.

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Thanks for all the advice!

Some updates: My “old endo” at the large endocrinology pracitice has announced just yesterday she is now kinda “the endo” at an urgent care clinic. She got me a renewal on my Humalog. Yay!

However her new clinic doesn’t has staff do paperwork for prior authorization etc on my CGM. The prior authorization I had was for CY2023 and doesn’t extend into 2024. So I will likely be without CGM from now until June when I have an appointment with my new endo, unless I decide to pay out of pocket. If someone knows about a “coupon deal” for Dexcom (kinda like the coupons for insulin when you don’t have a prior authorization and insurance won’t pay) please let me know.

The discussions about switching insulin brands/formulations/analog-vs-non-analog aren’t wrong. I wouldn’t want to throw a big switch-up on a newbie. But I’ve been at this since 1982 and while I have my personally preferred insulin brands, I’ve had to switch several times - including pre-Obamacare when getting insurance coverage was impossible - and it was never a big deal.

GoodRx coupons make it about $60/sensor. G7’s are a better deal because, although the price per sensor is similar, the G6 transmitter is another $60 or so on top of the price of the sensors.

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The Relion, Novolin route is a lot trickier to use. It has weird peaks and drops. You can learn it again if you used it before. But the new insulins are so much nicer.

Since our life can vary, it’s a lot harder to make adjustments. I used it for years on my diabetic dog. Unusual drops and peaks etc happen, because life happens. But I’m glad it’s available when needed without having to get a prescription.

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I used to pay cash for Dexcom. Sam’s Club with the Plus level membership ($100 per year) was the least expensive place I found for sensors. $184 per 3. That was several years ago, before prices dropped, so I assume it’s less now. And then I’d restart them until the data was doing acrobatics. Could usually get a solid month out of a single sensor. Unfortunately, the problem with Sam’s is that nobody actually knows what the final price is until you swipe your membership card. It’s like a big coupon and they don’t tell the pharmacy staff what it’s worth. You can always refuse the sale if it’s too much. Transmitters are pretty widely available for $45-60 now, cash price. That’s obviously all if you can get a script, though.

If you can’t get the script, then I’d look at Mark’s Marine Pharmacy. It’s a legit Canadian pharmacy a lot of site members order insulin from. I think they changed the name to CanShipMeds or something like that. I’ve ordered a surplus transmitter from them for $45 plus shipping. The site said “Rx required”, and I know they do look at scripts for most things, but they never actually required the prescription for that order. So they might ship the sensors without a prescription, too.

And then there’s Dexcom’s new over-the-counter one, Stelo. They say it will be available in drug stores this summer, but maybe they’ll have a way to order direct sooner than that? Long shot, but better than nothing…

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Well nuts. I just wrapped up an appointment with my endo and found out she’s leaving and the other two in the practice aren’t accepting new patients. Then she added they were taking her “acute patients”. I asked if I was cute enough but no luck. :pleading_face:

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I feel for you! I myself thought I was “safe” by choosing a large endo practice last time I switched endos (about a decade ago). That in case of any retirements they would hire new ones, and in case of major business change the whole practice would remain intact. I was wrong!

The most senior one - the one who had set up the practice - retired last fall, then everything began falling apart.

Waiting time for new patient endo appointment in my area (Washington DC/Baltimore) is 4-6 months. I tried jumping the queue to see my new endo sooner but no dice.

Some further advice for endo retirement:

1: Get renewals of all your prescriptions ASAP. My endo had previously only done 3 months of prescriptions at a time but wrote them for the max (1 year) after I got her attention.

2: Most pre-authorizations are done by the calendar year. You are at March right now so maybe some 3-month-renewal cycle prescriptions have to be re-upped for this year. OR maybe you got lucky and the pre-authorizations were already done in January or February.

3: Call multiple endos/practices looking for appointments, take the first one each one gives you. After you’ve sized up the market and chosen the best, then you can cancel appointments for all the other ones.

4: Start all the above NOW. Your endo retiring is undoubtedly at least a minor and maybe a major event in the endo market in you area. All your endo’s patients are going to be looking for new ones. If you put off by 2 days starting to make new appointments, you might lengthen the wait by months before you get in.

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Here is the Dexcom patient assistance program information thanks to the JDRF forum.

https://assistance.dexcom.com/

+Eligible household income is less than 400% of the federal poverty level
-Excludes those with insurance/medicare/medicaid/etc

From what @Tim12 has told us I’m pretty sure this doesn’t help but I wanted to post it in case anyone else can use the info.

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