Prescribing insulin is hard compared to take x number of pills so often, here’s x times y pills. Every dose can be a different amount. Health plans we rely on to pay for insulin add to the complexity with the contrived “days supply” metric. How has your doc solved the problem?
I had a doc that would prescribe “Inject subcutaneously x units before meals 3 times a day” and say to me not to pay attention to the label because x was big enough to get a spare bottle of insulin 4 times a year. Great for me but put her prescriber license at risk.
My current doc does nothing to account for pharmacy and health plan shenanagans. “INJECT SUBCUTANEOUSLY 10 TO 14 UNITS 3 TIMES DAILY WITH MEALS AND AS NEEDED UP TO 60 UNITS DAILY” This one broke a pharmacist at OptumRx who couldn’t figure out if she needed to dispense 3 or 4 boxes. CVS and Walmart would just short me a pen and happily charge me another copay every 25 days.
Feel free to substitute x’s for drugs and numbers for privacy.
I had started using a pump when this amount was decided, now I do a pump and MDI combo. But it’s been 60 units 2 times a day. I even talked to Optum who had once asked because it is a large amount to inject 2x a day and I told them the Omnipod requires and holds a certain amount of insulin. But that amount gives me a generous amount so I don’t have to worry about an interruption in supply or getting sick etc. And it’s always just stayed the same.
My prescription simply states, “As Directed”. I get a 90 day supply from my pharmacy, which works to about 14 vials of NovoRapid. As a senior in the province of Ontario, the cost to me is $6.12.
My doctor prescribes me 80 units a day and I use a little more than half that at 45-50 units a day, most days. Some days it’s 40 other days it’s 60, but it generally works out to 45. When it’s time to renew your script, just email your doctor telling her or him how much you are using so he can alter your prescription.
I remember a time when I would go to the pharmacy and they would just charge 10 percent of whatever it was and you could order as much as you wanted.
Then they started limiting it to units per day, at the time I was on 2 insulins so I was using about 20-25 units of regular insulin, but I would tell them 50, so I could get more vials.
This is before they leveled you to your monthly costs instead of volume.
Now I just get a bunch of vials every 3 months and since my doc says 80, I always get enouh and I end up refilling it every 4-5 months
Mine just says “deliver 75-100 units subconsciously daily as necessary”, which nets me an extra vial every month. Except I’m bad at refilling promptly, so I never seem to build up the stockpile one would expect.
My Endo tries to prescribe close to what I use/need, with a little buffer, since needs can change when you get sick, etc. I have recently had to increase my use of insulin, and she wrote new scripts to reflect that.
While I know insurers have to deal with corrupt patients in order to manage costs, I wish they allowed getting an extra supply to have on hand in case of major supply disruption. I live in earthquake country, and one can imagine not being able to get insulin normally for a month or possibly longer. If that happens in the 3rd month of a 90 day Rx, that could be a big problem. And no matter where you live, unplanned problems could happen, from hurricanes, to floods, to fires etc.
My insurer is Medicare. Here are the Rx’s:
insulin aspart U-100 100 unit/mL - Inject 12-14 Units under the skin 3 (three) times a day before meals. Refill Details - Quantity 40 mL, Day supply 95
insulin degludec 100 unit/mL Soln injection - Inject 0.2 mL (20 Units total) under the skin daily. Refill Details - Quantity 30 mL, Day supply 150
I also live in Southern California and we get earthquakes here.
I try to keep extra bottles but I can’t always manage it so well.
The last time we had an earthquake it was a major one in 1994
Reality is that all you need to do is drive a few miles away to fill your script.
It’s not as bad as you might think.
I ran out of my apartment with no shoes on
My apartment was declared unsafe and my car was flattened so I couldn’t go back in, but I just caught a ride 2 miles away and I got some shoes and insulin. I can’t even remember what about the script but they probably just called or looked it up.
I also walked into my bank with no identification and they let me withdraw $200
I sort of doubt that would happen now. But then I can use my phone to pay for things. We didn’t really have cell phones in 1994.
I always keep syringes in my car and a bottle of insulin in my back pack just in case I’m not home and I can’t get home fast. But in reality we just do our best,people are usually understanding in emergencies.
I was in Pasadena during the Northridge Earthquake. Lots of stuff knocked out of the cupboards (we were on 3rd floor) and broken, lots of plaster broken, but nothing any more substantial.
In the Landers earthquake a couple years earlier I was taking a shower and ran out of the apartment naked :-).
The one thing that prevents me from stockpiling an infinite amount of insulin (say more than 2 years worth) is that we have occasional mult-week power outages and if one happened in the summer (when we have the most storms and when it’s actually hot) it’d be a major chore to keep that much insulin at room temperature or cooler. Right now I have over a years worth but am looking to get built back up to maybe two years.
Speaking of that, when I was on injections, my shirts would all have tiny blood spots at the waist. And I really hated it, I couldn’t have a shirt longer than a year without looking homeless.
Somehow I have learned through decades of MDI as to what good/bad spots on my belly and leg are and I very rarely have even the tiniest drop of blood. I inject through my shirt and pants ALL THE TIME.
I think I’ve gotten better with sensor insertion too. I simply do not have gushers anymore and I think that somehow I’ve learned where not to put a sensor based on where I had gushers in the past.
