Continuing the discussion from Experts Please Guide : Dawn Phenomenon:
@DrBB made a comment in the linked thread that raised a topic that I’ve long thought about but held back from writing about it for various reasons. The issue is using the current US insurance-based system to accumulate a surplus of insulin and all the supplies related to dosing insulin to protect us from the very real threat of losing access to that essential continuing stream of supplies.
I’ve read assertions by some that this is insurance fraud. I think that’s rather harsh and does not acknowledge the reality we insulin users face. If we don’t take insulin, we die. It’s a cold hard truth. Losing access to that life enabling liquid is an existential threat. It is equivalent to preventing someone from breathing. The thought of running out of insulin engages the primitive emotions of very old parts of the brain.
In an ideal world, we would all be assured that we will always have access to insulin and the supplies that support it. Cost, employment, insurance status, weather events, age or any other factor could all cause the withdrawal of this access. But that is not the system we live with.
We are forced to deal with the crazy context of an insurance-based system that controls access to the precious liquid of insulin. Insurance companies are constantly trying to optimize their rules so as to serve the only constituency that they value, their shareholders and the senior managers who serve the shareholders. Profit is their single focus and they don’t care one whit about us.
Their constant revision of their medicine formularies is one example of how their business decisions impact us. They seem to think that adjusting their list of medicines that they make economically available to their insureds is a completely rational action and has no impact on their customers. They think the various insulin formulations are medically equivalent commodities and may be swapped into and out of the formulary list with no affect on patients.
What planet are these business thinkers on? They obviously have not lived one day struggling to substitute the exquisitely sensitive healthy glucose metabolism with a manual one. We all don’t respond the same way to all the so-called formulary equivalent medications. I am, for example, allergic to Novolog insulin.
They’ve played the same game with glucose test strips. They think all test strips are qualitatively the same and we should just accept their business decisions. Now we know that there is a quality variation with test strips. We use the data from the test strips to dose insulin and also to calibrate our continuous glucose monitors. Reasonably accurate test strips are essential to our health and quality of life.
What if we lose our job? What if a weather event or a wild fire threatens our diabetes supplies? What if our suppliers unilaterally decides that we no longer need five test strips per day and three is good enough? CVS, by the way, just implemented this policy for its Medicare customers.
The point I’m trying to make is this. We, as insulin users, see an insurance system that seems highly unstable, capricious, and nerve-wracking. We are kept off-balance and must accept whatever the system decides is best for us.
Accumulating a surplus of essential diabetes supplies is the antidote for all this business-driven insanity. Having a several month supply on your shelves, under your control removes much of the uncertainty that the existing insurance system creates.
In an ideal world, I’d make an offer to the insurance companies regarding patient stock-piling. Guarantee us that you will never threaten our access to insulin and related supplies and then we’ll cooperate and adjust our requested quantities to better reflect actual usage. If we experience an increased need for insulin, we expect that the insurance company would not question or delay meeting that increased need.
But, I see that situation, given the actions of the health insurance market in the US, as pure fantasy. I have no faith, at all, that insurance companies and pharmacy benefit managers, have any moral conscience. They have one singular focus: profits. As long as this situation remains a reality, I will continue to choose to stock-pile.
To be fair, I realize that some members of the patient population participate in unethical behavior. They get their doctors to over-prescribe test strips and then sell that excess on the gray market for cash. I’ve never done that. Like @DrBB, I delay periodic diabetes supply orders so that I can keep the level of my stash reasonable.
It’s darn hard to make moral choices when you’re dealing with immoral and corrupt market players.
