I want to try Lyumjev insulin, but my insurance company has turned me down. My physician wants me to have it, but doesn’t know what to say to the insurance company to make them change their minds. A couple of years ago they approved FIASP, but for me it was eventually like injecting water. I would like to try another faster working insulin.
How am I supposed to know if I would be happier with Lyumjev if I can’t try it. I have never had my insurance company turn me down for anything before.
Also am I being unreasonable? My physician and I started laughing because my A1c is 4.8 and my TIR is very good.
I guess I just feel like I should have my choice of insulins. Any suggestions about what my physician could tell the insurance company?
Yeah, I agree with going the sample route. I did that when I wanted to try Victoza off label. So my endo gave me samples for the first few months until we both felt it was doing what we wanted it to do and I got the prescription filled. I pay $150 for a 3 month supply which is what I pay for my 3 month supply of insulin. So while they are “covered” it is still expensive whenever you want to try something different. Good luck with the sample route. I find it is the best way to try something before committing. Pump and CGM companies should try this also!
Lyumjev is so new I have a feeling it’s not on all insurance lists yet for coverage and then it won’t matter what your doctor writes. Lily will try to create enough of a demand so people start asking and insurance companies at some point cover it. Insurance companies are having a little more bargaining mindset too with the insulins they cover so it will also depend on Lily.
Lily has a savings card program to get it for $25 with insurance but not with any government funded insurance and Medicare is specifically listed. I’m not sure if they have any other programs.
Have you looked at your drug formulary for your specific instance? They can be downloaded, and pretty much spell out exactly what hoops you have to jump through for approval. Mine lists which drugs in different classes are “preferred”, and which require prior authorization. It will also say which conditions must be met to get the prior authorization approved.
For instance, mine says for the non-preferred Lyumjev/Afrezza/Apidra/Fiasp:
“Non-preferred products may be approved following trial and failure of treatment with two preferred products (failure is defined as allergy [hives, maculopapular rash, erythema multiforme, pustular rash, severe hypotension, bronchospasm, and angioedema] or intolerable side effects).”
So my doctor could make chart notes that say I’ve been experiencing rashes (everyone gets a rash at some point), pain at the injection site (who cares if it’s from the actual injection), questionable inflammation, flushing, etc… My doctor has no qualms about writing chart notes to accommodate insurance bureaucracy. I would just have to make sure I’ve met the physical requirements, in this particular example, that I’ve tried 2 of the preferred drugs… which I have (Humalog and Novolog).
No, we haven’t appealed the decision. The GP is writing another letter. I remember that we had to jump through hoops to get Tresiba, but it wasn’t difficult. I was recently approved to get another year of that.
They also wanted me to use Baslagar, but my GP wrote a letter so that I could continue using Lantus and then we eventually got Tresiba.
I don’t remember how we got FIASP since it wasn’t on the approved list. Seems to me that they should be willing to substitute Lyumjev since FIASP doesn’t work for me.
I realized that Lyumjev wasn’t an approved insulin, but figured I could get around that. We are paying a great deal of money to get our prescriptions covered by our university insurance, so it seems to me, that they should cover the insulin that I feel that I need. I do understand that the world doesn’t work that way though.
I have to remember that I have always eventually been able to get the insulin I wanted.
I use Humalog in my pump, I tried fiasp and it didn’t work for me either. I have the testing set up so I can then try Afrezza.
Within the 3rd of shot of fiasp it stopped working and like you it then became like water. So since Lyumjev is Humalog with a change I am a little concerned about trying it when Humalog works so well. If I try Lyumjev and the same thing happens as with fiasp, will that leave me with Humalog not working as well? I don’t think that happened with people that went back to Novolog. But I will probably wait to see more feedback from people trying Lyumjev before I do. I think Afrezza is supposed to be faster so I might be very happy with adding Afrezza in addition to my Humalog. anyways.
I used Novolog and Fiasp at the same time. I only used Fiasp when I had a high reading. It had no effect on how well my Novolog worked.
I would like to try Afrezza but when I took a breathing test, my breathing put me at 72 yrs instead of 68,so my doctor wouldn’t approve it for me. I had an infection at the time, so am wondering if that affected my breathing. I need to redo the test.
I should be okay with the test, I think my swimming helps big time with that. I did delay the test until next week as a new 45 pound Spuds McKenzie tank type dog plowed right into my knee when playing chase with my other dog and I went down landing with my arm under my rib and hurt some ribs. It hurt to breath.
They sent me home with a AirLife Volumetric Spirometer so I wouldn’t get pneumonia, they’re only $10 at Walmart for the one you inhale from, I test really well on it. You could buy one to practice on!
Wow sounds liked what happened when the army recruiter was informed I had Type 1 diabetes. Hmm he wondered, if you could stop taking it for 90 days you get thru basic and then be discharged on a medical. He said that would be sweet.
Oh ouch! Sorry to hear that. Thanks for the suggestion, I will order one. I tend to not breathe deeply. Yes, all the swimming you do will certainly help.
I want to try it too, but my insurance won’t cover it.
I will be visiting Lilly this month for work. I want to see if I could get a free sample, but I doubt they would actually do that since it’s a prescription.
I haven’t tried Fiasp either.
I have only ever used Humalog, both on MDI and in my pump. It is my insurance company’s preferred brand but I just found out that Lyumjev is also covered, probably because they are both Lilly insulins. Humalog also works well for me most of the time except for bringing down stubborn highs. Do to a pump issue that was completely my fault, yesterday it took me 5.5 hours to bring down a high BG. In normal range Humalog works fast enough for me.
I’d love to try Afrezza for situations like that but it also is not on my insurance drug formulary. I could probably get my endo to get prior authorization but insurance will then make me pay a lot more for it.
