What to do when you've gone beyond your 30 day supply

#1

So I’ve been fighting off two colds and lots of work stress so my numbers have been high. I warned the endo and she recommended some things (usually she tells me something and reverse her opinion the next time I return). Also, one of my pens malfunctioned and it’s still 1/4 filled… but won’t put out any dose. While I looked down at my pen this morning, I knew I had 12 U left of Humulog. Quick, run to the pharmacy to order more… and then it happened. “You’re filling this too soon.”

Slightly shocked reply… “What?”

It says that you can’t get your next refill until March 11th. Let’s see… 18 days early.

“Seriously?”

“Yes, that’s what it says here. Do you have enough until then?”

“Enough for lunch. I guess I’ll see what else I can do.”

What to do, right? I know that by calling my endo, she’ll have me come in again today (was just there last week) and she’ll refuse to call anything in. She’s fun like that.

So rather than wait it out, I guess I go get some OTC Regular with some OTC needles and tough it out. Since I kinda hate humulog, maybe it will be a nice vacation.

Does anyone else have stories about what happens when you go beyond your daily recommended dose?

#2

Yes this has happened to me in the past. I became very emotional about it. When I got my feelings in line, I picked up the phone and found a primary care (family) physician and went to him for my regular visits and medicine needs. I still went to the endo for follow ups but didn’t ask for meds. If ny endo changed any meds, I let the primary know when I saw him.

It amazes me that no one hears the problem that you are having with the pen. They should, at least, write a new prescription to allow for this problem.

On a last note, I refuse to go to doctors that make you come in for every single issue; especially since you seem to be responsible.

#3

Thanks for the advice, it’s actually pretty helpful. My sugars are usually in the low 6 range and my recent A1C went to 7.1 (first time in eons) so my endo has those numbers. But I do have a trend to go higher than normal lately. Her reaction is to up my Lantus… now that I’ve upped the Lantus almost every time I go, I tend to think that Lantus isn’t all that it’s cracked up to be (even she says that I take more Lantus than any of her other patients). I miss my old two shot dose of NPH and Ultralente was vastly superior at keeping the numbers in check.

Thanks again Barbara.

#4

I don’t know if you’re in a financial position to do this, but you should still be able to get humalog, your insurance just won’t pay for it. You can probably apply for a waiver from your insurance company to reimburse you, but that might be more pain than it’s worth and may not be successful. I would start by talking to your pharmacist, he can tell you your options.

#5

The pharmacy can call the insurance company and let them know what went wrong and they can give the pharmacy the ok to fill the prescription early. Also call the drug manufacturer to have them send you replacement coupons or replacement pens.

#6

I just have my doctor write me a whole new script with new dosing instructions on it. If it has a different dosage then they insurance company can’t fight the refill.

#7

All good ideas. The only problem is that my endo seems to disappear on mid-day Friday and then returns sometime on Monday. If you call on a Friday, you’re usually given a number to call. I called the number once and found that it was the information desk for a local county hospital.

I’ll talk to the pharmacy and see what options they can suggest. Thankfully, I saved my last two pens and there always seems to be a 15-20 units per pen so I cracked opened a few spare needles and decided to use that. So far so good.

My endo tends to be rather militaristic. Tonight, I actually added up the math and based on her calculations (plus 1u prime for each shot, I come short by like 100+ units for a three month stint).

Anyways, it’s good to hear some real time suggestions. I’ll relay what happens once I get through this. I did call the endo and… haven’t heard back from her. Somehow I think that this makes my doc a drug pusher.

#8

Here in Britain, we have different sysems, but the doctor accepts you need to refil prescriptions early if you have an infection and so you just have to email a requet to them and it’s fixed. If you can’t get them the you attend the Emergency service at the hospital and they’ll cover you until you can get to the doctor.

#9

I’ve ran into this before relating to insulin. I’ve had prescriptions for Humalog expire at the end of a week and tried to fill over the weekend and found out it was a no-go from the pharmacist. And they act like I am bothering them to get some Humulin as a backup for the weekend. Humalog is definitely off limits, without a prescription. For some reason they think I am buying a controlled substance rather than something that is required to sustain life, namely mine.

I really don’t understand how there cannot be some type of ongoing prescription that does not expire for medicines that have been documented that the patient is required to take daily. And, if the patient is out, they can still have access to (whether covered by prescription payment or not - this hurts our out-of-pocket budgets). At least I can buy test strips out-of-pocket if an emergency. Would the insurance companies rather pay for a trip to the hospital instead?

#10

I’m not sure if there is a difference from state to state, but in Georgia, Humalog, Lantus, etc. is available by prescription. Humulin R, NPH, etc. are available without prescription. I’ve included a photo that shows the Rx Only designation on the Humalog bottle (right).

#11

It seems like Im a VIP with my pharmacy and it has happened once before and they gave me a vial of insulin, but when i reorded the time I was able to, I got 3 vials instead of 4.

#12

Humulin R is available without prescription most places.

It works just fine, if you realize that you need to give it 45 minutes to an hour to kick in. Then it lasts about 3-5 hours with the peak at 2 hours after injection, for me at least.

The other stuff is so much more expensive that the drug companies promote it heavily to the doctors, many of whom, mine included seem to think R is “old fashioned” and not very good. They are wrong.

#13

So either my endo or my pharmacy took pity on me since I went back today to get something for my wife and they had my humalog pens waiting for me. I was shocked. So crisis averted (for now). My wife’s suggestion to get a new endo may be finally seeping in (although I think that my endo is losing biz, they fired the only two staffers they had and I never see anyone else waiting in her office area).

So no emergency room for me this weekend (thankfully my wife said she would donate a bottle of her private humalog stash to ensure my survival, I guess she still loves me).

#14

As far as I’m aware, all insulins are prescription only in the UK. Diabetics don’t pay prescription charges, which are paid to the NHS for filling most prescripions, currently over £6 per item. Young children. over 60s, new mothers and people with certain chronic conditionditions, including diabetes are exempt I think there may be a system by which your regular pharmacist is permitted to dispense essential medicines, to patients who normally have a prescription if they run out. Our local pharmacy and several others in the area now have a system where they collect repeat prescriptions from the health Centres on behalf of patients and refil them. You do have to remember in time. All I or my husband need to do is a phone call to the pharmacy and collect everything 5 days later. then again most Diabetics are under the care of GPs, so they go for all the other stuff too.
My battles with the Primary Care Trust are because I wnat a bigger ration of test strips. 2 strips per week isn’t enough for really tight control, even of type2. I can buy them, but it would make a huge hole in my meagre pension. Freestyle strips are about £24 a pack, I think that’s about US$45. They’re cheaper on US websites, but the sellers won’t ship to here. My brother is a vet, so I asked if he could get them cheaper for me, but they use a different brand for their patients. He does have several canine and feline diabetics. Some of their enslaved humans are very good at keeping their friends in good health.

#15

i actually have more problems getting them to remember to write a script for my needles and test strips than my insulin. it was like they forgot i needed them to get the insulin inside me. osmosis? lol

#16

I went through a bunch of problems last time my scripts ran out because the insurance company wouldn’t cover the quantities of test strips and insulin my doctor prescribed. Here is what I have found that helps with the situation.

  1. Don’t let the doctor write “as needed” for the dosing instructions. For test strips, have them fill in “test 6 to 9 times a day” or something like that. Same thing for insulin, “use 40 to 50 units daily.”
  2. Depending on your insurance company, your doctor may need to call in a prior authorization for what the insurance deems as “excessive” dosing.

I had to get a prior authorization to get more than 100 test strips a month, which is ridiculous, but with the prior auth and a well-written prescription I now get 300 test strips per month and 2 vials of humalog. Of course this method requires a good doc, which may be a reason for you to switch. Also, my PCP will write me diabetes scripts if I ask him, and I know that his office gets in touch with my pharmacy much faster than my endo’s office. Work the system to your advantage!!

#17

Thankfully I don’t have much of a problem getting enough supplies as my doctor rewrites scripts for me. Another thing on the extra test strips is make sure you show a log that you test a lot and you will get the test strips easier. I get enough to test 10-12 times a day.

#18

Sorry to hear about your dilemma. I will make one suggestion that you might not find too easy to do but if your Endo doesn’t think you need insulin you need to find someone else. Being a T1 we always need insulin.

#19

My battle with the NHS in Britain is the belief that testing twice weekly is enough for type 2s. Apparently some study somewhere decided that more testing didn’t improve control in us. I can and do use test results to modify what I do next, but I know a couple of diabetics, older than me, who NEVER test… My husband and I attended a weekend gathering for a wedding l and I kept tight on track with using a large proportion of my meagre ration. I kept to under 5(90) untill Dawn phenomenon put me up to 5.8(104.4) I couldn’t have done it without strips and “misusing” my Starlix… Type 1s CANNOT get away without frequent testing and most would do better with continuous transcutaneous monitoring.