I agree. There is just so much that we can fight (although, it is an important and worthwhile fight), the test strips brand, the test strip quantity, the insulin brand, the pen vs the vial…etc. There is something truly messed up about “disease management” or “illness management” rather than encouraging “wellness” and positive behavior. Why is frequent testing discouraged? It makes no sense, especially for those of us who know what we’re doing.
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In my thinking having the best insulin is near infinitely more important than ones preferred strips and strip quantity covered… I’ve bought my own strips out of pocket for years just because I don’t like my insurance option and it really doesn’t cost much more than the copay for the ones they offer
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Do you know what are the specific words that the insurance companies are looking for in the appeal or the prior authorization? That would help greatly. It is additional work for the doctor/healthcare team. I want to be able to “coach” them. I’m surprised that they seem somewhat reluctant, or not knowledgeable as to what specifically to state on the appeal/prior authorization form.
The nurse wrote me (everything is via email these days) that the insurance company covers Toujeo and Basaglar and since I have not tried these, the insurance company wants me to use either one…This is not completely accurate. The reality is that I tried Lantus more than 2 years ago, under a different insurance plan. (I also tried Levemir; it was ok). Tresiba seems to work the best. Although, my understanding of diabetes management improved GREATLY in the past 2 years too… Therefore I am uncertain that I can attribute my better BG data, and reduction of A1C from high 6’s/low 7’s to 6.0 to Tresiba alone. Nevertheless, there ought to be a general motherhood statement that the healthcare team could make, something to the effect: The current regime of xyz, abc, and 123 for the patient has been working well as evidenced by the reduction and consistent maintenance of the A1c. Therefore, let’s not mess with a good thing.
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I have done a few of these insulin-brand or insulin-type appeals. It wasn’t too hard.
It was a month of supposedly “trying” the alternative insulin and then the endo reporting back to the insurance company with great dismay ( 
) that the trial of the other insulin did not work.
Your endo can write observations like:
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After a month of trying LanTeoBaRiba insulin in place of the patient’s normal basal regimen, the patient’s glycemic control had diminished.
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Lh378 experienced uncontrolled morning hyperglycemic episodes
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Lh378 experienced inconsistent daytime blood glucose
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Lh378 experienced greater instances of postprandial hyper-glycemic excursions
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Lh378 experienced greater variation in daily blood glucose measurements
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Lh378 experienced difficulty regulating basal doses
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Lh378 experienced Inconsistencies with accommodating the <24 hour duration of the new basal insulin
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Lh378 experienced dangerous episodes of hypoglycemia
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blah, blah, blah…
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With the diminished control and the increased risk of complications, Lh378’s basal regimen should return to blah blah…
Just highlight problems that you think exist with the other basal. Duration? Inconsistent delivery profile?
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Short answer is “no”. Longer answer is " yes, they both don’t work as advertised, and are inferior insulins when compared to Tresiba.
Fight the insurance company like your life depends on it.
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I am on the same wavelength as everyone else: I would fight the insurance company on Tresiba.
There are now lots of ways to get large quantities of strips for evonomical amounts, so, right now, it would be cheaper for us to go off insurance for strips… I figure the same may be true for you 
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They are different, but not necessarily inferior. For me, I would prefer Lantus or Levemir over Tresiba. It depends on what you are looking for.
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Lantus and basaglar are advertised as 24 hour flat insulins. They are not. Tresiba is advertised as a 24 hour flat insulin. It is.
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Some people may get 24 hours out of Lantus. Others may not.
With Levemir, since it is dose dependent, it can last up to almost 24 hours (23 hours) for some people.
And for some people (perhaps most), Tresiba lasts longer than 24 hours.
There is no basal insulin that last exactly 24 hours for everyone. So I stand by my statement, that any particular insulin is not necessarily inferior, it just depends.
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All I am saying is that Tresiba lasts, as advertised. Baseglar and Lantus, both useful insulins, do not live up to their advertising.
I just saw a commercial for Lantus that made the 24 hour claim. I have used several basal insulins and Tresiba is the only one that does not involve multiple injections daily.
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Lantus lasts 24 hours for us…
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Your doctors staff should be very well versed in PAs without any additional coaching necessary…
But typically I think it’ll start with them rx’ing the forbidden fruit and getting denied, then unfold from there. I’m sure they have plenty of practice…
Not in my experience, no matter how many times I try it.
It’s a little more nuanced in my mind than just lasting or not lasting…
For the sake of an analogy; Lantus is like filling your gas tank up when it’s almost empty… tresiba is like never letting the tank drop below 3/4— in the latter case the amount of gas generally in the tank remains much more consistent
I’ve never tried Lantus so can’t comment on it. I’ve been getting really good results with splitting Levemir, more consistent 24-hour coverage than with Tresiba. Lantus seems like the default basal, at least in North America. For whatever reason the hospital gave me Levemir when I was diagnosed, maybe because it was new at the time. I probably would’ve never thought to try it if I hadn’t been given it back then. I’d be curious if it would be as good of a fit or better for some.
Ironically, 2x levemir is what I told my doc I wanted, after using Lantus for several years becaue I wanted to take a different amount in the morning vs at night… I insisted that’s what I needed to do— it fit my patterns logically… … my doc insisted I try tresiba first which irritated me because it was exactly the opposite of what I was explaining to him that my patterns indicated, but… it worked out well for me
It just shows how we’re all different. I take basically the same amount every 12 hours, maybe going up or down a unit but no more than that, so you’d think 1 shot of Tresiba would do the trick for me.
@Scotteric It did for me. Tresiba is the ONLY basal that I’ve taken that requires only 1 injection/24 hours.
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It seems to work well for some people and for others it’s chaos. But that’s everything in diabetes.
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Here’s what wikipedia has to say about insulin glargine:
Acceptance and repartition in the body
Insulin glargine is formulated at an acidic pH 4, where it is completely water-soluble. After subcutaneous injection of the acidic solute (which can cause discomfort and a stinging sensation), when a physiologic pH (approximately 7.4) is achieved the increase in pH causes the insulin to come out of solution resulting in the formation of higher order aggregates of insulin hexamers. The higher order aggregation slows the dissociation of the hexamers into insulin monomers, the functional and physiologically active unit of insulin. This gradual process ensures that small amounts of insulin glargine are released into the body continuously, giving an almost peakless profile.
I haven’t found an explanation for Levemir mechanism yet.
I’m pretty certain that, at least, in two previous instances of using Lantus, more than 2 years ago, that the physiologic pH was such that it caused the pre mature release of the insulin than the “expected” time release, thereby causing me low BG. The whole “time release” medication is a pretty tricky technology. I don’t really care for the “long acting” pain reliever, time release capsule. The encapsulation, the agglomeration, the dissolution rate…etc. that can all be so tricky to achieve. I’m old fashioned in that regard; just let me take my pain reliever every 4 to 6 hours as needed.
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