FUDiabetes

Buying insulin without going through insurance

Hello,
I am wondering is Insulin available to buy without going through your insurance? Currently, my insurance only covers 2 boxes of humalog( 10 pens) pre filled pens for 90 days. It’s hardly enough. We need to give some.to the nurse too. Im always afraid of running out. If needed.could I go to the pharmacy and buy insulin and pay out of pocket? I also think I need the dr to write the prescription for more.
Thanks.

If your doctor writes RX for what you really need, does this exceed a limit set by your insurance ?

Seems unusual, but if so, you could certainly get 2 rx, one to get with insurance, the other without. But will likely be quite expensive.

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Definitely get your doctor to write a script for more insulin.

If employer based insurance, check with your HR benefits to see if there is way to override this.

Yes. 2 boxes every 60 days would be better. Or 3 boxes every 90 days. I just dont think they are factoring in corrections, priming and giving some to the nurse? And she has to throw hers away after 28 days.

@Nreid77
As long as you have a prescription for the insulin you can go to the pharmacy and buy it out of pocket (i.e. pay for it yourself). I do this all the time with test strips. They are very expensive but what are you going to do when you need them.

If you are close to either the northern or southern border or are taking a vacation literally anywhere else in the world, you can purchase insulin over the counter for about $30-$50 per vial, depending on which type of insulin you are acquiring.

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Wow. Do you need a presciption?

My doctor writes insulin RX as “up to XX units per day”, which includes the amounts for priming, or thrown out after 30 days. However many of us also continue to use past 30 days, and don’t throw it out, as long as its not kept in extreme heat.

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The pharmacies that ship (mark’s marine pharmacy, and others) will require a prescription. It’s about $50 US per vial at mark’s, plus shipping.

If you buy in person, I understand you don’t need a script, since it is sold without a prescription in Canada. It is cheaper too, about $30 US per vial, last I checked. I’ve never bought in Canada, but others here have done so.

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No you don’t need a prescription if you purchase in person. We might be one of the only large counties where a prescription is required. As was mentioned above, if you want to mail order to yourself it is a bit more expensive and you do need a scrip for them to be able to ship to you. Why we need scrips for insulin is a really frustrating thing to me. It is insulin after all, you aren’t going to have an insulin party, and even if you did, everyone would get low blood sugar and go home.

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If you get desperate, Wal-Mart sells vials of the older version of either NPH or Regular (Novolin, not Novolog). I bought a vial without a prescription in Moorefield, WV for less than $25 and took it on a trip to Germany as my second backup. You may need a prescription in another state.

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In the US the major manufacturers (Lilly and, I believe Sanofi) will give you an insurance card which will reduce your payment to $100/month (yes, that number). It takes some searching but it is there, it’s free, after you 磕頭.

In, I think, almost all of the world non-GM insulin is not a prescription drug and that includes the genetically engineered human insulin; i.e. the stuff that chemically matches human insulin. This is certainly true in the US, the UK and, well, almost anywhere. That means that it is relatively cheap and, a side benefit, even in the US you may be able to import it without being arrested at the border.

It may be worth discussing with your doctor the merits of the “fast acting” insulins; if it is a choice between something you cannot afford that has been modified to act a little faster and original human insulin then there is no choice.

The non-GM major manufacture insulins are “Humalin” and “Novalin”, the GM insulins require a prescription in the US; there are a lot of them (more and more; patents only last 17 years, diabetes lasts for life). Humalog is actually (chemically) “Lispro”. In the US it is available as a US “generic”, currently only manufactured by the same guys who make Humalog, however it is a “generic” so should be covered as such by US insurance (yes, US insurance is really weird). It may be necessary to ask for “insulin lispro”; your doctor should be able to fix this.

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Just to clarify a little, and hopefully make it easier, the first time I ordered from Mark’s Marine they wanted proof that I had been prescribed insulin. I could furnish this via a prescription, a copy of an old prescription, or even a pic of the pharmacy prescription label off of a vial. It was a one time deal as well. I haven’t ever had to submit proof again in subsequent years.

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I seem to remember purchasing insulin without a prescription in Virginia. It was super cheap back then so the insurance coverage didn’t help the price any.

I’ve also purchased insulin syringes without any hassle in a couple states. In San Francisco, pharmacies will give you a free sharps container and when it’s full, they’ll take it back and give you a new empty one. (My point here is that things vary by area.)

I second the previous suggestion of talking to your doctor about getting more. I’ve had doctors who don’t want to over prescribe it but who have always bumped it up to a reasonable level when I’ve asked.

I’ve also had doctors who have a fridge full of free samples which they were happy to give out. And I’ve had doctors who have been surprised about pricing when I brought it up; one was able to switch a $1000 (non-diabetes-related) prescription for a nearly identical $30 one after I told her the price.

I also second the above suggestion about the prescription plans from the insulin companies. If that doesn’t work, the goodrx.com website can save you some serious money on all kinds of prescriptions (but nothing as good as $100/mo for insulin).

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After you watch the rainmaker again, I would speak to your insurance company again, you might need to switch to the cheaper version of humalog, or novolog, or cartridges, or a prior authorization for more boxes. Also try to estimate the maximum number of units possible for a pancake buffet, then pizza buffet for lunch and dinner, and a birthday party cake dessert, and use that as your daily amount of insulin… most endocrinologists will gladly write it and send prior authorizations, however a lot of general practitioners really have little knowledge of a type 1s insulin useage day to day…they can be clueless about using more or less insulin dependent on activities. So request a prescription for 70 units per day, have them send a prior authorization, and pick up your 4 boxes for 90 days… but maybe when you are not working, or on an early Saturday morning… might take a little time…

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I re-read what you said more carefully:

My own insurance company imposed limit is 30 boxes in 28 days, or 40 vials in 28 days, but:

The limit you quote corresponds to a little over 30 units per day, so I believe that has to be the result of the prescription. The pharmacist can’t supply more than that for a prescription drug like humalog so, as @ned implied and @jason99 stated talk through the problem with your doctor and obtain a higher per-day requirement to deal with the priming (2IU/injection at least) and the nurse.

Yep, nurses have to follow orders (unlike doctors), so maybe the answer there is to get a separate prescription for the nurse; 1 pen every 28 days, so that would be four every 90.

If the insurance company makes trouble over the two prescriptions then the pharmacist can do the math given the daily dose (30 units?) the number of injections (2 units prime per injection) and the nurse (one pen every 28 days, so 5.36 units per day), or the doctor might manage that though they aren’t as good at math:

Daily requirement (in units) =
    daily dose in units
  + number of injections per day times 2 units
  + 1500 units divided by 28 days

It is a very good idea to also get a one-off (non-repeat) prescription for an emergency box of pens then refill at the earliest opportunity on the repeat prescription. In my case I can refill a 90 day prescription at 80 days, but that probably varies by insurance company. In any event if you do this (the diabetic squirrel approach) you end up with a reliable supply in the fridge.

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Thank you all for this very useful information. I am going to reach out to her doctor to increase the units per day she uses, so at least we can get one extra box per 90 days. What’s crazy is that when she was 15 months old, she used to get one box per 30 days. That was way more than we needed at the time. Now she is growing like crazy and needs way more Insulin. I agree about keeping the pens past 28 days, but the nurse at school will not. I use my pens at home much faster and never make it to 28 days.

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Have your doctor write the script for 75 units a day.

Will the nurse accept a partial pen? Or does it need to be unused? If she will accept a partial pen, you could use one down to the level that would be required for lunches and then provide that, or you could have the nurse send the 28 pen home and you could use it. Seems really wasteful to throw away good insulin.

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