Insurance now requires pharmacies to pick SHORT end of prescription range?

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61

Oh…also…about me getting 1 vial of insulin every 20 days…

I called and spoke to the pharmacist to see if I could get one vial one month, and then two vials the next month since I’m prescribed 1.5 vials/month (and I only got one vial at my last pick up when I forgot to ask about this). The pharmacist said I’d have to work through my endo to get a prior authorization to get two vials every 40 days.

I’m not even attempting that. I’ll spend less time going through the drive thru every 20 days than I will getting a 40 day prior authorization worked out between my endo, my insurance and my pharmacy. I’m not that masochistic.

ETA: And I want to say that I really like my pharmacy. They are not the bad guy here. The pharmacist felt bad that I’d have to come through every 20 days and said she’d do everything she could to get it approved correctly for the 40 days. But when I explained my complete lack of faith in my insurance company…and in clear communication between all four parties (me, pharmacy, endo, and insurance)…she totally understood.

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62

Best to just circumvent all the bs and have your doc prescribe 2 vials / month…

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63

I see him again in April. I’ll test the waters with his nurse and him then. I don’t know if they’ll take issue with that or not. It’s the nurse who actually does the prescriptions for all practical purposes. And I see her before I see him…will have to think about my approach on that one.

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64

I’d just shoot strait… “my current prescribed quantity is causing headaches with the pharmacy, can you up my prescribed quantity to 66u/ day? Cuz that’s 2 vials divided by 30 days”

They’re not stupid people and they’re not the insulin police. If I got anything other than an “of course” they’d immediately be losing a patient and the source of many of their referrals…

Whenever I just shoot strait with my doc and nurse regarding quantities I get nothing but assurances that they understand exactly what I’m talking about

(Except for afrezza, that’s a whole lot more complicated)

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65

I fill through mail order for 90 day supplies because it’s much cheaper that way with my plan

So it is significantly less that $95/month for each prescription? (I’m assuming you use long lasting + short acting, so that would be $190/month?)

Because if it isn’t you need to get the assistance program from Eli Lilley or whoever Novo Nordisk are these days; those guys issue co-insurance that refunds the supplier (pharmacy) for the difference, they then get the kick back from the pharmacy that makes up for the refund, so you end up paying closer to the price the insurance company pays (much lower than what you pay otherwise).

It seems that a lot of diabetics in the US don’t understand how this works; if you have insurance you HAVE to apply to the insulin manufacturer for the co-insurance AS WELL otherwise you just end up subsidizing your insurance company. It took me a while - I was paying $300 and increasing per month just for Humalog, now (no change in insurance, pharmacist, etc) I’m paying $95.

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66

Whenever you remove your pod, after taking it off but before you deactivate it, bolus it all out until the pod alarms that it’s empty. Bolus everything remaining in there before deactivating it. The PDM does not show that you peeled the pod off before that bolus.

That automatically increases the average amount of insulin you “use” (:wink:).

Or, let’s come up with some numbers and I’ll send you a PDM that has whatever you want on it. (again :wink:).

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67

Yes… I have found that the way the prescription is written can cause these problems. I feel a good doctor would write it for more even if you don’ Use it all. Better to be safe than sorry!!!

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68

I love your clever solutions. :slight_smile:

I don’t think my endo knows how to navigate an Omnipod menu. I’d be shocked if I saw him ever pick up a PDM, let alone scroll through one.

His nurse is always uncomfortable that I have a prescription for insulin pens and also a prescription for vials. I have a feeling I’ll have to navigate carefully with her.

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69

Don’t get shorted on the insulin. Do whatever you need to do. Tell them you are using a certain amount so that your prescription gets bumped up to the next vial or pen.

I think Sam said this somewhere up there, but take the amount that divides into the vial.

As an example, if you use 33.33 units per day, that is one vial a month. But if you use 35 units per day, that puts you into a second vial for a month.

Do the math ahead of time.

And…we know that insulin does not really expire. But they have to honor the 30 day thing of once you open a vial, you can’t use it after 30 days. So that’s why the pharmacy can’t say, “But you have leftover insulin…”

And, tell them you want 90 day scripts because driving to the pharmacy every 30 days is not possible. Doing it 90 days helps get more.

Get tough with them. Don’t let them put you on the defensive or let them boss you.

Screw that!

Hey nurse, do you want to give me your damn pancreas so you don’t need to worry about being uncomfortable with the prescription? Otherwise, shut-up and write what I tell you. You work for me!

One other note, and this is very important!!

If you say something like, “I use 50 units per day”, that sounds like a made-up number.

Really, you use exactly 50 units per day? :roll_eyes:

To make it more believable, use a non-rounded number.

Instead, say “I use 51.6 units per day.”

Much more believable.
:wink:

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70

His nurse is always uncomfortable that I have a prescription for insulin pens and also a prescription for vials. I have a feeling I’ll have to navigate carefully with her.

I just use KwikPens. I stick the 'pod syringe needle into the kwikpen rubber then inject 150IU from the pen (60/60/30) and then inject the result into the pod. This way I only have to carry around one thing (the pen) for emergencies or, for that matter, for travel.

It turns out that in the US at this moment if I were to have both vials and pens I would pay twice as much; $95/month for the pens, $95/month for the vials. The negotiated price of either seems to be the same (i.e. the special high price my insurance company negotiates so that it can get the big kickback from my pocket.)

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