My new pharmacy coverage is no longer covering my Lyumjev insulin. Through GoodRx it’s running $300/vial. Any suggestions?
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Can you get your dr to appeal for coverage? I’ve done that a couple times when my preferred insulin wasn’t covered.
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Check the formulary, mine replaced Lyumjev with Fiasp. Fiasp works equally fast or better than Lyumjev for me.
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I had the opposite problem and Lyumjev is much better than Fiasp for me.
I don’t think the insulin matters, we just want to make it work so each time we are forced to swap we get better.
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Toast worked for about 45 days, the stopped being any different than Novolog. Lyumjev has worked fine since it was released for me.
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We have done that too. However, for Lyumjev, we used manufacturers coupons to get it ar a reasonable price, $35 per month because not covered.
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As @Michel stated, Lilly does have a mfr coupon program here to bring down the cost for most patients to as low as $35 per Rx. Not sure if this program is right for you or not, but it’s worth exploring.
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Have MD write a letter for approval / appealing it. The denile are automatic now.
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Sometimes it’s step-therapy, i.e. it won’t get approved until you’ve tried something, or somethings, else. It’s pretty difficult to prove, maybe impossible, for the lyumjev/fiasp crowd because showing a benefit over humalog/novolog/apidra is difficult if not impossible. Fiasp is probably the easiest to avoid because of the skin reaction.
I suspect if you really want to stick with it then go with the manufacturer’s coupon. It’s the same as I will be paying on my new US insurance per month (in fact for 3 vials) but I selected the new insurance because they cover Lyumjev; next year I will probably have to change either the insulin or the insurance.
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Lyumjev is too painful for me-I’d gladly swap my supply out for Novolog or even Fiasp. At this point I’d take the risk of occlusions in the X2 over the pain from Lyumjev.
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Pain suggests a site reaction, I can’t think of another explanation. This certainly occurs, e.g.:
https://www.aaaai.org/allergist-resources/ask-the-expert/answers/2023/insulin
Site reactions themselves are know to cause a reduction in insulin sensitivity with pumps certainly going back to 2010:
There is a lot of research between 2010 and today. The balance seems to be that the catheter (or, for Omnipod, the pod) can’t be relied on past 3 days and starts to fail at 2 days but this varies enormously between diabetics In addition, as the first paper suggests, there is also variation between insulins.
So the idea that a particular insulin fails to work with a particular pump seems unlikely; Occam’s razor. We know that particular insulins fail with particular people! An endo will most likely respond to the information by swapping to a different but similar acting insulin. To me any demonstrable site reaction, including pain, seems a sure-fire reason to swap. If that means a formulary exception then I don’t imagine that would be hard though in the US the cost must also be considered.
This second link comes from this thread, which is also discussing site reactions and is certainly worth reading:
Welcome @squidsdc! And so sorry to hear about your problems w Lyumjev 
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Thanks all - I have tried flonase at the site to be able to make it thru the day. It’s definitely a site reaction as I didn’t experience it when I was using Novolog, or with Lispro. However Lispro is like water for me, so now I am using 50/50 Lispro/Lyumjev, and that gives me almost an extra day of use. I was barely making it thru one day on Lyumjev alone. I will be changing insurance in May so am hoping to find Afrezza covered, so at least I can have something to use as an adjunct to Lispro.
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@sturonasbrown An appeal often works. Your Doctor states why you need Lyumjev. But be warned an appeal often bumps it into a higher tier category and the costs might go up. My insurer just switched Part D suppliers and all 3 of my “drugs” were denied. My Doctor appealed them for me and they were all granted for the year. Humalog 200, Dash Pods and Affrezza. They put them all in a higher tier which means $100 for a 3 month supply, with Optum it had been $40 for a 3 month supply. and a $100 for the Afrezza for 3 months. So still cheaper for me, but depending on your insurance the manufacturers coupons could be more beneficial.
I didn’t have to try anything else first this time, I have in the past before Medicare to show I tried what they preferred. But I gather my husbands past employer had a back up plan for claims turned down because the formulary list has dropped a lot of covered drugs to generic versions. So maybe CVS is being generous in okaying appeals at least this first year so they keep the contract? But I gather they wanted you to switch to generic drugs if possible and the trick is if there is a generic available? In my case it’s a no on all 3 of mine and they couldn’t list anything as alternatives.
@squidsdc Fiasp didn’t work at all for me by about the 3rd use. Lyumjev somewhere between the 1-2 years was really pretty close in timing to my Humalog 200. The point is we all can react differently to the different insulins, the type of insulins or the additives in them. I am having a lot more of an issue with site failures from my pods, if I get itchy or sore I will have a failure pretty quickly. So it could be totally a site failure because you are reacting to the adhesive, or to the cannula used. If its a Omnipod and you want to stay with it, there is no switching, you could try some protective under patches if it’s the adhesive, and with a tubed pump you can switch to steel sets that sometimes work for some that are reacting to their current set. But first you should narrow down if it’s the site or the insulin. Have you tried to inject Lyumjev with a syringe to see if you react to it? Because if you are reacting to the Lyumjev it needs to be switched to a different insulin and your doctor should be able to appeal that pretty easily. Plus there was some research that Humalog (Lyumjev is the faster version of it,) doesn’t always last in a pump as well as Novalog or Fiasp. It degrades faster in the plastic cartridge.
But it’s usually easy to appeal for a different insulin when there is a strong medical reason for it. Good Luck and I hope you find something that works!
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