FUDiabetes

So it's apparently law now?

#1

Insurance companies have made it law that they HAVE to split up boxes of insulin pens? Even if you get 5 pens a month?

My dang doctor also only didn’t order 3 test strips a day, so guess who only got 50 test strips at the pharmacy today? :face_with_symbols_over_mouth: . Was told my needs of test strips more doesn’t matter, even if I tell them, the doctor has to put that in, not me . I cannot have any input in my own medicine.

I’m currently battling a new possible diagnosis, for something I can’t get any medicine for (the whole EPI situation, I’m gonna get that further checked , but there’s no way I can get meds for it if I have it :frowning: ) and I had a battle with walgreens today, and the pharmacist told me no if ands or buts: I can no longer get an unopened box of insulin pens.

I am starting to understand diabetes burnout, not that I wanna do that to myself, but I get it. When you keep getting the short end of the stick and are specifically told at the pharmacy: You don’t matter if you’re not your doctor.

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#2

@Sensorium139 actual US Federal law or we made it up to help our revenues Insurance company law?

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#3

I don’t think any laws were changed, rather I think someone at a PBM or insurance company did an analysis and realized that they were giving away an awful lot of “free” medicine, and they came up with a way to punish the pharmacies that weren’t breaking the boxes down. Since it takes labor to break a box down, my guess is the pharmacies didn’t come up with the rule.

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#4

Pretty sure insurance companies don’t make laws…

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#5

except for when it comes to paying for what we are promised…

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#6

Yes your doctor has to precisely define the quantity of anything they are prescribing you. You can have a lot of input in your own medicine, you just have to ask your doctor to prescribe you more. Same with strips. Lot can be solved with a quick phone call and message left… that’s how I always do it anyway

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#7

I spent all day on the phone telling them : 3 test strips a day at least, if not possible to get more , attempt to get whole boxes of insulin (which I told them specifically : 5 pens in a box, 15 ml per box) , aaaaaaaand what do I get? None of that. 50 test strips (1 per day I guess not quite 2) , no admelog even though I asked for that. I got Basaglar yesterday so that’s not a big deal right now but :confused: . Also had to cancel the Creon even though I wanted to know if that’d work to help my other issues, since insurance was refusing the dose. Originally doc put in 3 month supplies as well and I had to spend most the day trying to correct that based on the fact my insurance doesn’t do 3 month supplies. I tell my doctor’s staff and him all this multiple times, yet it still turns out wrong. I wanna say it’s a walgreens issue as they don’t do good at this, cvs has less issues with it but the cvs is so busy I have to wait all day for like one rx and I don’t know if it’s worth it and it’s got a terrible parking lot and it’s kinda out of the way :confused: .

Apparently, I researched it and walgreens got sued for $270k for giving people “more insulin than they needed” when…it’s not . A whole box is pretty good for most people here I imagine, I don’t think most people like the box split ? We like extras don’t we ? I sure do. I hoard them, but they do not get wasted. I like having enough incase I break a pen or it’s one of those ones that doesn’t prime up /work right. So now they split boxes, you’re not allowed any extra, and you have a hoop if you have to get another pen because yours broke or something, fun times. They consider giving you enough+a little bit extra fraud??? These insurance people have no idea how diabetes works nor how the supplies work.

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#8

Dunno what to tell you. That sucks. Makes me glad I seem to have a reasonably competent and responsive healthcare team.

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#9

I miss my endo, he would get everything right. I haven’t had a good of a doctor other than him in any field…for anything…as far as rxs and overall care go. I hope I can get back to him if I ever get private insurance before he retires lol D: . I mean, it’s possible the other younger doctors in his office could handle me fine as well though so? But he was a nice guy and did my primary care and my endo needs and would work with my gi doctor really well and I never had this issue until I had to switch due to medicaid. It’s hard for me to handle and figure out when I didn’t have it before. I miss the fact he’d also set me up with huge rxes for insulin so I’d always have it (which is why I had a huge surplus that let me survive most of the 6 months I was uninsured) and samples of everything before the rx and was super through about stuff. He got it, he was a type 1 himself.

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#10

I think when I move here I’m just going to try to stick with a family doc or internist instead of an endo. My experiences with them have been better, though that could just be luck. I think docs who consider themselves primary care tend to feel being responsive is more a part of their job.

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#11

I have a family doc right now , instead of an endo, it’s prolly why I’m having issues as they don’t deal with endless diabetics lol D: . Who knows though. This guy seems to get what I need (decent strips, the two insulins, doesn’t toss diet advice, really wants me to get a libre ) but he can’t seem to get the rxes right .

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#12

Nah, they don’t make 'em, they buy 'em.

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#13

This is so annoying! And it makes me feel like you pretty much need to get your endo to help you game the system if you want to not constantly be stressing about supplies…

For a personal example, if I wanted 2 10ml vials of insulin a month I would need to be using… 66.67u/30 days? Do you think they’d give it to me if he wrote 65u/day, or would that unaccounted for 50 units a month be “fraud” lol? :stuck_out_tongue:

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#14

Previously I used ~185 units TDD. I’m down to 73. I have my Endo write for 185 which is 4ish vials/month. I’m lucky if I use 2. I backstock the balance and help those less fortunate when the opportunity arises. I don’t feel guilty, I feel supremely fortunate. I also don’t feel bad about a rainy day supply courtesy of a system that could care less about my health, that cares about numbers only.

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#15

My pharmacist only gives me full boxes of Tresiba pens and Novolog cartridges.

Since I’ve been on Medicare, they calculate that the 2 full boxes of Tresiba will last me 40 days, so Silverscript won’t refill it before 35 days.

Can’t build up a stash anymore, but I never get opened boxes.

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#16

We have this problem frequently. I find that persistence is the key. Also much over a phone call I prefer the portal or email or any written and traceable method of communication.

Also, a friend who’s a doctor gave me some advice when I was struggling with health issues and medical incompetence recently: be polite and persistent and KEEP IT SHORT. (Last one, not a core competency of mine :rofl:)

The doctor/staff/whatever doesn’t have the thru put to care about your backstory. Even if they want to. They have hundreds of patients to help. So get right to the point. In your case that might sound like “I am a patient of Dr. SoAndSo. I need a prescription for insulin. It should read Up to 150 units per day. Please dispense pens.” Clearly, figure out how much you need first and then add in the oooops factor and use that number. And maybe you went the direct and clear route and are still not getting what you need. But persist kindly!

Also this thread might be of interest to you:

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#17

My fiance’s going to the same doctor I do, and he’s going on Monday. So I’m gonna talk to them in person and try to find a paper copy of my previous insulin rxs to show them what to do maybe? That’d prolly work if I can find, which it might. I’m worried I’ll only get like one admelog pen a month and 3 basaglar which doesn’t leave much room if one of those doesn’t wanna turn up or busts open like they seem to do once in a while :/.

The test strip thing is a whole nother bitch+ my GI issues which seem to only be getting worse so yipee. Found an over the counter probiotic that contains enzymes with hope it may kinda alleviate it + a lower fat diet , but we’ll see .

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#18

100%
Short
Sweet
To the point
No ambiguity

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#19

Absolutely. A message to your healthcare provider regarding your medication needs should never exceed 2 sentences. It’s not a discussion, that’s what this forum is for,

It’s a “doctor, I need _____ please. I prefer ____ pharmacy”

If they want more discussion they’ll ask. I can almost assure you they don’t, unless you’re asking for narcotics.

ETA of course that’s assuming it’s for a medication for a condition they’re already treating you for, it wouldn’t be appropriate to expect them to just fire off rx’s for meds unrelated to a condition they’re actively managing the meds for you without more than just a message…

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#20

Absolutely true! Fewest words possible

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