Yep, it’s pretty easy.
Also, recording dosing differences and having BG logs that show there were problems can be helpful as part of the appeal you submit.
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You definitely need to try the alternative product before you can file the appeal though, and ideally have that documented in your chart. It was a pain for me re: switching from Lantus to Tresiba, because my insurance company wanted me to try Levemir first, which I know gives me reactions at injections sites, but I had only ever tried free pen samples from a doctor friend a long, long time ago, so it was never in my chart. I had to fight that one much longer as a result, though I eventually got my approval.
That said, when I did an insurance mandated switch to Humalog (planning to request a switch back after a trial run), I discovered I liked it as well if not better than Novolog.
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Yes, I recently read that! 
I have a few co-pay cards with term limits and all I’ve needed to do was reapply after the year was up - some I haven’t even had to reapply, it just rolls over into the new year. I’m hoping this one (for Novolog) is as easy as that!
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Wow! That’s awesome that those cards work.
The ones for the Humalog didn’t do a thing.
I mean he is going to of course have to try the alternative insulin. But we are not happy about.
We just found out that his insurance covers Humulin, that’s the craziest of crazy.
We used to have Kaiser insurance and while they definitely have Humulin on the preferred tier ($5 copay), they will also supply you with Humalog but the cost is higher, $25 copay, was what we paid a few years ago. This was still much cheaper than on a PPO where we pay a huge deductible bill in January and February, then just something around $100 per month for the rest of the months.
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I got a Humalog card this year (after realizing they were available); it fixes the cost for me at $100/month. It was fine, actually I think it was better than fine; I’m not sure I actually ended up paying all the money I was meant to. It is certainly true that it is way to complicated to understand (co-insurance, what? Only in the US.)
It’s not really insane; it is designed to make money and it does. The complexity is necessary to make money; certainly elsewhere there is no such complexity and things are, at least, easier, but the amount of money made is so much smaller. We (T1Ds) have to live with it because we are an enormous money making opportunity; that doesn’t mean we can’t make it work for us, it’s just complicated.
I did learn that talking to the Humalog reps does work; the person I spoke to knew exactly what was available and got me the right card. There were a couple of hiccoughs getting it through Walgreens and really, it doesn’t save me any money because I use the Omnipod so I meet my OOPMax, but I liked the guys in Eli Lilley who I talked to, so that was good.
I’m individually insured, so I don’t know what would happen if I had to buy at the company store. I would say that $800 x 12 is likely to cover both the OOPMax and the actual insurance contributions of a younger guy (I’m a boomer, therefore somewhat age’ed). It’s always an option with the company store (courtesy of Obamacare) to buy an individual policy and report the company to the feds 
I was actually asked this year to do the opposite thing; Humalog to a Sanofi product. I got a choice and that choice allowed me to experiment. I’m retired so I have the time and, sometimes, the energy to do it. So far I’m working through pumping Fiasp. It’s interesting. So far as I could determine based on comments on this site Humalog and Novolog are pretty much interchangeable. It wasn’t so clear with Fiasp, so I tried Fiasp 
I do think that the two ‘fast acting’ insulins are effectively generics; they are both going out of patent. This means that the two companies (west and wester) are battling for increasingly trivial amounts of money. So I figure, live with it, let them shoot it out and let’s wait until the lone ranger from the east comes with bucketloads of both.
Meanwhile I would be far more concerned about being told not to pump. That doesn’t make any sense to me; sure it is cheaper for an insurer in the very short term, but US health insurers tend to be bound by results in the long term. What gives?
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Because private insurers change over time for people, they are more driven by short-term costs than long-term savings. Something that prevents more costs in the short-term (within a couple of years) is probably deemed worthwhile, like flu shots. Things that prevent complications over decades, probably not, since that may well end up being another company’s costs (but the short-term costs are definitely their own). Only a nationalized system like Medicare for All, where you stick with the same system your whole life, would be adequately motivated to prioritize preventative care over the long-term.
We have never been denied anything from my employer (private) provided health insurance.
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Cardamom, I think your comment is probably somewhat true for a closed HMO like Kaiser or Healthpartners, but I also have never been denied anything from a PPO type of insurance. In fact one of my employers insurance companies paid for everyone to be given a health assessment and gave you a list of items you should pursue that year that were mostly preventative things.
After getting my first old person colonoscopy this year, our friend who has Kaiser and has reached the esteemed age most get their first colonoscopy I found out that he was only given a stool test rather than the full procedure. I guess they are hoping the stool test is as good as the procedure, but I couldn’t help but wonder.
Sure, it can work well if you have a good, comprehensive insurance plan like most PPOs, which you and your employer tend to pay a good deal for. I’m fortunate to have one myself and get pretty much everything I need covered (sometimes with some struggles along the way, but eventually) with co-pays I can afford fine on my salary. But if you don’t have that kind of good plan, they are going to cut costs where they can, in the ways that I said. My coverage in grad school was atrocious, and I was lucky to have financial support from my parents at the time, or it would have been to the great detriment of my longterm physical and/or financial health. Not being denied anything nor having costs of necessary care be impossibly high is a sign that you are very lucky if you live in the US.
I am not getting into a political debate if that is where you want to take this.
I would hope by now that it would be agreed by rational people on all ends of the political spectrum that nobody is going to change another’s political viewpoint based on any sort of posting that anybody else makes.
There is only a single result from going down that road (of political posting) yet again.
It was not blind luck that allowed me to have the insurance coverage I have. I spent many years obtaining education and skills which than allowed my to choose employers which provided compensation packages including benefits which are advantageous to myself and my family.
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Well, yes, in one respect; an insurer will swap you from Humalog to Novolog and back in response to price changes, an insurer will swap you from a name-brand to a generic. It may be possible for an endo to reverse either swap with effort and time but it is difficult to see why one would bother unless you or I persuade the doctor that the change really does affect our medical well-being.
That said, this is different; this is a change in treatment from one accepted treatment (pumping insulin) to another accepted but very different treatment (poking insulin). I can see that an endo might do that, and I can see that a new insurance company would require the fairly standard “justification” statements from the endo for ongoing pumping. What I cannot understand is how an insurance company could cause the change without the endo going along with it; after all the endo has done a justification once. Maybe the insurance changed forced an endo change; that’s actually quite common and, IMO, an extremely bad side-effect of the US health care/profit system.
It’s not a nationalized system. Our school system is nationalized (socialist, if you prefer); the government owns the schools, the means of production, and the government (we the people etc) directly controls each and every public school.
The UK health system is still, despite attempts to change it, socialist. The hospitals (the public ones) are owned by the government and governed through governing bodies broadly similar to public school government in the US. When it was set up the hospitals were nationalised, taken into public ownership, though at that time the government was the central government (as in the fed); no local government. Family doctors eventually agreed to be contractors to the government, the government allocates districts (like school districts) and when you sign up for the doctor you have to choose one of the ones in your district; just like schools in the US. Of course you can go private, show us your money.
The UK system does not allow the doctors, it’s contractors, to prescribe arbitrary treatments and this is true even more than it is in the US; that because profit is not a motive, rather long term health is. So the treatments that the system will pay for have to have an accepted, proven, effectiveness that is better than any significantly lower priced alternatives; like pumps have to be demonstrably better to the accountants than syringes. The current US system has the same rule just implemented in a far more complex way; doctors have to justify expensive treatments to insurance companies, but every insurance company is different (there is only one NHS) and we live in an incredibly bureaucratic country where all the paperwork has to line up in triplicate and march through all the inboxes before anything happens.
So, yeah, give me “medicare-for-all”, but don’t try to persuade me that it is remotely comparable to other countries’, socialist, systems.
Love the sarcasm, but some people may misunderstand; this isn’t politics, it’s health care, at least for us in the US. It probably is politics for people who live in a system were they do not so directly control their government, but here in the US we control our own health care system very very directly. So what will seem political to people who don’t enjoy that freedom is health care to us.
This is slightly off topic for this thread, but there are too many unexplained details of what is going on (who dictated that @winterprincess’s son can pump no more?) Those unexplained details raise questions of “what is going on” and the inevitable hypotheses, based on little evidence, fold back into the incredibly important debate that we are having about the future of the health care system that we really do control.
I always come back to this point; we have a system that is incomprehensible and we have to decide what, if anything, to do with that system. So we can, indeed must, have a productive debate on that system and that must involve everyone, since everyone votes (or not, which is the same).
As a young 10 year old I didn’t suffer from diabetes and I couldn’t [* * *], even though I didn’t know what that meant. Ever since I have had to either care about or despise the health care system. I know there are a whole load of, probably most, Americans who only care about the profit, but I don’t think that applies to anyone reading this. We have a duty to inform and educate our fellow Americans about health care; not only do our lives depend on it, theirs do too.
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No sarcasm. 100% serious.
Completely agree.
I have yet to see a thread that ventures down this road and is productive.
If you can keep a discussion like this on the rails and not have it end up in a screaming match where opposing sides are simply trying to yell over each other and the outcome is a bunch of angry pi$$ed off people than all the more power to you. Certainly anything is possible but I have not seen it yet. IMHO txt msg (forum posting whatever) is too impersonal and leads to people getting overly heated and way over the top with behavior that they would never do in person. Similar to road rage.
I am a fan of productive debates and a huge fan of voting.
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Indeed. Totally off topic of course, but worth saying anywhere.
The ideas posted here do inform and educate the debate in wider society; people think about what is posted here. I have always believed since coming this country that I can change it be speaking to each person, one by one, and planting a single, small, useful idea in their head. I don’t know how I will change it and I have no desire to change it in any particular way, but I like change: that’s why I’m trying Fiasp.
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It’s impossible to keep discussions about insurance and why they do what they do from being at least somewhat political, given that this is one of the biggest topics in US politics these days. But it’s basic economics that a for-profit company that may or may not still be insuring you a decade later and who isn’t being paid enough to provide more premiere levels of coverage has no real motivation to prioritize care that is more expensive but is more effective at preventing primarily very long term costs. It’s pretty much irresponsible to share-holders for them not to deny that whenever possible in favor of cheaper options if they can justify them, and as a business first and foremost, their duty is to their shareholders, not to the people whose medical access they control. You don’t see that to the same degree in PPOs because those are there for people with the means and influence to buy plans that keep them happy, so customer satisfaction is going to play a much larger role in coverage, and since the premiums are substantially higher, different economic forces are also in play.
It would be a nationalized and not-for-profit system of medical reimbursement, not a nationalized medical system.
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@winterprincess’s son can pump no more?) Those unexplained details raise questions
@jbowler Yes my son still pumps. He uses his Medtronic 670G
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So far as I know it is, in fact, illegal for any corporation to act in a way that doesn’t maximize payments to shareholders. It’s also a very real motivation for individuals; even people who have curiously large amounts of money seem to want more, mostly. So, indeed; so far as the health care industry is concerned profit, not health, is the driving force.
But there are problems including health insurance corporations in that broad generalization for two reasons:
- Quite a few of them (including moda, who I use at present) are non-profit; that exempts them from the “you must profit” laws.
- Those who aren’t, for example LifeWise, which my wife used to use but went out of business, are, like the non-profits (moda) and the weird one (Blue Shield), very heavily regulated, at least in Oregon.
The regulation basically limits the profits; they have to set rates based on prior expenses and a limited percentage profit.
This creates a very very WEIRD situation; if they want to increase their profits in absolute terms they have no choice but to increase their costs in absolute terms, so, ironically this statement is not true in Oregon:
Now that’s really weird, isn’t it? Because the percentage profit is limited you need to increase your turnover. That’s actually a common feature in capitalism; sell more stuff, make more money. But in this case you can’t increase the consumer base; well, you could, you could infect everyone with measles, but that is a different political discussion. So what you have to do is increase the cost you, the insurance company pay for the treatment for the illnesses.
Oops.
Sorry, I misunderstood your original post. Rest assured Humalog and Novolog are pretty much interchangeable in a pump; I swapped from pumping Humalog to pumping Fiasp; Fiasp is Novolog with accelerants added so it should make a big difference. I can’t honestly say I can tell; maybe with a whole long set of experiments involving no eating and then binging. I have suspicions but they are not knowledge.
I would not hesitate to swap between humalog and novolog every other day if it saved me grief.