They won't write me a year long insulin script

It’s been 5 months. They just aren’t gonna do it. I think I have to go onto over the counter Walmart NPH. I’ve tried everything.

I’m not OK with the type of leverage a temporary insulin script brings to the table.

It’s really hard to make informed lifestyle decisions without some assurance that consistency via particular treatment will be availible.

If I have to run off NPH, I will make more conservative decisions. I can’t have them waiting in the wings to remove my pump and Lispro access constantly.

It’s better to have predictable supply and experience with a particular “crappy” treatment, than to have unpredictable and unreliable access to a “good” treatment.

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Well that is cheaper than using the insurance for many people!

Do you mean your doc won’t write a prescription with 12 repeats? I think they are getting more careful and won’t write repeats beyond the next appointment. However I don’t know; I never see the prescription because it is sent electronically and Walmart has started obfuscating the repeats remaining (it seems to be the “Ref =” entry on the receipt based on perusing a few of mine and my wife’s).

It’s complicated. I think I know what the problem is, but I haven’t fixed it yet. I think it’s the ol’ Walgreens software problem where they have multiple accounts under my name. So, I have doctors all over town calling in scripts regularly, but Walgreens randomly inserts those scripts into one of numerous accounts.

Let me try to explain this because I want to be able to, in the event that I ever encounter someone who can fix it.

I’m getting kinda overwhelmed by administrative failure.

Let’s assume that there are three walgreens accounts with my name on them.

Does this drawing make any sense to you? I believe there are multiple accounts under my name. That was a problem some years ago. It lasted for years. Finally, they fixed it. But I think it has returned.

I’ve been trying to pull those scripts into a new pharmacy (Walmart), but Walmart only has a 1/3 chance of hitting an account with a valid script in it, each time they call Walgreens. So, it takes me asking them MANY time across many days to move one script. They will typically call me back by the end of business day and say, “There is no valid Dexcom script at Walgreens.”

If I call Walmart once a day, for 3 days, the odds are that I can move a script. Sometimes you get lucky. Sometimes you are unlucky and there is run of ten days where they can’t find the script. Persistance is the key. I’ve learned to be very persistant. But I just can’t fix problems like this before I run out of supplies.

These problems reappeared not long after S.F. 2744 came into play. I do sometimes worry that it is intentional because if I can fill 2 scripts at once, they can only charge me $50.

What is your interpretation of this state law?

Yes. That all makes sense particularly because it is Walgreens and they swallowed the Rite Aide pharmacies; two patient databases and two sets of database staff one of which had to go… The chances of the two databases being merged correctly were probably close to zero.

We swapped all out prescriptions to the other Wally too mainly because all the Rite Aide customers were simply told to go to Walgreens to fill their prescriptions and the Walgreens was overloaded. Quite a lot of their staff moved to Walmart as well; for a year so it was, “Oh, hello, it’s so nice to see you here!”

Some things still go wrong. We always refill online and sometimes there are two prescriptions for the same thing or a minor variation; choosing the wrong one normally causes weirdness.

For transfers I suggest always use the prescription number. It’s always on the receipt, so just pull the receipt from the last fill (or, indeed, the one you need) then give it to Walmart; that way they will track it down instantly:

If you click on “Transfer” and enter the city,state (the zip code doesn’t seem to work ATM) you will get the Walgreens (select it) then get this dialog:

Enter the prescription number… IRC it should be possible to do it at the customer service stall in the pharmacy as well. I don’t think they really even need the pharmacy information if you have the number.

You might also discover the different accounts this way; a different spelling of your name is a favourite. Walmart keys on first and last name plus date of birth for pickups; a problem for the John Smiths but not the John Bowlers, there’s only one of me born on that date round here.

I don’t think the insurance companies would try gaming that and I don’t read the legislation you quoted as requiring the two refills to be simultaneous. There seem to be three conditions:

  1. Chronic disease.
  2. Co-pays limited to $25 per item per month per item.
  3. $50/month limit for all supplies for a chronic disease.

Each of those items is tricky. Firstly there’s no definition in what you quoted of what a “chronic” disease is. For example obesity is a chronic disease. Bottom line medical definition comes down to whether there is normally a cure which can be achieved in a reasonable short time (an acute disease). When I was in the UK there was a prescription copay; a fixed amount per item (IRC). I didn’t pay it because I was a T1 diabetic; the NHS did not require prescription copays for people with chronic medical conditions which it duly defined…

For item (2) it only limits “co-pays”; this is not defined. It might be intended only to cover “tier 1” drugs, which traditionally do not count towards the “deductible” (also not defined) but have a “copay” (no hyphen IRC). It talks about insurance “setting co-pays”; they only do that for “tier 1” and sometimes “tier 2” items. Otherwise the amount we pay (also often called a copay) is a proportion (40%, 60% etc) of the price until the “out of pocket maximum” is met.

Item (3) does, however, seem to be the joker in the pack; the ultimate trump. Even if an item isn’t covered by (2), such as (apparently) CGMs and pumps (e.g. Omnipods) which are certainly not normally tier 1 (so far as I know) there’s a $50 max on everything. The ambiguity is whether “related medical supplies” includes the items covered under (2); might your insurance shift your Omnipod and your CGM to tier one so you had to pay $75/month (including insulin)?

I don’t think the last was the intention of the law but unless it’s defined elsewhere it’s lawyers akimbo to establish the momentary truth.

I also don’t think the insurance companies will try to game the system; they will just say $50/month, so max $300/year for chronic medical conditions. They might, they will, pick a fight over the word “chronic” unless the law does define it. IMO they should; lawyers should write definitions that computers, and therefore computer programmers like me, understand. Define every term, initialise every variable.

As for the text itself it is apparently a good step towards a socialist solution; it shifts the cost of “chronic” conditions to the insurance premium, which is paid by everyone with that insurance. That is also the capitalist definition of insurance; a shared risk, albeit on the basis of a buy-in and for a specific risk.

The problem is that no one wants to buy insurance for something that they don’t know will happen; lottery tickets, “Someone will win.” Health insurance, “What if I don’t lose?” Health insurance really is a loser’s game. Think about what I just said.

That said, isn’t SF2744 DITW:

You didn’t include the footnote[*] for SF2744 but I think the actual source is elsewhere. A better way to quote this stuff is to give a real link to an MN government web site with the actual bill with the text you are quoting.

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Thanks, John. That helps.

I need to look at the detail related to some of what you wrote, but answer this question, in your humble legal opinion…

I went to walgreens and they quoted me this, for a fill of Lispro and a Dexcom G6 transmitter…does this obey the law?

Walgreens quote:
Lispro (a butt load of it, probably a 3-months supply) = $42.16
Dexcom G6 transmitteer (also lasts 3 mo) = $46.34

Now, conventionally, Walmart will cap it (whatever it is, no matter the quantity) at $50. Walmart will cap a 6 mo supply of pods, plus a 4 month script of glucometer strips, plus syringes at $50. Walmart does that. But Walgreens doesn’t. They cap each prescription at $50.

I honestly don’t recall what year this passed, but it went into effect on Jan 1, 2025. Let me look. Rep. Michael Howard - Minnesota Legislature Caps the Cost of Insulin, Asthma Inhalers and Epi-Pens It passed in 2023. Must have been S.F. SF2744 from the 93rd session.
SF 2744 Status in the Senate - 93rd Legislature (2023 - 2024)

$25 cap on meds. Insulin has a $25 cap.
$50 cap on medical devices.

Here’s an example recipet from Walmart this week. I bought R and NPH.


They define “chronic disease” as any common chronic disease (things in an Emergency Medical Techinican textbook) that have been getting jacked around by insurers on price (according to the federal government) - that’s diabetics, athsma, and epi pen, right?

An “Epi pen” is for life threatning food allergy. It’s epinephrine in pen form: https://www.justice.gov/archives/opa/pr/mylan-agrees-pay-465-million-resolve-false-claims-act-liability-underpaying-epipen-rebates

Diabetics: FTC Sues Prescription Drug Middlemen for Artificially Inflating Insulin Drug Prices | Federal Trade Commission

Athsma never had a federal settlement, but they started the wars over patent thickets that the feds are still weeding through.

@jbowler, the part of the law that I don’t see anyone follow is the $50 monthly cap. I also don’t know how you would enforce that, other than annually (as you elude to). But maybe I could start trouble with it. :thinking: Maybe I should tell the feds. :sweat_smile: What do you think? I love starting trouble for the medical establishment, John. It’s my favorite new past time. If it’s more than 1 Million dollars in total billing errors (I think), you get a 30% cut, personally. I like those odds. Maybe losers can be winners. https://www.youtube.com/watch?v=OVbCaeA5k6k

It’s the tax receipt, they stick it into the baggie with the drugs, it looks like this (in Walmart’s case):

The full prescription information (including the refills, apparently the “Ref:” entry on the left) is below. I’m not showing it because there is a lot of information there and there are a lot of creepy guys who really like to get hold of stuff like that out here.

Walgreens do a similar thing. It’s the information that is used to justify a Schedule A deduction on taxes, which is rarely worth doing these days but I keep all of them (good thing since I had to do it for last year…)

Why not? It’s the insurance company that does it; the law as quoted applies to insurance, not to anything else. (I.e. if we don’t have insurance, or avoid using it, that doesn’t count.)

The insurance company tells the pharmacist what to bill us. If we use multiple providers, for example a pharmacy for insulin a DME provider for CGMs or pumps, then the insurance might quote for both without assuming the other if orders for two are posted simultaneously. Then we can overpay.

This happened to me on the ACA with the out-of-pocket maximum; I hit it twice because two separate providers applied to my insurance simultaneously. In the end it didn’t matter because the insurance company refunded the overpayment. At the time they had an antiquated accounting system which had separate accounts for physicians and prescriptions so the information they sent me monthly was complete garbage but they did get it right in the end.

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I wouldn’t know because I haven’t been able to fill through Walmart yet, but I’m close. Walmart is pretty darn good at following the law. Walgreens, on the other hand, isn’t.

Thanks for the feedback & perspective, John. Very helpful. Let me stew on this.

P.S. My sugars have been remarkably stable since I switched to NPH (split dose). I just hit the perfect dosage today (didn’t result in a morning high).

Yes, that’s interesting. I’ve seen the same thing when some event causes me to lose the CGM input, so my Omnipod falls back to my fixed basal. Things just flatten out fine, like my body is set to wake up at 100mg/dL so long as it isn’t interfered with…

On the 90 day refill costs (I’m assuming the “boat load” of Lispro was for 90 days) I think the costs you saw were just the interaction between the $25/month prescription charge ($75 over three months) interacting with the $50/month cap; you paid $90 for both but there’s probably some overlap within another 90 day prescription or some other charge that counts.

The arithmetic of the two interacting caps is not that tricky so long as the insurance company treats a “month” as 30 days, so the $50 cap applies to today and the preceding 29 days. We can’t scam it if they simply handle it as $50/30 per day, or maybe if they want $600/365.2564 So long as they don’t try to do it per calendar month; that would be a disaster.

Here’s what I have for a years worth of data out of Walgreens.
No data for Walmart yet, which is where I moved the pods presription so I was guaranteed reliable access to those.

The prices are all over the place because they are filling a different prescription every time. Multiple doctors are writing these scripts, everytime I fill. It’s messy.

More than anything, I’m just curious about how this law is being applied.

Typically, walmart charges me a $50 cap on all devices (pump pods plus glucometer).

If there’s a $50 monthly copay cap, over 12 months, that should be $600 annually.
$50 x 12 = $600.

I never exceed a $50 monthly copay cap on insulin or medical device, but I exceed a $50 monthly copay on insulin AND medical device. That’s not how I understood the law when I read it originally. I need to look at the details.

They never exceed a $50 monthly cap on medical devices.
They never exceed a $50 monthly cap on insulin (no matter the duration of the script).

Maybe if the insulin is in a vial, it doesn’t count in the cummulative total becuase it’s not a medical device?


Source: SF 2744 4th Engrossment - 93rd Legislature (2023 - 2024)

This has been nagging at me since Jan 1, 2025. I need to re-read the law.

Nope. I read it as John does. I think I’m being overcharged. It’s a $25 copay cap on medications (like insulin) AND a $50 copay cap to include all related medical devices to administer that medication. Is that right?

I’m getting hosed on my abnormally cheap meds. :sweat_smile:

I’m too scared to go in and look at Walmart’s digital records. I have to go into the store tomorrow because it shows multiple accounts. I don’t want to select one that doesn’t have valid scripts in it. It was a lot of work to move these successfully over to walmart.

What if the “multiple accounts problem” cascades from Walgreens into Walmart?
I can’t take the risk.

I got it all.

All I can say is that they are defintley honoring a $50 copay cap on medical device.
They seem to apply different rules for medications (insulin).

Yeah. That’s what the numbers say in their weird way but I can’t make any sense of them so I think there is a bug in the insurance company software.

I think the law is meant to put a cap of $50/month for all “related medical supplies” but it is not written in the same way as the prescription $25/month, which says, “$25 per one-month supply” (emphasis added), rather than “$50 per month in total for all related medical supplies”. The definition of “related medical supplies” does seem to exclude “prescription drugs” so by that reading is separate.

Ok, so clearly the insurance company can charge $75 for a three month supply of a “prescription drug” but, apparently, the reading is that they can only charge an extra $50 each month for “related medical supplies” (as defined). What is more if you are prescribed a rapid-acting insulin, an NPH and some asthma drug (but not an inhaler) you will pay $75 for each month supply; 3 “drugs” x $25.

Maybe your Lispro is tier 1 and the tier 1 copay really is $35.54/7 ($35.54 does not divide by either 7 or 3! Like buying a gallon of gas, do they round down or up, and how do we tell?)

That said it looks like something changed in the insurance company before June because your partial (3 sensors) cost you $0 and so did the fill to 3 months on July 7. Those two months make no sense to me.

Walmart’s web site is full of bugs too. The log in is by “email or phone”. It is possible to have two email accounts with the same phone (we do of course; one for my wife’s prescriptions, one for mine) but “login via email” will send the two step verification to the 'phone (so it has to handle text messages). You can’t tell the two accounts apart from the information on the screen (unlike me) but you could just try it; it will do a two step verification.

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They are certainly applying the law differently to medications vs medical device. That much we can say.

I wrote to one of the guys who passed the bill in order to clarify, but I might not hear back for a LONG time because they are a mess down there at the end of session.

As usual, John, it’s totally nonsenical and there’s no way to assign blame. You try to debug one problem and it just leads to a rabbit hole of other problems to debug. I hate medicine. I’ll get them somehow, someday.

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I recall some years ago, while Ron Wyden was working to promote the ACA, there was a “town hall” in Cave Junction (where I live, don’t ask.) So it got round to the questions and I asked whether the requirements for pre-existing coverage were met by the Oregon State High Risk Insurance Pool (no swimming allowed), which every T1 requesting private insurance would end up in.

Ron said he’d ask his Staff to get back to me. That never happened.

On the other hand I didn’t have to argue about pre-existing coverage when I signed up for the ACA, so maybe I helped. Who knows?

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Yeah, you have to be very persistent with them.

It’s particularly difficult with federal members because it’s hard to schedule an in person meeting - travel to DC is not realistic for most people. I have only seen my federal house member only at party events this year. I don’t even try to talk to him at those events. Political partisans get a lot more access to some members than everyday constituents trying to solve practical problems, in some cases. But they are more accessible since covid because they will often schedule a zoom meeting with you. One of the things to keep in mind is that if they get letters from ten constituents on an issue, that’s a lot. Even 25 consitituents reaching out on a particular issue, really gets their attention. It helps.

There’s a whole history of ACA written in a super long boring book called Americas Bitter Pill. I think that recomondation comes from Dr Eric Bricker. I’ve only read a quarter of it. You might like it. I’ll keep reading it on my train ride to DC.