Insulin and Medicare


Being this time of year, I fall into the donut hole for coverage. I use Humana Walmart for additional insurance coverage and I had something happen I need to get off my mind.  I called the Walmart pharmacy and asked what the costs were for my next prescription was going to be, I find it impossible to cover 300 dollars insulin costs a month at one time. I like to live indoors and have electricity at the same time. Anyway, I spoke to the pharmacy about getting one bottle at a time, that is how I have to survive with the fixed income I have. He said ' I am sorry there is an issue with the Lantus bottles and we had to send them all back, we have none' , I thought that was strange and began to search what might have happened, but I have not been able to find any recalls or issues. I had to have my prescriptions transferred to another pharmacy so I could get my insulin, this is something I just cannot stop taking until the next time I can find it. So they sent it to another store (not Walmart) and I got the insulin I needed.  What happened to me was biased and from what I can tell, almost illegal for them to deny filling this in less than one month supplies.  Anyone have any ideas what I could do about this ? I know I cannot be the only one in this situation, and there has to be recourse to help others not have this happen to. Thanks!

Jeff, first piece of advice is to vote next month!  I'm planning to vote for Obama again, particularly for his having addressed the greater good of universal healthcare coverage in a practical and cost-effective way.

Your local pharmacy may have had to return/replace their insulin supply as a result of a damaged shipment or incorrect storage.  If so, it reflects diligent managment practices at that pharmacy.  

Otherwise, it may be that they ran out of Lantus.  You can lessen the impact of such a shortage by having your physician write your prescription for a bit more than your average daily dose.  Definitely you want to round UP your total monthly need to the nearest full bottle count.  You might also consider having him compute the prescription based on your maximum daily need.  For example, if you use 40 units 1-2 days a week, and 35 units for the remaining days, compute the prescription for 40 units x 30 days=1200 units, which rounds UP to 2 bottles per month.  

Jeff-  Have you called your doctor's office and asked for samples?  They can sometimes provide free bottles.  You can also contact the manufactureres of Lantus and ask if they can help.  And like Randy said, when you start the new year make sure your monthly prescription is for as much as possible.  Add at least 20% on for waste, sick days, etc.  

Randy - I do NOT want to start a political discussion, but needed to clarify something about Obama's Affordable Healthcare Act.  It does not provide free healthcare for everyone.  It requires all citizens to buy healthcare insurance.  

Those who choose not to buy insurance must pay a substantial fine in their annual income taxes.  And if you have insurance you still have to pay co-pays for doctor visits and prescriptions like we do now.  The "good" news is that the IRS cannot seize your personal property to enforce that the fine is paid, but the IRS will be able to sue individuals for payment.  Full details are:

The penalty/tax will be phased in from 2014 to 2016.

The minimum penalty/tax in 2016 will be $695 per person and up to 3-times that per family. After 2016, these amounts will increase at the rate of inflation.

The minimum penalty/tax per person will start at $95 in 2014 (and then increase through 2016)

No family will ever pay more than 3X the per-person penalty, regardless of how many people are in the family.

The $695 per-person penalty is only for those who make between $9,500 and ~$37,000 per year. If you make less than ~$9.500, you're exempt. If you make more than ~$37,000, your penalty is calculated based on a formula (specific information below).

The penalty is 2.5% of any household income above the level at which you are required to file a tax return. That level is currently $9,500 per person and $19,000 per couple. The penalty on any income above that is 2.5%. However, the penalty can never be more than the cost of a "Bronze" heath insurance plan purchased through one of the state  agencies that will be created as part of The Affordable Healthcare Act. It is estimated that these policies will cost $4,500-$5,000 per person and $12,000-$12,500 per family in 2016, with the costs rising thereafter.

Penalties for not having healthcare insurace will be approximately:

Less than $9,500 income = $0

$9,500 - $37,000 income = $695

$50,000 income = $1,000

$75,000 income = $1,600

$100,000 income = $2,250

$125,000 income = $2,900

$150,000 income = $3,500

$175,000 income = $4,100

$200,000 income = $4,700

Over $200,000 = The cost of a "bronze" health-insurance plan

Jenna, thanks for the details about the ACA tax penalty for not buying health insurance.  Did I say free?   You must be a tax accountant! ;-)    

I'm just so relieved to soon be able to buy health insurance coverage at an affordable price!  And very much afraid that someone might take away that priviledge, even before it becomes available!

There definitely needs to be some kind of reform, I'm just concerned that this won't be much help.  

Unfortunately there's nothing at this point in the Affordable Healthcare Act that requires insurance companies to offer reasonably priced insurance.  

Hi Jenna, Yes I have done all that is available to me. The ACA really won't help for another 19 months or so and even then it will be questionable as to what changes will be made. The other side of that is, Medicare does not pay for all the doctor visit and as I see the doctor, I fall into the rear for payments to his office. Lantus has no help for insulin, so next year when I need another set of scripts for needles and insulin I have a different set of problems to deal with, like how am I going to talk him into writing those for me when I owe money. He won't like that much and could stop seeing me. So the ball keeps rolling down hill, sometimes I think it is just not worth the stress and headaches and relying on someone else to do for me.  But I will get over that feeling.  Social Security is no help either, I have enough to live on and none to save back right now, it just stays tough.

Randy,  I have always asked for the maximum amount for my insulin requirements and I do jump the doses 20% for emergencies. That is the only way it makes sense to do. I vote every time I get to and have been doing so since 1980. If you don't vote, you don't get to gripe about it.