Insurance and TD1

Does anyone else have trouble with their insurance cutting down their prescriptions? I have a really high deductible and my endo gave me 10 vials of Humalog and a bunch of Bayer test strips. Until I meet my $1500 prescription deductible, I have to pay full price. At Walgreens it’s $180 per vial and the strips are almost $3 a piece. I normally go through 3-5 vials a month depending . So I started using the freebies 1-2 a month until all 10 were gone. Then I got a letter from United Healthcare saying they’re dropping my insulin from 5 vials to 3 a month and strips from 200 to 100 a month because I’m not using what the Dr’s script said! Plus why does Medtronic put your supplies under major medical instead of prescriptions? There has to be a cheaper way. PLEASE give me some suggestions.

Go back to your doc, who can write up a letter of medical necessity to authorize more than the “usual” amount of insulin and/or strips. Pump supplies are classified as “durable medical equipment” with pretty much all insurance providers I’ve had. This is the same category for stuff like ostomy supplies or CPAP equipment, basically products that are required to treat a chronic condition. But I think it’s weird that test strips are considered a prescription.

I agree with advice per angivan.

Hopefully your doc will write the med necessity authorization. Caveat: my son’s doc has done this only to be denied by megapharm Caremark. When I asked about the denial and the credentials of the Caremark person who denied my son’s MD Rx, turns out it was just a high school grad with no medical background employed at low wage, apparently, just to “hit the deny button.” My son’s doc was then too tired to fight the fight, so I did… and eventually he got the insulin he needed.

Once you receive the correct amt insulin Rx, you need to know that a buffer should be built in in case you break a vial or the insulin is spoiled by heat/cold. Then never lower your Rx amounts.

Agreed: pump = DME.

Always, my son’s strips were RX based. Recently not covered so I bought directly from the Bayer website and they were a bit less expensive that way.

I have fought mountains of battles for over 20 years to get my son his insulin and other requirements to ensure that he can stay as healthy as possible in context of T1DM. That’s my life, essentially.

Keep fighting. You deserve to have the insulin and other supplies that you need to live.

yours truly

Check out a new company called Livongo. I got an email from them and rather than prescriptions for strips you pay a monthly subscription and they mail you strips for their meter, plus a lot of features that seem great.

I have bcbs. I use mail order for our insulin. 1 vial was $70.00/month. Now I get 4 vials for $125.00. For your strips like Bayer they offer a discount card so for 300 strips(your dr will have to write for that) it cost us only $25.00/month. As for as any discounts on pump… No luck our durable medical equipment continues to go up every year. Really think Medtronic should help in some way.

Thank you everyone for your suggestions! That’s what I love about this site, others have the same problems and can help us all with solutions!!