Insurance not covering novolog for pump
Hi @otteson welcome to Type One Nation. Every insurance plan is different. Some will say they don’t cover a brand and so you have to get a letter from your doctor and fight with insurance. Some cover a similar insulin under “Formulary”. Sometimes the similar insulins work just as well. They are allowed to charge you more for non formulary. Good luck.
Admelog and Novalog can also be used in pumps - as far as I know all of them. But if they are not compatible with yours or if you can’t take them for any reason, ask your doctor to request an exception or do an authorization for the one you need. Your doctor will know what to do.
I’ve used Novolog, Humalog and now Admelog - I think it depends on which one insurance negotiated the best price with. I personally have found I did not need to make any changes to dosing, but I am not a physician so check with yours or your pharmacist if you have concerns.
Unitedhealthcare is refusing to refill my husband’s long-time Novolog prescription. They are listing Admelog and Humalog as non-formulary [not included in the insurance plan’s preferred list, hence not fully covered]. The other insulins that are covered are not for use in a Dexcom pump. My husband is running low on insulin and he has a heart valve replacement next week. This is all a nightmare.
So they are not including any of the three in their formulary? I think that list covers most of the fast insulins and to the best of my knowledge the others are not approved for pumps.
I have had my insurance remove one of my pump insulins from their formulary but my endo wrote a request for exception for that very reason and it was covered. Your doctor is your best resource for this.
I took a quick look at your formulary and while Novolog is not even listed(!) you can still get Humalog or Admelog - they are listed as non-Formulary but “may be filled at a Tier-4 cost share if certain criteria are met” (https://www.uhc.com/content/dam/uhcdotcom/en/Pharmacy/PDFs/pharmacy-pdl-essential-4t-jan-2024.pdf , pg. 6).
So you can get it, but at a price. Check Goodrx for prices in your area - in mine, a bottle of Admelog runs anywhere from about $8.50 to $60.00(!) and there may be coupons you can apply.
@otterson Are you on Medicare?
If Dorie did find the formulary for your plan I see the Novolog vials are not covered but the pens are. If the prescription is for vials ask to speak with a pharmacist then ask the pharmacist to substitute the pens.
I might see about switching to pens rather than a vial for filling my pods (a brilliant idea!). I would never have thought about needle length but another forum member who uses pens for filling recommends the 4mm ones (italics are mine):
Need vials for insulin pump.
Thanks! The endo is trying to get an exception as he considers the formulary insulins that UHC offers as working too fast and/or not approved for pumps. Not familiar with Goodrx. Will check it out.
You can use insulin pens to fill your husband’s pump. Use the syringe that comes with the pump to pull the insulin out the pen just like you would with a vial. Of course if you feel more comfortable using a vial do that
Tandem pumps and cartridges are ONLY indicated for use with Novolog and Humalog U-100 insulins. The safety and efficacy of other insulins including Fiasp or Admelog have not been established for use with Tandem pumps as they have different times of onset. Still fighting with UHC trying to get the insulin needed.
Last year I got a notification that Novolog or Humalog (I forget which) was dropping from my carrier’s formulary and patients must switch to Admelog. I did.
Ironically I got written notice in today’s mail that Admelog will no longer be on their formulary effective March 4th and patients must switch to Lispro (Humalog). Thankfully I have no problems with any of them - just need to have my doctor wrote a new Rx - after I get my next bottle in a couple of weeks.
I wonder if doctors can’t write one scrip specifying either Admelog or Humalog or Novolog as preferred but the plan? Oh well…