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Issues with insulin coverage

Discussion in 'Parents of Children with Type 1' started by CheriMomTo8, May 22, 2017.

  1. CheriMomTo8

    CheriMomTo8 Approved members

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    I haven't posted on this forum is so long. I guess we have just been cruising along and we have families with T1 in real life but here I am needing some input.

    My husband changed jobs two years ago and that changed our prescription coverage. We use apirdra for insulin. He was a teacher, and BCBS covered it with a special waiver from our doctor and it was either free, using apirdras coupons or not too much. Now with his new company, which is a better job with better insurance, our prescriptions changed to Express Scripts. It's been a nightmare. Now I HAVE to get apirdra and test strips through their formulary, they do not allow me to use coupons or any programs that apirdra has that would make it free and the insulin alone is costing us $1300 a year out of pocket. And every time I need a refill it's such a hassle because even though there is a waiver from our doctor, it never automatically refills because they don't want to cover apirdra. I wind up on the phone forever every single time. I just am hating this company. I'm forced to use them and have no other options of places to buy our insulin!

    So it's either pay that much or be forced to humalog. I have no experience with it. We used novalog very briefly until I learned about apirdra on here not long after diagnosis. It stacked up so horribly that she would experience terrible lows. It just was so long acting with her, she was 5 then, that her doctor was all for the apirdra. Until puberty her a1c has been so great, upper 5s or 6s and even now with crazy hormones she is in the 7s.

    Has anyone changed from apirdra to humalog? I really hate to even consider it and will probably keep paying this crazy amount out of pocket but thought I would get some other experiences on it. Thanks.
     
  2. wilf

    wilf Approved members

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    In Canada we can buy insulin over the counter. Is that an option for you? It would at least avoid the hassles.

    Switching to Homolog from Apidra would not be easy. It is slower to act and will last longer in her system. That means she needs to perilous by at least 20 minutes, and keep an eye on blood sugars several hours after each injection.
     
  3. CheriMomTo8

    CheriMomTo8 Approved members

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    No, over the counter is not am option. Those were my thoughts about switching. Right now in life, she would not be good about pre bolusing. She is doing all her D care now, which is so crazy to me, but doing a pretty good job. But it has been a transition from my doing it all at age 4 to now it's not my deal except I do lows at night. That's the way she wants it but her management is still developing so having to change the whole way she thinks about insulin would be terrible. I guess we just have to deal with this company and pay lots of money. So frustrating. I'm mostly venting.

    Thanks.
     
  4. susanlindstrom16

    susanlindstrom16 Approved members

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    We've only ever used humolog and I see how you wouldn't want to change things up as she is transitioning to self-care. Its such BS that you have to pay so much out of pocket when you already have insurance. Maybe they will switch their formulary to include it eventually, that has happened to us with the test strips we wanted.
     

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