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number of vials of insulin covered by insurance?

Discussion in 'General Discussion' started by emilyandkevsmom, Sep 14, 2011.

  1. emilyandkevsmom

    emilyandkevsmom Approved members

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    I have not been on this board in forever but my daughter is using Novolog insulin via an Animas pump. I am prescribed 3 vials a month and it usually have to have it filled about every month and a half. At her last endo visit they rewrote her prescription to 2 vials a month. she averages about 60 units a day and is going through puberty and I am constantly adjusting her basal. They refuse to change her insulin prescription back to 3 vials even though she is using more insulin and when she was prescribed 2 vials before we would run out. Sorry this is long, I guess I want to know how many vials other people are using in similar situations.
     
  2. nanhsot

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    Is it an insurance thing or an MD thing? Did anyone explain WHY they are limiting her to two?

    I get as many as my MD writes, with a 17 year old growing/eating boy, we get 4 per month right now. Don't always use all 4 but often we do.

    I'd demand an explanation and tell them that 2 is simply not enough for her growing needs.
     
    Last edited: Sep 15, 2011
  3. emilyandkevsmom

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    They are saying because they are audited by the insurance company and they cannot justify 3 vials with the amount she is taking. her insurance has been covering the 3 vials and I tried to explain to them that with priming and her growing that 2 will not work. I can understand limited test strips but wow, I do not understand why they are being so difficult.
     
  4. Flutterby

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    There should always be extra built in, for dropped vials, bad insulin, illness which take more.. Instead of filling the perscription every month and a half, can you fill it every 30 days?
     
  5. emilyandkevsmom

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    Yes, i can fill it every 30 days, but even doing that with the 2 vials i had no cushion, i would run out at times and the pharmacy would have to call the endo, there were times I wld have to fill the 3 vials sooner. when i was talking to the doctor's office they acted as if i was wasting it and could not understand why i needed three vials.
     
  6. Jordansmom

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    We get 4 vials covered by insurance. We have to change sites every 2 days which increases wasted insulin. We need 3 exactly for 30 days with zero waste. But I asked for the 4th vial at the Endo last time to account for bad sites, priming, bubbles, etc. It was just getting too tight. She seemed a bit reluctant until I did the math for her.

    My back up plan was to ask for a sample vial at each visit. One vial every 3-4 months would have also given us a little buffer. If your Endo isn't willing to write the script, maybe they'd give you a sample vial.
     
  7. nanhsot

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    Can your endo's office give you some samples so you can build up a bit of a padding to your supply?

    I talk or email to the CDE when I have rx changes and she has always supported what I need. That would bother me greatly. A vial every 2 weeks is not that much insulin in a growing child.
     
  8. emilyandkevsmom

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    Thank you so much for the responses. I have asked for samples and they will not do that either. I think that I will call the insurance company directly, it may not do any good but i am not getting anywheres with the endo. I just thought maybe I was doing something horribly wrong and as jordansmom said frequent site changes uses a lot along with priming.
     
  9. Flutterby

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    I would fill as you need it, if the pharmacy needs to call the endo often, maybe they'll realize the need to increase it.. honestly, there is no reason why the endo can't give you three a month. They may get audited, but they're looking for someone that is getting a lot of extras.. if the insurance company had a problem with it they wouldn't fill it.

    I'd flat out tell the endo that you need three vials a month or you'll need to find another endo that is more concerned for your daughter's well being.

    We get three amonth, have for as long as I can remember, and she's barely at 30u a day. We do have extra, I don't plan on never having extra, the insurance company doesn't piss and moan about it and the endo's office was happy to give us the script for it.

    This reminds me of my dad.. not diabetes related, but he really needs a handicap tag, he can barely move, has bad hips, bad knees, takes him FOREVER to get in and out of the car because he's in constant pain, and walking, its painful to watch him walk.. his dr will NOT fill out the paperwork for him to get a handicap tag because they're crackin down on those that get them but don't really need them.. he doesn't want to get into trouble.. But my dad really needs one, and because his dr is being a total jerk ad afraid of getting into trouble he can't get what he needs.
     
  10. emilyandkevsmom

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    That is what i will do. Changing endos is not an option right now and honestly other than this they are great! I just feel that i should not have to fight for insulin! It's not like i can just cut back. That is awful about your dad.
     
  11. fredntan2

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    I'm having same problem. I used to get 12 vitals for three month supply.then bboom they fil l my three month supply and give me like six, had to go back and forth, think I ebbed up with 8 maybe 9 for three month. We have bottle and half, I think we may make it.no buffer though.
     
  12. lisac

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    Wow! This is so interesting to find out!! Hadlee gets 2 vials a month and we throw 1 partially used bottle away at the 30 day mark, cuz we can't use 1 bottle in a month. She was on MDI for quite a while and to get pen needles, we had to get get insulin refills for her Novolog Jr. pen. (If you by insulin, you pay $30 and needles are free... pen needles by themselves were $100 and something and she got 2 boxes a month.) So we have only recently run out of the stock of insulin we already had! I can't imagine having to fight for insulin!!! It's just so wrong!!!!
     
  13. Darryl

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    Sooner or later every kid approaching teenage years needs 3 vials a month... it's not unusual at all. I can't see any reason your endo would not agree to it. You can always skip filling a month if you start accumulating too many. Also when you consider the state of the world today, you may want to keep more than a few extra on hand. We keep a 1-year supply.
     
  14. wdhinn89

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    Our perscription is for 12 vials but the pharmacy (Walmart) said we could only get 9 vials. We refill as needed. Don't know if there is a specific time frame for when refill is refillable because we never were told we could not refill.
     
  15. obtainedmist

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    Do you store them out of the box in the refridge, or do you have an extra fridge? 36 boxes would take up quite a bit of space! I'd like to have such a back up but I cringe to think about a situation where we might need it.
     
  16. Flutterby

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    I bought an extra drawer for the fridge, it sits right under the drawer we keep the lunchmeats and cheese in.. nothing else would fit in that spot, things would tipe over, it wasn't very tall, so now that spot is taken up by the drawer for her insulin/sensors.. works well.. plenty of room in it and we lost no space in the fridge.
     
  17. jcanolson

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    I'm assuming you are at ETCH since you're in Jonesborough. Howdy neighbor!
    Anyway....the insurance is apparently REALLY cracking down on this. Just learned this recently in talking with the nurse when I called in Nat's refill request. Apparently they got in some trouble for writing scripts for more than was actually needed.
     
  18. emilyandkevsmom

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    Update

    :) We are back to three bottles! I spoke with the most pleasant nurse today about another matter and brought this ordeal up. She apologized for the other nurse and called in a new prescription.
     
  19. CAGrandma

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    That's good news! I'd suggest going on an automatic renewal plan if it is available to you - so the pharmacy automatically will renew the insulin as soon as the insurance will allow (usually every month). Hopefully you will be able to build a backup supply that way. We always try to have one, keep the unopened vials in their boxes in the fridge in a little plastic basket, and try to use the oldest ones first when we start a new vial.
     
  20. Amy C.

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    I would continue to challenge them on why they are not giving you enough insulin. Maybe provide stats on how often you change on the cartridge and how much insulin that seems to use (priming pushes out a fair amount).

    My son gets 3 bottles a month, with no questions asked.
     

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