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Insurance changes affect insulin coverage!

Discussion in 'Insurance Issues' started by RBJervey, Mar 10, 2010.

  1. RBJervey

    RBJervey Approved members

    Joined:
    Jan 28, 2009
    Messages:
    37
    Hi everyone, I just got a letter from my insurance company (Keystone East, which is a subsidiary of BCBS in eastern PA) informing me that as of April 1st they will no longer cover Humalog Insulin. The only insulin's they are keeping on their formulary are those produced by NovoNordisk. They sent me this long letter "proving" that Novolog works just as well. The problem is I was on Novolog about 10 years ago and every shot I took ended up swelling up around the injection site. My doctor at the time decided it must be an allergic reaction and took me off of the Novolog and put me on Humalog. I'm a bit scared that if I go back to Novalog now that I'm on my Omnipod I'm going to have serious problems after three days of allergic reaction at each site. Does anyone have any experience with fighting this type of insurance decision? Or any suggestion as to other options? According to the insurance I can still receive Humalog (at twice the price) until June but then would need prior authorization and would have to pay even more. I can't afford that. Does anyone know any other options?
     
  2. Toni

    Toni Banned

    Joined:
    Sep 14, 2009
    Messages:
    2,882
    Have your endo override the insurance company. You will be able to get the insulin you need with Preauthorization. Get the Preauthorization Code, write it down. We have endo include it on every script and have renewable as many times as you can per year on the same one script. Otherwise you may be haggling every month.
     
  3. sarahspins

    sarahspins Approved members

    Joined:
    May 5, 2009
    Messages:
    2,205
    I don't know what to tell you.. Apidra costs me twice as much as my other options, but I also have allergy issues to both Novolog and Humalog, so they're not really options fo rme any more... so I kind of have to pay for it. My insurance keeps sending me letters letting me know how much money I could save if I switched.. it's annoying. What's even more annoying is that my RX co-pays went up in October with no notice from DH's employer. Apparently they changed plans mid year and didn't tell us before it happened.

    My endo and CDE give me as many samples as they can every time I have an appointment though, which helps a lot.

    You might also look into how your insulin is being paid for by your insurance. Under a lot of plans it can be covered under DME since it's required for use with your pump, rather than having it go through pharmacy. You might need to go through a 3rd party company to have it billed that way, but unless you have a high deductible it could be an option.
     

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