Next Year my employer will be providing a private exchange to their employees instead of a company run insurance program. What that means for me is that I have to choose between Aetna, UnitedHealthCare or BCBS as my new insurance provider. They all seem to be the same from the info that I have gotten. My biggest concern is that Prescriptions will now be handled by one of these companies. From What I can see all have Apidra listed as NonFormulary which means as much as $100 for a 30 day supply...Ouch. Not 100% on which one would be better for DME (pump, CGM or Test strip supplies), if any of you have good or bad experiences please list here. I know each plan varies just wanted your experiences with these companies including customer service. Thanks, Dan
I have BCBS of IL PPO. Customer Service has been good. We have the option to go either way (RX or DME) for test strips and lancets. We don't have a CGM. Our mail order prescriptions got through a company called PrimeMail, which I am so thankful for right now, and our DME is through a local brick and mortar distributor called Doubek Medical (so no online ordering, but I could literally drive there in 30 minutes if I needed supplies TODAY.) BCBS had no problem, based upon a letter of medical necessity, of filling a supply order that requested full site changes every 1-2 days. My most recent order, so I could build up a back supply, was for 90 cartridges and 90 infusion sets. I doubt I will ever do that again, but it made me breathe easier because we had adhesion issues and ran through infusion sets like water when my daughter first started pumping.
We have Anthem BCBS. I'm not sure if all BCBS use them, but our DME is run through a third-party billing company called Care Centrix. We've recently ordered an OmniPod, test strips adn a CGM, within a month, and they've handled the billing side of it. They take a long time to actually send a bill out to the subscriber though. DS' pump was ordered 9/25 and we've yet to see a bill from them yet. We've always liked BCBS and except for one year of our 10 years being married, we've been covered by them in some form at each of my husband's three employers, and my employer when I had DS. Good luck!
We have UHC/Harvard Pilgrim-MA. They now have an in-house pharmacy called Optum-Rx. We are able to get everything through them including pump supplies. Novolog is considered 1st tier, though we haven't been forced to use Humalog?yet. Letters of change of formulary usually come out this time of year. Overall our experience with them has been very good. They are quick to get the scrips refilled and sent out. Coverage is very good (though that obviously is based on the plan we have).
I was told we would be using Optum-RX for test strips...they said $5/30d and $12/90d supplies. I was lead to believe that Pump and CGM would go via medical via EdgePark. I currently pay $60 for one box of pods and $62 for Dex Sensors. Do you get better rates with Optum?
Our current plan uses OptumRx for everything. We get 40 infusion sets for $50 and 40 carts for $70. This is a 90 day supply. 9 vials of insulin is $70. 1100 test strips $20. Glucagon 2 boxes $50. Ketone strips (Abbot) 5 boxes $70. Obviously it varies by plan, but this is what we've paid for the last year. Novolog is more expensive as it's a top tier med.
BCBS uses differing mail order companies, so you'll want to find out which one you might be dealing with.
