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United health Care insurance...

Discussion in 'Parents of Children with Type 1' started by Jilleighn, Jan 18, 2011.

  1. Jilleighn

    Jilleighn Approved members

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    I think I need a new insurance company... United Health Care has moved Novolog to tier 3 now and according to our plan it is 50.00 for the first 3 months and 223.19 every month after. Unless we go mail order with the lady said was 150.00 every 2 months!

    Anyone run across this? UHC/Medco said for us to switch to humalog which we do not really want to do.. We are thinking of giving apidra a try now.
     
  2. virgo39

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    My DH has United Healthcare with Medco as the pharmacy benefit provider. We use the mail order service as that provides use with a higher prescription benefit compared to using our local pharmacy. Our plan does not use "tiers", drugs are either "preferred", in which case a 90-day supply is provided at a lower price, or "non-preferred", in which case a 90-day supply is provided at a higher price.

    So far, Novolog remains "preferred."

    ETA: According to the drug information for Humalog (http://pi.lilly.com/us/humalog-pen-pi.pdf), it should be replaced in insulin pumps every 48 hours -- so if you are pumping, perhaps you can get some kind of override?
     
    Last edited: Jan 18, 2011
  3. amberdawn33

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    YES! I am really upset

    I cannot believe it! My DD - just the insulin will be $200 a month - she uses over 3 bottles a month. That doesn't count the strips or the Animas supplies that you have to pay the full price for until the $1000 decuctible is met! My cost will be around $600 a month not including the cost of insurance -another $300 a month with my job. I am just at my wits end - cant sleep at night thinking about it!

    Any suggestions? by the way we dont qualify for medicaid or chips - I just took a promotion.

    Amber
     
  4. HBMom

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    We have UHC too. I believe you have to switch to Humalog to go back to the lower price (1st tier).
     
  5. ecs1516

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    They told us $150 for a 90 day supply. They didn't say it would be cheaper the first three months for us. Hmmm. They did tell us that we could fill 3 Novolog prescriptions at the pharmacy.

    What really stinks is that we are forced to do mail order for the orders and I am buying insulin for two kids.
     
  6. obtainedmist

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    Can you possibly ask your endo office to help you out and give you a script for a larger dose/day than you use so that it brings the cost/vial down?
     
  7. sam1nat2

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    this!! We got 3 vials for one copay.
     
  8. Jilleighn

    Jilleighn Approved members

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    we tried getting 3 bottles a month to last us more but UHC will not cover the 3 because as they said in their denial a 3 year old does not use that amount of insulin.
     
  9. Joretta

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    I just started with United health care they said if there is a medical need the Doctor and appeal for the med and then they take it down to the lower tier. We are trying right now to get the pens as she is allergic to vials not sure if this really will work.
     
  10. Flutterby

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    If its going to cost you that much, how much are they going to cover.. I have a love hate relationship with insurance companies.
     
  11. Beach bum

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    Sorry to go off topic here, but your last sentance caught my eye. How is it that your daughter is not allergic to the pens, but is to the vials?
     
  12. Beach bum

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    I know even though people have the same carrier plans are different. UHC sent us this about the change in scrip benefits:

    Note: Tier 1 was previously referred to as Generic, Tier 2 was previously referred to as Preferred Brands and Tier 3 was previously referred to as Non-Preferred drugs or Brand Name Drugs that are not included on the Prescription Drug List.

    I have yet to hear anything about 3 bottles a pharmacy then the price goes up. I think I need to do some more digging with them.
     
  13. Jilleighn

    Jilleighn Approved members

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    If you can Log onto the Uhc webpage and go to price a medication. That is how I found it and when I called to dig for more information I was told pretty much the same thing, just with a rude customer service person. As for us going through and fighting to have it dropped down to the old Tier is possible, but according to Medco and UHC right now they are backed up because of it being the new year and it can take up to 4months before it is approved.

    I am wondering too, how you kiddo is allergic to a vial and not a pen?!
     
  14. Lakeman

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    I don't mean to make light of your situation. Clearly it is no fun to have to pay for prescriptions especially when the amount is that high.

    But to look for the silver lining and a different way of thinking about this...

    Consider how much you pay for your premiums? Could it be that someone else pays more for their premiums and then does not pay for prescriptions? If that is the case then you and this other person would be in an equivalent situation. (except when the insurance company pays for prescriptions from premiums then you do not know if they are charging you too much or not)

    Perhaps your employer pays you more in salary but provides an insurance policy that does not pay for prescriptions? (that would be the scenario I would want)

    Really the question comes down to whether or not your total compensation (salary plus insurance premiums plus prescription drug benefits plus retirement package) provides you with more or less than someone else with your same skill set.

    Your insurance benefits, or lack of, are a part of your pay. You are either underpaid or adequately paid or overpaid. The fact that your insurance company does not pay for all of your prescription drugs is not enough information to know. You might even be better off than someone else who does have prescriptions paid for.

    (If we want a fairer and cheaper health care system in this country then we need to reverse the act of congress that gives tax breaks to employers and individuals who get their insurance from their employer rather than paying for it in a more competitive market. We need to have as many people as possible working and buying insurance from their own salaries (with the tax break) and making insurance companies and doctors and hospitals competing for their business)
     
  15. chbarnes

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    Would Apidra be equal to, or less than Novolog? It is usually pretty pricey.
     
  16. Jilleighn

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    Lakeman- for a family of 4 we currently pay $1156 a MONTH for health insurance premiums. Granted I do have a child that has type 1 diabetes and I also have a husband that battled stage 3 testicular cancer. So yes, I pay a nice pretty penny for the cost of health insurance to have to pay that much for a medication. It has also nothing to do with premiums, it is an insurance telling me that I need to switch my daughters insulin because her Novolog is now a different tier. They also did this to the test strips across the board also, from what they are telling me. I did get a letter in the mail regarding the limiting how many test strips one gets a month, but never regarding the price of insulin.



    chbarnes: On our plan Apidra is now actually cheaper then Novolog, so we are looking into switching to that! :) Do you use Apidra? want to share any helpful hints about it?
     
  17. Caydens_Mommy

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    Jill, sorry you are battling the insurance demons, it can be sooo frustrating.. Hope you guys can figure something out that works best for you Loren and you guys! Cayden uses Apidra, has for the last year I beleive.. It drops him faster then humalog did.. I don't really have any tips or tricks for using it but if you need me, you know where to find me!! :D
     
  18. Beach bum

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    Ugh. Just did deeper digging and yep, it's true.
    3 month supply ok via pharmacy, but after that we have to pay 100% out of pocket. They are basically forcing our hand to use mail order.

    This is my biggest complaint. UHC told us the insulin would be knocked to tier 3. Fine. I called and they told us the cost difference. Ok, we will stick with Novolog. What they did not tell me was that after 3 months we would have to pay 100% out of pocket if we chose to still use the pharmacy.

    What really ticked me off is the fact that they did not in any way tell us either verbally, email or mail about the change in policy.

    Oh, and what ticks me off even more is that they have uninformed customer service "messangers" telling me that we are strongly encouraged to switch to Humalog as it is exactly the same as Novolog. I asked her to supply me with information to back it up, particulary in regards to performance in pumps, and of course, she could not.

    I'm sorry, but an insurance company has no right to tell me what insulin my child should be using. They can tell me what they will cover, but they can't tell me what we are to use. That, in a nut shell, pissed me off royally!
     
  19. Jilleighn

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    I am sorry it pissed you off. i know the feeling :( I just wanted to see if anyone else has had to deal with this. UHC also told us to switch to Humalog because "it is the same as Novolog just made by a different company"
     
  20. ecs1516

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    Does anyone know what Apidra cost would be through UHC? What tier?
     

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