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UnitedHealthcare hits some insulin users in the wallet

Discussion in 'General Discussion' started by Ellen, Dec 6, 2010.

  1. Ellen

    Ellen Senior Member

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  2. joan

    joan Approved members

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    This is the kind of stuff that gets me upset. The insurance companies are ruining our medical system.
     
  3. MHoskins2179

    MHoskins2179 Approved members

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    This is incredible. I'm a Humalog user who has UHC insurance, but the idea of this "bidding war" and the simple fact that UHC is putting itself in place of a doctor-patient choice.. I mean, seriously. It says it's doing what's best for patients by allowing them to switch to Humalog???? What planet do these fools live on? This article just floors me.
     
  4. OSUMom

    OSUMom Approved members

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    Before Novolog I've seen it happening with other medications. Yesterday we received a letter from our insurance regarding a medicine my son was on and how the company has updated its list of preferred drugs.

    "Your plan uses a "formulary," or list of commonly prescribed brand-name and generic medications. These medications are selected because they can safely and effectively treat most medical conditions while helping to contain your plan's cost."

    So what if you're not one of the "most"? Your prescription cost will rise and rise. Is the cost of medicine that has been on the market rising?

    Something is so askew with all this, and it's very disheartening. What can we do as individuals?
     
  5. selketine

    selketine Approved members

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    I read the article and this seems similar to what Kaiser Permanente (the HMO) does - which is my healthcare plan. Kaiser does the "bidding" thing to get a better price for strips, pumps, insulin - you name it. For most items they offer you one choice - One Touch strips, Novolog, Animas pumps, etc.

    The big "BUT" in this is that the doctor can prescribe something different if it is medically necessary. So, for example, William had humalog as a toddler because it was the only one that came with a dilutent. Kaiser paid this at their usual co-pay - no problem (the reduced rate is what I got in other words). They will pay for the Freestyle strips - enough to calibrate the Navigator, etc. (They also approved whatever cgms I asked for - took them awhile - they never denied it - just were slow).

    So - for UHC - can the doctor argue that a patient needs a tier 3 drug because it is medically necessary and, if approved, UHC will charge the patient the tier 1 price? The article didn't mention if that was possible. I'm sure there are UHC users here - so perhaps they know?

    I have so far appreciated the way Kaiser works - I think their negotiating the lower prices have really kept down the monthly cost of their insurance as well as my co-pays. That has come at the price of not having the ability to go out there and try every type of test strip to see which one I like - but I'm willing to make that trade off. I've had Kaiser for a long time now - and I don't get the sense they're out to line their pockets with gold or anything. His pedi and her whole staff will see William immediately (as soon as I can drive him there). I have his pedi endo's cell phone number - I can literally call her 24/7 if I had a serious problem. I bet few can say that.

    I agree that there are lots of problems with the whole health insurance industry and more choice is better.
     
  6. jules12

    jules12 Approved members

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    I have BCBS and novolog has always been a tier 3 drug. I never thought to try to fight them on it. I also have to take another drug that is a tier 3 and I cannot take the generic. I will have to look into it.
     
  7. Chippy28

    Chippy28 Approved members

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    For those that are dealing with this issue, it is my understanding that you can ask for a "tier exception". This should bring your copay down. Your doctor's office will need to call your insurance company and provide them with clinical information to prove why the higher tiered drug is medically necessary and why you can't have the lower tiered drug.

    I actually work in a psych office and called UHC today to get such a form for one of our patients because their medication is moving from tier 2 to tier 3 next year and it is medically necessary for them to continue on this drug.

    Hope this helps!:)
     
  8. redmcgee

    redmcgee Approved members

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    YIP. That is one problem we are facing this next year. UNited Healthcare has always been good to us and now this year bam. You have to change from novolog to humalog and the onetouch strips you use well they are going to be higher for us also. Just lovely. Not to mention several other changes. We are not happy and are really worried. The doctor says that humalog is the same just made from a differnet company and works good on pump and then I read where others have had problems with it in the pump, praying for the best. I have gotten smart though and upped ours to 3 bottles a month b/c we are going thru more insulin now, exp. the last month b/c of alot of ketones, so hoping that will pull us through March of next year and going to do the same with the strips.
     
  9. redmcgee

    redmcgee Approved members

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    When I called our nurse she mentioned something about this for the strips b/c it works with pump she is on.
     
  10. twolittleladybugs

    twolittleladybugs Approved members

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    How would a tier exception work for things like Glucagon and EpiPens? These are both tier 3 for our insurance and there aren't really any alternatives (there's Twinject for EpiPens, but the school won't train on them). One other thing I just found out is that if I order EpiPens at our local pharmacy, it's a $50 copay for a 2-pack, if I go through Aetna mail order, it's $100! I called thinking it was surely a mistake, talked to 3 different people who couldn't believe it. Finally, a pharmacist said they upped the price (only on EpiPens) because people were ordering "too many." Evidently, the fact that they last a year if you don't use them was making them lose money. How's that for shady?

    We just switched from UHC to Aetna and I'm not sure what I think of them yet. We had a huge mix-up already about preexisting conditions with Emily and they denied all her claims (fixed now, they screwed up). However, ALL diabetes related prescriptions are tier 2. There isn't a single generic/tier 1 choice. So, I guess we're stuck for the moment. We did have issues with UHC denying an asthma med for my daughter even though their approved brand didn't work for her and had nasty blood sugar side effects. The dr. appealed and we never could get it approved. I hate that insurance companies can dictate care.

    Kelly

    Emily 8--dx @ 2 1/2, multiple food allergies
    Kaitlyn 4
     
  11. OSUMom

    OSUMom Approved members

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    This is so wrong. :mad:
     
  12. MHoskins2179

    MHoskins2179 Approved members

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    Where do you hear that One Touch Strips are moving up Tiers? My formulary lists them for this past year as Tier 1, and the same for 2011. Is this specific to your state or particular type of plan? It seems odd that UHC would do that since One Touch is one of the most common and well-accepted brands of strips out there....

    Phoned UHC today upon reading this, and they confirmed that the Tier 1 sn't changing. Though the supply limit is decreasing significantly, from 600 per month to 204 per month, with a doc still able to get that overrided for a higher amount and a corresponding co-payment hike will apply.
     
  13. stevecu

    stevecu Approved members

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    For us, the Novolog v. Humalog issue has been a non-issue, we've had to switch twice already (once when we switched to UHC and again the last time they changed their formulary, and oh yeah, again now. So I guess it's three times).

    We have enjoyed similar success with both. There are other items we find bothersome though, like the fact that we have to give up our Freestyle test strips (going from $15 a month to $90 for us) or the fact that Singulair is tier 3 even though there is no tier 1 or tier 2 equivalent.

    But if I could change one thing about the way they conduct this part of their business, it would be to make it more transparent and easier to navigate.

    Every year, we go through open enrollment and have the opportunity to choose from a small list of plans. And every year it is next to impossible to get our hands on a current and complete formulary list from each of the carriers in time to make the deadline.

    Add to this the fact (I think) that they can, and sometimes do, change the formulary list mid-year (when we're all locked in). Luckily they have so far not done anything completely goofy (like move all the insulin off of tier 1, like one of the other carriers), but I don't think there is anything stopping them.
     

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