Based on your insurance benefits, are insulin pumps and CGMs covered under your pharmacy benefit, durable medical equipment (DME) benefit, a combination of those two, or some other benefit(s)?
The actual process of requesting the refill is easy enough. I do it online and 1-3 days later I get an email and text letting me know it’s ready to pick up. But there is always a long line and long wait at Walgreens when I go to pick it up and that’s the annoying part.
Most of the time it’s easy. However, every few years some doctor will screw it up (arbitrarily reduce the amount, neglect to prescribe it, or cancel it) based on their mistaken belief that Type 1s are little kids who don’t produce any insulin and Type 2s are fat,old, lazy adults, so I couldn’t possibly need insulin. Many refuse to believe that LADA exists or believe that they can get along without insulin.
I have had so many problems with my pharmacy, I have called their corporate affairs group and written to their board of directors. From prescriptions misfiled, to medications missing, to misshipping and over shipping, my pharmacy very very rarely gets it right. But thanks to my insurance, they are the only one I can use without a sizable cost increase. I used to use the pharmacy by the college simply because they did a better job, but thanks to covid I am back to the neighborhood pharmacy which is a freaking train wreck.
I selected moderately easy. I stepped over to Medicare in August and the last order was my first on Medicare. I had to have a C-peptide test again, and my Endo had to document medical necessity. After be T1d for 30 years, I thought that was incredibly obvious to the most casual observer. Nobody wants to put up will all this mess if they didn’t have to. Would they?
My Endo had a lot of work to do, but I just called his office up an asked them to send a prescription on to my mail order provider. I was charged $87.50 (for 8 vials) because I had not yet met my deductible. And it took over 3 weeks to get my order.
I chose moderately difficult, because I can’t afford my insulin most of the time; I have to confirm I am who I am, they can’t find my prescription so a new one is needed, then a new exception is needed because of my allergy to preferred brand, etc. They do pack it well & it arrives fast once everything is in order per insurance. It would be SO much nicer & easier if Medicare just cover all insulin for $35/month.
Every third month Medicare rules cause a delay and I miss getting insulin that month. Thankfully I have a small stockpile since I only usually use one and a half vials per month.
I use CVS for my insulin and the pharmacist there told me the billing they do is quite difficult and there are specific code numbers that have to be entered so that Medicare Part B and my Medicare supplement will cover 100%. My only problem is when they don’t enter the information correctly and then want me to pay a huge amount since it’s a 3 month supply. I’ve learned to go there to pick up my insulin with a large dose of patience in my pocket!
Refilling through the PBM is easy as long as you wait the number of days until refill is permitted. RENEWAL is a nightmare….. faxes to the doctor either are not correctly sent or are lost. Every year, I have to play middle man to get the prescription renewed. It is not the doctor’s fault as far as I can tell. PBM suppliers are just too large and many diabetic supplies are not ‘pills’ with consistent daily dosages and strengths. Average units per day varies and PBM computer systems will not go up one vial if the number of vials for a 90 day supply calculates to 6.42. Frustration.
I don’t work with an endo. I have a primary care doc who is willing to work with me with T1D and follows my direction in writing scripts to fulfill my insulin needs.
I order on line every 90 days. It is mailed to me. The last order was delayed by UPS and came spoiled. But, it was refilled quickly and shipped overnight. I pay a $55 copay with each order
My insurance company changes their formulary once a year so I go through requesting different prescriptions. My doctors office is very busy so this is sometimes a 2 week process because of mistakes and do-overs. Recently, my pharmacy stopped carrying BD Nano Pens, but the one they switched to wasn’t covered by my insurance so had to switch pharmacies. Last month, my Rite Aid wasn’t able to get Tresiba for 2 weeks. Fortunately, I had kept some Lantus from two years ago that had not been opened or expired. If I hadn’t had that my doctor would have provided Tresiba samples. Refilling prescriptions used to be simple, smooth and dependable. Now it’s arduous.
How easy or difficult do you find the overall process of re-filling your insulin prescription? Cancel reply
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Personally put very easy. I have my monthly insulin vial on auto refill at my local CVS pharmacy. They text me when ready for pick up and submit refill request to my Endo. However, I have decent HMO insurance visa employer. My mom is on Medicare and has to jump through more hoops.