39 Comments
In the past 12 months, have you been required to change medications or devices because of your health insurance?
You must be logged in to post a comment.
© 2023 T1D Exchange. All Rights Reserved.
Yes, but indirectly. I must order my Diabetes Medical Equipment and supplies through an insurance approved supply company. The company, Edgepark, does not carry all of the supplies that I “want.” So, for example, I cannot get my VariSoft cannula and tubing measuring 43 inches. I must buy it with 32 inches, which causes me some inconveniences. I cannot get the IV Preps that I “want”. I must use their brand. However, I am able to use the Tandem Insulin Pump and the Novolog that I need.
My mistake, that’s Durable Medical Equipment, not Diabetic Medical Equipment.
I hear you there with the VariSoft tubing length and EdgePark.
I had to switch to getting my CGM supplies through pharmacy rather than DME, which I am fine with since Edgepark sucks anyway. I also switched from Novolog to Humalog since it was preferred by my insurance.
Not required, but there are definitely financial advantages to using their preferred brands.
I did have to change pumps and CGMS, but not because of insurance. It was because my old pump had died for good and was both out of warranty and discontinued. Insurance had nothing to do with it.
No, they tried to make me take Humalog – which I’m allergic to.
I answered NO. I have original Medicare and Medcare Part “B”, along with Federal Employee Program, Blue Cross, Blue Shield. Little to nothing comes out of my pocket. I pay $6000.00 dollars a year, however, my Insulin Pump, Dexcom supplies, Doctor visits (No Copays) and Prescriptions are far more the $6000.
I had to change, but not due to insurance. It seems that I am allergic to almost every long-acting insulin. Through a process of elimination, I have finally found one that doesn’t cause hives or a severe bronchial cough, Humulin or Novolin N. So, I am back to the original long-acting insulin taken when I first became diabetic. It was determined that I am allergic to metacresol. After doing some research on the ingredient, I have no idea why they would put that in insulin!!!
Im confused… do you mean that the Humalin and Novolin N are OKAY for you??
Yes, it is safe for me to take either Humulin NPH or Novolin NPH. Humulin NPH was the original insulin, along with Humulin R, that I took when first diagnosed. I cannot take Levemir, Tresiba, or Toujeo, or some of the new quick acting insulins. For my bolus insulin, I use the inhalable Afrezza, which as a powder, is acceptable.
My insurance required my switching from Humalog to Novolog, and from FreeStyle Lite strips to One Touch Verio.
I had a rash with Novolog. My endo helped me. Medicare allowed me to return to Humalog at $100 per vial. I did not have to pay for Humalog in previous years. I have found the One Touch strips to be less accurate than FreeStyle. Many times there is a 10-30 point different difference between the One Touch and finger stick numbers.
Multiple freaking times!!! The doctor knows nothing about any new changes! The pharmacy knows absolutely zero about whatever the new formulation they demand might be. Have been forced 4-6 times this year alone to change meds and never told what, why or when.
Enraging and never excusable
my buddies at Express Scripts just changed me from FIASP to Lyumjev. not terrible but not great, we’ll see
This happened more than a year ago, but I had to switch from Fiasp to Lispro because that’s all I can get from the only supplier I could find who would accept Medicare Part B for insulin.
Marty, who is supplying your Part B insulin?I can’t find a local supplier. Thanks.
Advanced Diabetes Supply in Carlsbad, CA sends me all of my Dexcom and Tandem supplies as well as Lispro insulin and they accept Medicare Part B coverage: https://www.northcoastmed.com
Marty, your DME (i.e. pump, CGM) and medication (i.e. insulin) normally come from two different companies. Advanced Diabetes Supply in Carlsbad didn’t pass my reputable company checks and doesn’t appear to be HIPAA compliant. Try Minipharmacy in Los Angeles or if you out of all other options for DME supplies, Byram Healthcare.
recognize that ADS is unusual, perhaps even unique, in providing both insulin and supplies to Medicare patients. I started using ADS when my endo recommended them after we had problems with other suppliers. I’ve been able to get everything I need for a couple of years now. They seem to work well with my doctor and with Medicare. I’m not sure I understand your concerns. What kinds of problems would you expect me to be having with them?
At first glance, yes, but with a Medically Necessary letter/form from my Dr, we got it covered again, but at a higher cost to me. Still worth it.
I will be in the next couple of months. I am going back on glargine (Lantus) and I have a supply on hand. The pharmacy told me that when I need a refill, due to the insurance, they will give me a different, but chemically the same, medication.
I hate insurance company formularies. Why should insurance companies be able to dictate medical best practices? I find it annoying that these can be revised mid-year too, after you have made your plan selection.
I had to change from Novolog to Humalog. Has not been a problem but I dont see why they get to decide over the doctor and all going well with what I was on and prefer.
I answered yes but the only thing the insurance company changed was my glucose meter brand.
Answered “no” not in the last 12 months but have had insurance force a change multiple times before that. Most of the switches were Novalog-Humalog.
No
I changed devices so I didn’t have to deal with Edgepark Medical. I could get a CGM locally and not deal with them.
Right now my pump supplies and Humalog covered. It’s the amount that has to be adjusted. For asthma it’s a whole new problem.
I am on Humalog insulin, and have been since 1996. I went on the Tandem pump in 2014 and migrated to the TSlim X2 in 2019. My insurance is Medicare with a supplement that pays 100% of what Medicare does not cover. On my last insulin refill (8 vials every 90 days) the pharmacist at Walgreen’s came out and informed me that Medicare wanted me to substitute another insulin “non branded insulin” for my Humalog. I politely asked him if he was going to dispense an insulin for my TSlim which was not approved for use by the manufacturer, not used in the testing for the pump the results being used by the FDA for the pump’s approval, and not prescribed by my doctor. He just said “Oh”, went back behind his station, made a call and I got my Humalog. I do not know if this was Walgreen’s or Medicare’s nonsense, but they tried this once before and I gave them the same speech and got my Humalog. Now I carry a copy of the Tandem paragraph from the Slim instruction manual when I go to the pharmacy. I am sure that they do not want the liability for dispensing insulin which is not tested in my pump and which the manufacturer says not to use! End of story for that nonsense! If insulin is costing Medicare too much, then yell at congress about it. Insulin costs about $6 a vial to make. The price they charge is OUTRAGEOUS!!!! When we were in France I went into a pharmacy in Paris and after showing her the box from my US Humalog she told me that I could buy it from her for $18 Euros (about $18 at that time) without a prescription! I guess the mark-up in the US is to cover the profits of Lilly and the costs of their lobbyists!
I said other: I upgraded to the Medtronic 770G and with it comes a glucometer that wirelessly transmits the BG number to my pump. I called Cigna and questioned whether I could go to this new accucheck glucometer at the same cost as my one touch that they made me switch to after being on a prior accucheck. They said yes in the chat. However, when I picked it up, instead of free test strips they tried to charge me. I am going back to one touch but I am appealing and getting my Endo involved. We will see. I fight with them all the time and usually win.
Yes. Greenshield Canada REFUSES to cover CGMs -Libre or Dexcom- for me, even with a letter from my endo.?!
Yes and no, because insurance will not fill a 90 day rx( they hold until 95 before filling). I have to extend my infusion sets past the recommendation of my doctor to keep from running out
I recognize that ADS is unusual, perhaps even unique, in providing both insulin and supplies to Medicare patients. I started using ADS when my endo recommended them after we had problems with other suppliers. I’ve been able to get everything I need for a couple of years now. They seem to work well with my doctor and with Medicare. I’m not sure I understand your concerns. What kinds of problems would you expect me to be having with them?
ADS? What’s that?
Sorry, I meant to add a reply to my comment below. ADS is the acronym for my insulin and supplies provider that required me to switch to Lispro insulin.
Lyumjev and Afrezza are not covered so I use coupons or pay out of pocket. Love Medicare.
Yes, as of the beginning of 2022, Express Scripts, nationwide, will no longer cover Lantus and have switched those who have a Lantus script with them to Semglee, which is an interchangeable insulin for Lantus. Any pharmacist can fill a Lantus script with Semglee without notice to the patient or doctor who prescribed Lantus for their patient. In their press release last years, they claimed it was being done to save their customers money, but it doesn’t save me much at all. I get two boxes in Lantus/Semglee as a 90 day supply, and all I save once they switched me was 6 bucks for that 90 day supply, so 2 bucks a month. That isn’t enough to validate a claim of saving anyone money. I believe, if anyone is saving money by this switch, that the only ones who are actually saving money is Express Scripts, and they are not passing those savings along to those who use the insulin, unlike what they claimed in their press release before making their customers make this switch.
No, but when I went on Medicare. Dexcom was a very good change.
No, I did not change insulin, but I did have to get Prior Authorization for an insulin that was previously covered by my old insurance company.