Tuesday, August 10, 2010

SYMLIN Insurance Sticker Shock

I just spent 40 minutes on the phone and I'm not a happy woman.

The first call was from my local CVS pharmacy, who called to tell me that my two SYMLIN pens were ready to be picked up and could be all mine for $163.32 - more than what my insulin costs per month.

Yes, I'm well aware that my insurance SUCKS.

I told the Pharmacist to sit tight on my order, because I needed to do some research before I could commit.

My second call was to my insurance company, who confirmed the price - and told me that my plan didn't cover mail order medicine purchases. They also told me that 50 % of non-generic RXs are covered under my plan.

It still didn't make sense- The prices quotes I found on-line regarding SYMLIN was $225 - BEFORE INSURANCE KICKED IN.
SInce my insurance company pays 50% for non-generic RXs - it should cost me $112.50 out of pocket. Not great, but much more affordable.

My insurance company then forwarded my call to CVSCaremark - the company who handles the prescriptions for my insurance. CVSCaremarkwho confirmed that $163.32 was indeed the price I had to pay. The nice lady on the other end of the line told me that my insurance was covering 50% of the cost, and that CVSCaremark rate for SYMLIN is $325 - BEFORE INSURANCE. The nice lady on the other end of the line really felt bad wanted to know if there was something else I could take in place of the SYMLIN.

Like I said: MY INSURANCE SUCKS! But for the love of God, where the hell does my insurance company come up with these inflated prescription rates?!

The irony isn't lost on me. I fought Dr.J on SYMLIN for years, but last week I finally agreed, and was looking forward to experiencing positive results.

Now, I seriously have to consider the our of pocket cost of using SYMLIN.

And the cost of my good health if I don't.

What's best for my health is always the winner in the end. Let's face it, we don't have a choice when it comes to our health.

But I'm angry that my insurance company is forcing me to once again cut back in other areas of my life in order to stay healthy. I didn't choose diabetes, diabetes chose me.
And I've made diabetes work in my life, I really have.

I do the work, I educate others, and I don't spend a lot of time wishing my diabetes weren't so. Diabetes has made me stronger, it's given me a passion, a career, friends, and a platform - and I'm incredibly grateful for all of those things.

But diabetes has taken away people that I loved, and diabetes has forced me to always be in fighter mode.

Insurance company Practitioners of Bull Sh*t; consider yourself warned - I'll continue to bitch, but more importantly - I'll continue to fight you in order to stay healthy.


Cara said...

Um. That's AWFUL. I'm sorry. :(

AngMy said...

I'm so sorry to hear about your horrible experiences with CVS/Caremark. I have them for my prescription coverage as well and have run into "fun" and "interesting" problems myself.

Michael Hoskins said...

This makes my blood boil just thinking about it.... Is there a specific policy reason why Symlin isn't covered by said insurer?

J.B. said...

That sucks. Completely.

It may not make a huge difference, but if they are paying a percentage, you could price the Rx around at a few drug stores. Some are actually cheaper than others.

Also, you may want to check the price of the vials. If it's the way it used to be, the stopper is very thick on the symlin vial so it's harder to get it mixed up with your rapid insulin. Good luck.

Michael Hoskins said...

And the Powers That Be wonder why we turn to Canada and overseas shipping at lower costs... Who's killing our system -- price-inflating, non-health-focused greedy insurers and suppliers, or the people trying to get the most economical costing medicine to better their health? Well, according to politicans and insurers, it's us. You know, because us PWD are all just fat and lazy and did this to ourselves. If only we'd exercise and eat better, the HFCS-containing crap out there, we'd be better.

Ok. This isn't fair to rant madly about... Sorry. Need to go take a walk in the 95-degree humidity to calm down.

This sucks, Kelly. And I'm sorry for that.

sisiay said...

Huh...so much for the argument that insurance companies use their purchasing volume negotiate LOWER costs.

It is true that pens can be more expensive. I found out (by chance) that a vial of Lantus was covered 100% by my old insurance (I think retail is around $100), but pens cost me almost $180. For 1/2 as much insulin. Not sure if the same is true w/ Symlin.

Penny said...

Ugh and I am sorry.
Maybe check around at other pharmacies?
Insurance and the D stinks Kel.

CBenton said...

Am I understanding correctly that CVS charged more than other rates you found? Does the pharmacy charge it's own rate for the insulin? My insulin costs about$350 (3 bottles)per month before insurance. I an no fan of CVS pharmacies. Most recently I have had difficulty getting syringes...I have received drug counseling literature, had to show my ID, and flat out been told I could not get needles - this because I buy my syringes by the bag instead of the box because THAT'S WHAT I CAN AFFORD. I've lived with this disease for 40 years and I find this offensive...It's hard enough trying to stay alive with insurance in the state it's in today, I don't need this on top of it. Unfortunately, my insurance requires me to use CVSCaremark.

Scott Strange said...

LOL, read http://babscampbell.wordpress.com/the-glycated-life/ for the same type of BS

The truly sick part of it is that there is a middle-man in there (for the life of me I can't remember exactly what they are called, I'm old you know) that actually negotiate the price and earn money based on that price

Kelly said...

REDICK!! Completely & totally. However, it's nothing new, really. Insurance companies, pharmaceuticals and physicians, for that matter, do not get rich off the healthy. This is why I firmly believe that there is a cure for many things. It just wouldn't be monetarily beneficial for some to introduce said cures.

I get so pissed because these sorts do not put the shoe on the other foot. They don't walk a mile. They don't care.

I'm so sorry. :( I'll keep my fingers crossed for your insurance company to wake the hell up and smell the broken pancreas. In the meantime, research other pharmacies. *clink*

La Char / Diabetic Lolita said...

Have you heard about a possible new sugar sensor? You can view the video here: http://diabeticlolita.blogspot.com/2010/08/futuristic-diabetic-implantable-blood.html

Karina said...

When I was diagnosed, I did not have insurance, and my first experience of going to CVS nad paying for my insulin out of pocket was a nightmare. I came home shell shocked that I needed money, that at times I may not have, to pay for insulin in order to survive.
This is what people that are against universal health care do not understand. damn it.

btw, why are there so many different brands of insulin?

Scott K. Johnson said...

Major. Suckage.

I wish there was something I could do to help K2. I'm sorry.

I HATE that we have to pay so much for stuff.

Kathy said...

I hope the Symlin works well for you. I used it for a few years with some success. It enabled me to take much less insulin which caused fewer lows. The ones I did have however were worse. Its a tradeoff. I stopped it once thinking it wasn't helping enough only to discover that it really was. I didn't have that feeling of constant hunger when I was on the Symlin.

good luck to you with the drug and the insurance.