Tuesday, April 10, 2012

What Are Your Monthly Insulin Requirements - And What Will Your Insurance Actually Cover?

Me & The Elixir of Our Life @ Breakthrough, The Dramatic Discovery of Insulin Exhibit @ The NYC Historical Society, 2010~
photo courtesy of kerri Sparling

So my questions to you Diabetesalicious readers are: How many insulin bottles per month does your insurance cover versus how many insulin bottles per month you actually require.

I’ll start the ball rolling. My insurance will cover two bottles per month and pay only 50% of said bottles.

My insurance only covers 50% of non-generic prescriptions and only 60% of generic prescriptions. Also, the price that Caremark works out with my insurance company isn’t a desirable one for the end user of that insulin, me.

I need my insurance to cover more bottles and give me a better price on said bottles because insulin is the magical elixir of my life and I need to live - AND SO DO YOU.

Also, my insurance will not allow me to order my insulin through the mail, PERIOD.

Look, sometimes I need more insulin than 2 bottles a month and sometimes 2 bottles are OK - Not great, but OK.

Seriously, it all depends on the month& the circumstances (both regular and unforeseen,) that that particular month brings.

For instance, sometimes when I get my period, I eat more carby foods and need more insulin, even though a few days before,

I barely eat anything and require much less insulin - Hormones are all types of tricky - And Aunt Flow can be quite bitchy when you add diabetes to her monthly visit.

Then there's the whole exercise thing. On days I exercise, I might need less insulin,in less of course my bloodsugar drops super low post workout and then rebounds towards the 190s later. Then it's pretty much an insulin wash.

What if my insulin goes skunky? Magic Eight-ball says YES there will be times when my insulin absolutely will,(and has,) gone skunky - especially if there happens to be a heatwave my area.

And there's been those unfortunate times when one of my insulin bottles has met an early death because it accidentally smashed onto a tile floor. Yep, its happened, multiple times. In my home, in the bathroom at a hotel, in my friends homes - both close by and in New York City.

Speaking of NYC, when I travel I have to bring extra insulin with me and there I times I can’t keep that extra bottle chilled, and I end up SOOL (Shit Out Of Luck) regarding that bottle. Most times I travel with the bottle I’m already using, but if it’s an extended trip ( like when I went to Hawaii and Europe) where I had to bring two bottles, not one. Good luck explaining travel plans/diabetes requirements to the folks at your insurance company!

And how about the times when I’m fighting some sort of infection during cold and flu season and require more insulin daily?

Of course I’m going to run out of insulin before my insurance allow for a refill - You don’t have to be a Rocket Scientist to know that!

Lucky for me, I have an Endo who is generous with the Insulin samples and I seriously don’t know what I’d do if I couldn’t ask him for some backup bottles when I need them.

As PWDs (people with diabetes,) our daily insulin requirements aren’t an exact science, even though we try our best to count the carbs and test our blood sugars even more than our insurance allows us to.

And it would be wonderful if insurance companies actually covered all of our daily insulin requirements, not the text book versions that never seem to reflect our real lives.


Rachel said...

I seem to be blessed in this respect. I use just over one bottle per month (right now) and my endo writes a prescription for 5 bottles every three months.

My insulin nets us the maximum cost for supply that my insurance provides and I'm REQUIRED to do mail-order for "maintenance" drugs. So of course they take their good sweet time sending me anything! I'm also sick of them trying to dictate how often I should test and limiting my strips.

Lili said...

Most insurance companies cover insulin in units/day, though, not bottles/month. Your scrip should have units/day on it. If that adds up to more than 1000 units in 30 days, your insurance should cover 2 vials for example. If you're a pumper, make sure your doctor includes all the units that get wasted, also.

Cara said...

My insurance makes me mail order or charges me three times as much if I get it locally. :/ Insurance sucks sometimes. :(

Carla said...

This totally sucks! Why does the insurance company always get to decided what is best for YOU? They are taking YOUR life in THEIR hands with their stupid policies. It's not like you're making illegal drugs with the extra bottles of insulin...you NEED it to LIVE!

Anonymous said...

i am very lucky to have good insurance coverage; my MD writes use in pump up to 140 units daily (i use close to 110 daily) and I get 13 bottles for 3 months
$40 copay; but Novolog has a copay card for upto $50 off; so I get mine for free

Mama 'betes said...

I use about 40 units a day, which gets me 4 vials for 3 months. When I was pregnant I was up to more than 100 units a day. We are very lucky though, and have insurance that didn't even question my increased need in insulin, blood sugar strips, needles (even though I'm on a pump), etc. I know a lot of women really have to fight their insurance over this when preggers. Pregnant or not, its so stressful to have to fight for the thing which keeps you alive!

Scully said...

The moral of the story is that our insurance companies base their decisions on stupidity. Also, that we must pay hundreds of dollars for this precious elixir that keeps us ALIVE. And really, 1.8ml for 4 days of life is only 0.45ml a day (for me). Is it really that difficult to let us have a couple more drops of this life sustaining liquid? I hear you

Kaitake said...

I normally use 20u Lantus and between 7 - 15u Humalog per day (MDI). My GP and Endo can both write me prescriptions, so I never run out. Plus it's only a $3 pharmacy charge. I'm very thankful for universal healthcare here in New Zealand! I'm so upset by the way insurance companies dictate treatment choices in US - that's not healthy! Sending you all lots of moral support in this battle.

Mike Hoskins said...

Thanks for the post, K2! I also am fortunate to have pretty good insurance lately that covers what I ask for. I can no longer get mail-order insulin, so have to get everything from my local pharmacy - which is Target. I get three vials a month, but do try to stock up whenever possible by ordering right at the month mark whether I've used it all or not. Plus, my Endo writes a Rx for a little more than I typically use anyhow to account for waste or crazy rage bolus situations. So that all allows a little security. Pay $40 co-pay for that month supply of three vials, and I believe (without looking) the total is about $400 or so for those three (so like $133 a vial?). I'm blessed to have that coverage, I know.

Michelle said...

We've recently switched insurance and it was certainly a wake up call for me..it used to be a $25 copay every month for my daughter's insulin and now it's covered at 80% once we hit our high deductible (over $2k - includes her medical and pharmacy) so needless to say we pay the total cost ourselves for at least the first few months of the year. We did switch to Apidra though before the end of the year which I am VERY thankful for since there is an assistance program which makes it FREE for us right now (it was originally just going to be through the end of April, but we just received notice that the program has been extended until the end of the year!)!

The Diabetic Camper said...

Damned if you do and damned if you don't.

Anonymous said...

So far, I haven’t had too much trouble getting what I need. I also have mine written for more than what I use because like you said, you never know. I just switched from Apidra pens to vials because of the unavailability of the pens and had a little bit of a problem with my pharmacy. I wanted 2 vials so I have some back-up and the pharmacy questioned that. The doctor called it in right and the insurance paid for it but it was the pharmacist that gave me grief.

Khürt Williams said...

My insurance covers whatever the endocronologist prescribes fully. So if I need 5 strips a day for 90 days that's what I'll get.