In December, 2012, I was told by my insurance company , Medical Mutual, that they will no longer be covering Apidra, but that all I need to do is get a basic prior authorization from my doctor and all would be ok. Wow, was that ever an understatement!
I had a little less than 1 bottle left over at the end of the year, so I went to try to get a refill around January 5. No go. I went to my Endo to ask for a prior authorization. The PA who handles such requests was not there and the woman who took her place seemed to not understand what I meant. I even had a rejection printout from the pharmacy and the number to call my insurance company to make the authorization, which I confirmed with a presentation of my insurance card. She said she would check it out and get back to me. The next week, I would soon be running out of Apidra, so I went back to the doctor's office, as they had called me in after my numerous phone queries to them. I had contacted my insurance carrier, Medical Mutual, who said that Apidra was not longer on their formulary and that they were not sure if a prior authorization would help. I called the insurance company the next day; and the customer service woman who answered their phone this time said that they would cover it if my Dr. Sent in a prior auth.
The next morning, I went back to the doctor's office and got a no copay card from the PA and I tried to explain to her that that would not help me. She said that the Apidra rep told her it would take the place of a prior auth. ARgghh!!! I felt like I was talking to a brick. It was late in the day; I came back a third time, two days later, and reiterated my predicament to the receptionist, and received two bottles of Humalog "to use while we work this out." She did say that the new PA was not familiar with prior auths. and that I would have to talk to "C", the more experienced NP (whom I have worked with in the past, as she has been with this practice, like me for years) to get the prior auth. the receptionist said I had been to the doctor's office so many times (Phone calls do not work with them, and there is no way to e-mail the office., just fax or snail mail), that she would get she would ask "C" to do it.
Meanwhile, I have been in contact with Sanofi-Aventis, the Apidra manufacturer, and they told me that there was a coding error with Apidra where it was inadvertently not covered for some Medicare recipients, and many insurance companies followed suit and refused to cover it in 2013. Supposedly, this discrepancy will be taken care of in the next few weeks.
I really like Apidra and do not want to continue using the Humalog I have been given. The tail is too long and I cannot get the quick corrections that I am accustomed to. Plus, I am a pre-65 retiree and my Humalog, before my high yearly deductible, would be 143 a bottle and I use about 2 bottles a month Pretty pricey!!!I could get, after the No copay card is used, the Apidra at $60 for the two bottles as Sanofi -Aventis would take care of the $50 copay per bottle with the savings card. Quite a savings, but I believe I will be forced to go to Humalog, unless my doctor’s come up with the info I need to go back to Apidra.
Yesterday, (Sunday 2/11) I went to the CVS pharmacy I usually get my prescription filled that has the Apidra script on file. We ran the script again and it was rejected. The pharmacist said to do whatever I need to do to get a prior auth. from my doctor.
I really like my endo, but his office is understaffed and many are not trained well. Will I have to write the pre-auth and just let my doc sign it? What do I have to do to prove that I get better control with the insulin that I have used for the past 8 years?
I have only been on Humalog for about 3 weeks SO FAR, in 2013, but I am seeing a difference. I have to wait 3-4 hours for a full correction to take, unless I almost double the correction suggested by the bolus wizard. This throws my day off and makes me want to "rage bolus" to get a high down quickly so I can go about eating and taking part in a regular day. Have had really crappy blood sugar swings from overbolussing to avoid 3-4 hours of highs. OF COURSE, I get a resultant, reactive low, and many times a rebound high. Vicious cycle. I just prefer a low to a high, any day. (Like 314 to 37 in the space of 7 hours. Not fun.
I had some roller coaster highs when was on Apidra, some due to user error, but I did not find I had to double the correction factor with Apidra.
I want to keep using it, but I cannot readily afford it straight out of pocket, neither can I do the Humalog easily. Will probably take me another 5 months to meet the deductible. I did not pay for Apidra at all last year, even prior to meeting my deductible. It went through with no-copay and no price as covered by my insurance. Now I am being told they do not cover it at all. BIG CHANGE
Should I just go and sit at my doctor’s office and demand a prior auth? What info should I ask from my insurance company prior to going for my "sit-in"? I do not plan to be evil and nasty, that is not my style. I will be sweet and persistent and will sit there for several hours, or all day if I have to.
Has anyone run into similar Apidra and doctor office problems? Perhaps those of you who work for or are familiar with insurance companies may be able to help.
Thanks for taking the time to read this, and in advance for your thoughtful consideration. TuFamily, mi familia