UPDATE: Part of my terror about this insulin coverage change was the fact that I wasn't sure if I would be eligible for unemployment insurance. I applied for unemployment and they asked me to fill out a seven-page form asking all kinds of questions in order to determine if I was eligible. I've been waiting, waiting, waiting on pins and needles to see if I would have any income, or be forced to start eating through my retirement savings (and paying a huge penalty for too-early withdrawal.) Well HALLELUIA, I just looked at my bank account and the state has started depositing unemployment insurance money into my account. This is a HUGE relief and will help me buy time on the insulin until I find another job and, hopefully, get better insurance coverage of medications.
I still hate Group Health, though, for what they are doing to diabetics. People shouldn't have to choose between insulin and a roof over their heads. Our whole medical system in the U.S. becomes more vicious and insanely cruel to sick people every day.
Hi folks. I haven't been around here in quite a while (long story.)
Today I had heart-shattering news: my insulin, which used to cost me a co-pay of $30-ish dollars has been kicked up to over $300 dollars. This is TEN TIMES more expensive than it used to be. I swear they've declared war on diabetics at Group Health Cooperative -- they want us to die so they don't have to cover us anymore (yes, I know I sound hysterical -- because I am hysterical.)
The only insulin left in their generic formulary are Novalin NPH and Novalin R. I've never taken either insulin. I have no idea how to dose them, how they're different, what to expect, how to switch over.
No one gave me any advance notice. I have 1-1/2 pens left of Novolog and 2 pens left of Lantus...and then that's it. I found all this out just this morning, when I went to refill my prescriptions. It was like being hit in the head with a rock when they quoted the price.
I have no idea what to do. My doctors have been utterly useless. I learned everything I know about managing insulin from talking to people like you on-line (you are all my angels) and from reading books like "How to Think Like a Pancreas". But I've been using Lantus and Novolog, so all my knowledge about how, when, how much, why...I feel like it's all been NUKED and I'm freaking out. I can't afford a ten-fold increase in the cost of my insulin. I'm unemployed right now and kind of hanging on by my fingernails.
I want to just stop injecting insulin, put a protest sign around my neck, and sit outside GHC's corporate offices until I go into DKA. If anyone has a better idea (!!!) I'd love to hear it.
Thanks and sorry for being so upset. I'm just freaking out.
Their "generic" formulary used to include Lantus and Novolog. Now it ONLY includes Novalin NPH and Novalin R. That's it.
Did you click through that "Exception to Formulary" box on the web site? You have to be a member to get through to it.......
Hi Laura S. You get a (((hug))) for your help, too!
From their website: "Tiering exception available only for Medicare Part D plan."
So they allow Medicare patients to request a tiering exception, but not people on my individual plan.
Jean, I would still pursue it based on formulary.
Insulin doesnt really come generic, it only comes name brand. I think you need to call your physician, and have them ask what it would take to get this authorized.
I wouldnt give up!
My HMO has a three tier plan and calls it generic, forumulary and non-formulary.
The insulin falls under formulary. Unusual or newer drugs may fall under the third tier.
I think you can get it authorized back down to tier two but you may need your doctor.
Your doctor's office can hopefully help.
Is It because Novolog and Lantus are not routinely prescribed ,by most GP's and some Endos, for Type twos on insulin, so they are not covered? HMMM.. another pothole in the highway.
But we will find a way around it and not IN it...
Thank you Brunetta, but I don't have an HR department. I'm unemployed. I pay $425 per month for an individual plan through Group Health Coop. I switched to this plan when my COBRA ran out from my last full-time, permanent job that had health insurance. I have been doing contract work ever since. Group Health has very different plans depending on how you are covered: individually, through a large and influential company, through a small and less influential company.
If I'm looking at the right web site, it says you can ask for an exception to formulary. I saw where you can click through.
You need to find a supervisor there, or better still make your doctor find one and say you must have your rapid acting, current insulin.
If your BG records are pretty good, even more reason they should be letting you have waht you need and your doctor should be beind it.
I've been through these things before, and always managed to get authorized via my doctor. Last resort, appeals committee but before that make some calls or have your physicians office investigate for you.
I know that you feel totally undermined by these events, but it is important that you develop some strong self-determination in this matter. Your health is yours and you need to convince yourself that you won't let some petty bureaucrat take away your health. If all you can get right now is NPH and R, then take this on and show them. Figure out how to get NPH and R to work. We will certainly help.
Don't give up on the fight. Continue escalating with the insurance company. Complain to your state insurance commissioner. Enlist the help of other doctors and a local diabetes center. But don't let this undermine your determination to take good care of yourself.
When I first went on Humalog, my endocrinologist gave me four vials, along with the pen, to start with. Can you get some free insulin this way from your doctor? Just to tide you over until you get things straightened out with the insurance company?
Don't be afraid to take your problem to your congressional representative and to your local media, either. It's often surprising the difference politicians and the media can make.
I very much agree with Ann. My CDE always asks if I'm ok with insulin and supplies because they get samples. While you're trying to get your bearings on this horrible news, call your doc and call around to other doctors offices telling them you're unemployed and need insulin. If you got a vial or two and some syringes, you'd buy some time to fight this. I'm old school and still use Lantus/Humalog with vials/syringes because for a long time my insurance wouldn't cover the pens.
I also agree about contacting your congressional delegation and your local media. Take that sign you were talking about making and go to the media. Maybe you'd find a donor willing to pay for your insulin that way. Who knows but it's worth a shot.
Take care of yourself Jean. You will be in my prayers. My husband was laid off last week but I am thankful to have my job with insurance benefits.
I just found my eyes filling up with tears and I don't know what to say to you! Sometimes all I can do is pray, and I will!
Thanks! I feel much better today. At least the wolf is away from the door and down the block for a few months -- and not actively nibbling on my poor toes!!!