My Insurance Plan Doesn’t Want to Pay For My Brand of Insulin

Dr. Bill Quick Health Pro
  • For several years, I've been on Humalog (insulin lispro) with my insulin pump, after switching from Novolog (insulin aspart) because it was indeed having too long a "tail" for me to accurately calculate my doses. (The "tail" is an extremely long duration of action after the peak occurs.) I'm not the only one: Google "Novolog tail" and you'll find others with the exact same concern, especially with insulin pumps.


    I've been with three different insurance plans since on the pump; the first two both covered Humalog without problem, so when my employer changed insurance plans on January first this year, I had no reason to anticipate any problem with getting my Humalog refilled by the third insurance plan.

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    So I imprudently let my supply of Humalog drift down to the final vial, and I've got about a week's supply left before it runs out. (Yeah, I know that's stupid - I could accidentally drop the vial and bust it, but I haven't done that yet in the four years I've been pumping. And the local pharmacy surely has a spare vial or two in stock so if I did lose the vial, I should be able to get a refill superquick.)


    Back to my story: foolish me; I didn't count on the idiocy of the health insurance industry.


    I called the local pharmacy's automated prescription refill phone number about three days ago, and ordered my Humalog. They robocalled dialed me back daily to remind me the insulin was sitting there, so I finally got off my duff and wandered over to the pharmacy earlier this evening to get my insulin refilled.


    Got there at about 7PM, and found I was at the end of a  long line of patient people. Finally got to the head of the line; reminded the clerk that I had new insurance coverage this month, and was told they'd have to enter the info into their computers; please have a seat...


    Well, fifteen minutes later, I got up and inquired where things were at, and was told it would be "just a moment." Five more minutes, and I was called to the side area where they discuss nasty things like STDs and insurance snafus. Seems that when they entered my info into the computer (by hand - despite the magnetic swipe strip on our credit cards, drivers' licenses, and passports, the insurance industry still isn't using swipe technology!), the new insurance plan doesn't cover Humalog; they want me to use Novolog.


    And of course, my doc isn't into evening office hours, so I can't do anything tonight. Wrong: I could, and did, go on-line to the pharmacy plan and learned about Humalog:


    "We're sorry; this drug is NOT COVERED by your benefit plan OR may NOT BE THE APPROPRIATE REGIMEN as defined by your plan. For more information, please refer to your benefit materials or contact your benefit administrator (Error Code 70).  (70)"


    Also called the pharmacy plan, and the representative told me that I had two choices: buy Humalog out of pocket and hope to get reimbursed, or have my physician call the pharmacy and order Novolog. Sure, I can appeal the decision. Later. Appalling.


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    It's now about 8PM this evening, and I'm not sure what to do tomorrow. I know very well that my control (A1C average of 6.0 since three months after diagnosis) will deteriorate on Novolog. It won't be by much, but it's irritating to cave in to the insurance monsters when all they are interested in is maximizing their profit, even if it p****s off half the people taking insulin.


    Oh, another thought. Mr. Romney, you mentioned a while back that if I didn't like my insurance plan, I could just fire them: "...if you don't like what they do, you can fire them. I like being able to fire people who provide services to me. If someone doesn't give me the good service I need, I'm going to go get somebody else to provide that service to me." Yeah, sure.


    I could also write a blog.  Just another angry patient, bellyaching about the idiocy of the mangled care system that we live with in the United States, let alone politicians who think we PWD can just switch insurance plans on our own.


    And someday maybe we can get Humalog without having to go through impossible hoops. Just not today.


Published On: January 30, 2012