Byetta: How do you get it through your insurance company?

By Melanie Wednesday, November 14, 2007

- A
- A
- A

Hello. I was diagnosed with diabetes a little over a year ago, and finally came across a combination that controled my sugar, helped me lose weight and made me feel great, but, thanks to my insurance company, is no longer available to me.

After taking Metformin for about 6 months, and gaining back weight I had lost, and still having high sugar levels, my doctor prescribed Byetta. She gave me a starter pack and sent me off to the pharmacy with a prescription. When I went to pick it up, the bill was $236. as my insurance company had denied charges. I called my doctor and she said it probably had to be pre-authorized and gave me a second months supply, stating that it may take that long to get it approved. I called my insurance company and they verified this was true. The 2 months passed, and I hadn't felt better in months, lost 10 pounds and was thinking that maybe I could live with this disease after all. I received a call from my doctor and she said I had been denied. My ASC1 was 6.5 and the insurance company would only approve it for those over 7.3 and I hadn't maxed out the dosage for Metformin. I know Metformin is marketed as not causing weight gain, but it did for me! I was crushed, I was finally starting to look good and feel good and now, bitter disappointment. Does anyone have any information on how to convince an insurance company to approve Byetta? Do I have any recourse? Please Help!

Comments (9) | Add comment

Anonymous

11/16/07 12:35pm

go to www.byetta.com and they have a link for help on insurance.

Vicki M

11/16/07 3:10pm

Hi Lanie,

Which insurance company are you with? I am with United Healthcare and they didn't bat an eyelash, but I am also considerably over weight. The only difference is my diabetes is under control. I am between 6 and 7 on my A1C.

Stay in touch and let us know how you are doing!

Vicki M

Melanie

11/17/07 11:02am

Hi Vicki,

Thank you so much for your reply. I am with Coventry Insurance company. I sure wish I were with your insurance company! Have you lost any weight with the Byetta? I wonder why some people lose weight with diabetes and others gain! If anything can possibly cause weight gain, it always does with me! I have struggled my whole life with it. In order to maintain an acceptable weight, I have to watch every single thing I put in my mouth and can't splurge at all! Life is just too short and complicated to live like that! Diabetes has made it crucial to do so though. I do cheat some, but the great thing about Byetta is I don't get the cravings that I used to and it makes it easy to turn down candy, etc. I still have a huge weakness for CAKE though...I just love it! I just can't have it in the house! Do you follow a strict diet?

Best wishes to you...and thanks again for your post.

Lanie

Vicki M

11/20/07 8:53am

Hi Lainie,

I have an aunt who works for Blue Cross Blue Sheild and she is researching to see if there are cases where insurance companies change their rulings such as your case with the Byetta. I will let you know what she comes up with.

The issue at hand is that Byetta is specifically for Diabetes and a by product is the weight lose. That has caused many people, even those who didn't need to lose weight as much to get their doctors to prescribe Byetta outside of it's recommendations. So the insurance companies have become really strict as to what they will and won't pay for. Your doctor should really step in with Coventry and get them to waiver this for you as your doctor is the one person who can validate its use for you!

Good luck and stay in touch!!

Vicki M

Melanie

11/20/07 9:09am

Good Morning Vicki,

Thank you for the research and thank your Aunt for me also. My doctor seemed pretty callous about the whole thing.

I called Amylin's reimbursement center, and they told me since I do have health insurance, I do not qualify for assistance. This does seem fair, as there are millions of Americans without it. My heart really goes out to them...I don't see how they get by....WITH insurance I may need to get a second job to pay my co-pays! LOL

Hopefully, your Aunt will have some good news for me. My pharmacy did offer a discount program that me saved $50, which was a big help. I was thinking this morning, that it is basically $7 and some change per day...I know I have wasted this amount without giving it a thought. So, I am thinking that I can set aside the $7 and at the end of the month...there will be my Byetta money! I used to spend that on lunch every day, but now I usually skip lunch and just have a quick snack, so basically it pays for itself, right?

Thanks again for your concern and for thinking of me. Your support really means a lot to me.

Sincerely,

Melanie

Monica Cohee

11/17/07 7:25am

Lanie,

You can get assistance at Byetta through the Patient Assistance Program

I personally would contact your insurance company and remind them that your A1c is the result of using Byetta not Metformin but its the combination of the two.

Also another thought for you and your doctor is to get your A1c higher. Since the insurance company is dictating to your doctor what can and can not be prescribed because of a low A1c is totally ridiculous.

I would fight with everything in me. I had a similar situation with strips. My insurance company was removing the brand I was using. I wrote an email to our benefit office and informed them of how much it would cost them to drop the brand I was using. And they waived it so I could continue with the same brand.

Don't give up!

Melanie

11/17/07 10:55am

Thank you so much for the information. I thought of raising my A1C deliberately, but was worried about the health related repurcussions. My doctor really wasn't very helpful. She told me they said they wouldn't consider it until I took 2000 mg (or whatever the measurement is) and that my A1c wasn't high enough to warrant that. That is a great idea to write to the insurance company. After watching "Sicko" though, I wonder if it will make any difference, as they only care about their own bank accounts and not about anyone's health!

I looked at the patient assistance program, but I worry that I there are others who need it more, as I do have health insurance and a full time job. I went ahead and paid for a month supply, charged it actually...as a single mom working in a non-profit organization, with a son in college, I really don't have an extra $200+ dollars at my disposal.

Thank you once again for the information. It helps to know someone out there cares!

Monica Cohee

11/17/07 8:02pm

[quote: I went ahead and paid for a month supply, charged it actually...as a single mom working in a non-profit organization, with a son in college, I really don't have an extra $200+ dollars at my disposal. end quote]

I feel a single mom qualifies for assistance. Don't you? And do contact the insurance company. Remember you are in charge not them.

Melanie

11/18/07 10:07am

Thank you, and I do think being a single Mom does warrant checking into it. My employment is in Workforce Development and I see so many people worse off than I am. so sometimes my perspective is a bit skewed.

I wish I could agree with you about us being in control versus insurance company...but it seems to me they are the ones holding all the cards. Better to try than lie down and take it...so thanks for the encouragement!

Byetta: How do you get it through your insurance company?

Ask a Question