Here We Go Again

This past week, I visited my endocrinologist. My lab results looked good. I had an A1C of 6.0 (126 mg/dl – this is the target for those with Type 1 diabetes).

An A1C blood test provides insight into a person’s average blood sugar levels over a three-month period. Anything over 7.0 (154 mg/dl) usually means a risk of diabetes. When I was diagnosed with Type 1, I had an A1C of 16.0 (420 mg/dl). The fact I hadn’t gone into complete renal failure still astounds me.

Six months ago, I switched jobs so I acquired new health insurance. And for the first time in four years, I was excited to ask for a new prescription for my test strips and insulin. I no longer had to go through Optum-Rx, a mail-delivery service, to receive 90-day supplies of my medical needs. I could finally return to the wonders of CVS.

A few days later, CVS notified me that my test strips were ready for pick up, but when I checked my online account, I saw that my insulin was listed as a “new prescription on file.” So, I called the pharmacy. Apparently to fill my order of Humalog insulin, my new insurance required I get a prior authorization from my doctor. Well, that was new.

Am I authorized?

But then the pharmacist told me my new insurance preferred Novolog – another type of insulin, which didn’t require a prior authorization from my doctor. This meant I would need to get a new prescription from my doctor, though.

I laughed out loud.

I had been on Novolog for the first six years of managing this disease until my prior health insurance told me they would no longer be covering Novolog, and I needed to switch to Humalog to be covered. I was nervous, at first, having never been on Humalog to manage my diabetes. I didn’t know how it would affect my blood sugar levels. But the nurse practitioner I was seeing at the time assured me I would be fine.

So, I’ve been on Humalog ever since. I’ve been lucky because I know there are some with Type 1 diabetes who are allergic or sensitive to different types of insulin and can only use one to manage the disease. And even with prior authorization, the insurance company may decide not to cover it.

I also know the hassle of trying to acquire a prior authorization form and then getting it through the insurance company’s bureaucratic process. Prior to the Affordable Care Act, anytime I switched health insurance, I had to do this for every single diabetes medication and supply that wasn’t a syringe or a test strip. For the doctor’s office, it meant additional paperwork. For me, it meant a delay in access life-saving supplies and medication.

Is it worth it?

I’d rather get a new prescription than endure that hassle again. By far, this new insurance coverage has proven so much better than my previous one. There are definitely not as many loopholes to jump through or denials to endure.

On my last health insurance, I spent months trying to convince them that I needed 90-day supplies of my continuous glucose monitor (CGM) sensors so I could monitor my blood sugar 24/7. Because Optum-Rx didn’t carry these sensors, and no other local pharmacy did, and I couldn’t go through Dexcom, the actual manufacturer of these sensors, I had to go through an outsourced specialty pharmacy located in California. And because I was not getting the sensors through Optum-Rx, I could only get a 30-day supply at a time, and I had to pay more ($70 per month).

I fought for months to have this rule changed. But I never got anywhere and eventually gave up. I started stockpiling my sensors and wearing them longer than the recommended seven days. I’ve had to endure many battles with health insurance companies ever since this autoimmune disease came knocking on my door.

I imagine I will have more battles to endure in the coming years, so for now, I like to relieve the stress and tension where I can. It’s not worth trying to acquire a prior authorization for a drug that, for me, can be easily replaced by another that my health insurance company deems “preferable.”

Fortunately, I have another vial of insulin leftover from my previous supply, which gives me about a month to figure all of this out. And whenever I change insurance carriers and have to acquire new prescriptions, I always account for processing delays and snags and try to give myself a little leeway.

Anything for my sanity.

cat sticking tongue out

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2 thoughts on “Here We Go Again

  1. This post is so needed. Anyone who has ever had to deal with insurance companies know how frustrating it can be (total level 1 trigger, right?). Having someone like you sharing their tips and tricks on staying sane is so vital- especially for people who have to make these calls often.

    Liked by 1 person

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