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OMG, I am working with an agent to find an affordable health care plan for next year, and what I'm hearing is horrific. Thought plans were going to be cheaper this year. The plan I had last year for $65 a month is now $256 per month. Many of the companies are NOT COVERING NOVOLOG!! I use Novolog in my pump, and that's all I've ever used. If they do cover insulin, there is a huge deductible applied ONLY to insulin. Are they trying to kill all of us off? Please forgive the caps and exclamation marks; I just got off the phone with her. And I thought I saw something as I was logging in which said they're not covering Eli Lilly insulins either? Susan
 

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Hi, Susan! Welcome to our site.

You've had quite the entry to health care in America. Fifty states and several stages of eligibility ("regular", Medicare, etc.) and it can get confusing and frustrating in a hurry.

I don't use insulin so the cost of it has not been something I've tracked closely, but I do know the price has gone up considerably even with demand and that individual states have tried to regulate the costs of at least some varieties of insulin to try to keep it more affordable. Other states have more of a market-based focus and let the price float based on what insurance companies (and their subscribers) will pay.

Would Humalog be usable as an alternative (if, indeed, it is less expensive through your health care plan)? I'll assume that the person you worked with juggled the cost of the monthly premium with the cost of the amount of Novolog you use?

For that matter, could you go outside of your provider if you got a better price on the Novolog? I've found several of my medications are less expensive through a PBM (Pharmacy Benefit Manager) like GoodRx than they are through my health plan. Weird world, but it seems to be so.
 

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Hi shrink111, welcome to the forum.

My insurance doubled for this coming year, so I can only say yikes to a 5 fold increase.

As far as your question, I think they are, after grabbing as much of our money as they can get.
 

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Yes, they are trying to kill us.
When you talk about insurance are you talking about Obamacare? I used to be on Obamacare before I turned 65. I hated it. I would switch insurance companies a lot trying to find a better one. Because on Obamacare the insurance companies hide things that you have to dig and hunt for. Shouldn't be that way but it is. They had me using Basaglar insulin and that was a pain in the neck . But it was the cheapest for them . It's not much better getting insulin with Medicare either, it's still expensive.
My neighbor uses the insulin that Walmart sells and she said she does better on it then she did on the kwik pens.
I tried using an agent when I needed Obamacare but they seem to have their own agenda so I just did my own research and believe me it does take time to find one that you can afford. And from my advertisement on TV it seems that you can get a Obama care with a $0 premium.
 

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I have my own thoughts on the state of US health care but that treads on the edges of politics, which is a subject we don't discuss at length on this site. My experience, though, with county governments, Medicare (for other people; I'm not old enough myself), and my own private health insurance is that there are mechanisms for appeal. They're not simple or efficient, but they exist and I've been successful in my challenges.

I have a skin condition for which my insurance company refused to cover a specific medication that worked pretty well. For $$ reasons they switched me to something else that I needed to use much more of, coming to the cost of what they wouldn't let me have in the first place. After a year of this, my doctor (an important ally in these battles) and I managed to get them to approve a smaller (but sufficient) quantity of "the good stuff" and everyone was happier.

I have a relative who needs assistance with activities of daily life (ADLs). The county remodeled the bathroom where they live so they could be rolled in with a shower chair. When that enclosure started leaking, I called to ask if they would send someone out to find out where it was leaking, only to be told that it was my responsibility. I didn't install a roll-in shower and wouldn't have a clue as to where to start looking; denied. I appealed. I won the appeal and they sent someone knowledgeable to come out and at least figure out where the leak was. If the plumbing issue was house pipes, it was my problem to fix. That was fair. The guy determined the enclosure that was there had a design flaw that caused the leaking after several years. The entire shower was replaced and the new one won't ever leak like that. I would have spent a lot of time and money patching "their" problem. It took a while, sure, and a couple of "government hearings" but it worked out.

The short of it is that If you can lay out and support your case clearly (especially with pro support like your doctors) and be reasonable in what can remedy the situation, my experience is that even the crusty bureaucrats can move in your direction. And everyone has a boss. Everyone. Using the chain of command can be helpful, too. That might not resolve every situation people have but I would bet the majority of people would be happier with the outcomes.
 

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OMG, I am working with an agent to find an affordable health care plan for next year, and what I'm hearing is horrific. Thought plans were going to be cheaper this year. The plan I had last year for $65 a month is now $256 per month. Many of the companies are NOT COVERING NOVOLOG!! I use Novolog in my pump, and that's all I've ever used. If they do cover insulin, there is a huge deductible applied ONLY to insulin. Are they trying to kill all of us off? Please forgive the caps and exclamation marks; I just got off the phone with her. And I thought I saw something as I was logging in which said they're not covering Eli Lilly insulins either? Susan
A couple years ago I thought we would be forced to switch from novolog to humalog. I asked our endo who was also t1 . He said that he personally use either. I think he said they were Interchangable
 

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I suspect the solution to the question for a person on Medicare, if you need Novolog. Go to Wal Mart, and buy Insulin by the Vial over the counter for $25.00 a Vial.

If one uses Medicare to acquire Insulin, one must use the price structure for Medicare Part D. Part D is the part of Medicare which pays for drugs. Medicare Part D does not negotiate drug prices, so drug suppliers can charge whatever they want. Medicare Part D will allow for that top payment for that drug. I now you are going to say, well that extra money is used to develop new drugs, and the US pays for the development of new drugs, while countries like Canada, or UK (Used to be Great Britain. Used to be England) and Europe just legally require drug companies to charge for just the manufacture/distribution of the drug. The end of the year Financial statements are public, and tell a different story. A great deal of the drug makers money goes to pay off kickbacks to doctors/clinics, pay Executives, that is managing Executives, like who come from Harvard Business School, not technical Executives who might be involved in the development of new drugs, and stockholders. To be clear, I personally, would think be slow to remove the kickback to doctors, as the law has greatly limited the doctors ability to charge, while requiring that they see too many patients over a long work day. Don't remove this doctors extra ability to make money, as they pay unbelievable amounts of money for student loans, malpractice insurance. Worse they have a lot of their time spent - wasted because they have to practice insurance rather than medicine.

This problem of price structure, Medicare pays whatever a Drug manufacturer charges is quite a problem, not just for Insulin. By comparison, Traditional Medicare payment amount for procedures what is a price that the government decides. To be a Medicare Approved provider for Traditional Medicare must accept 'Assignment." Assignment is the Medicare term for, the provider must accept as full payment for any procedure or service what Medicare says it should cost. Assignment Dollar numbers are far less than what the Providers business office says a procedure should cost.

Like I go to see a doctor, first visit the doctors business office wants to charge five hundred dollars. Medicare Assignment is like less than two hundred, which I am supposed to pay twenty percent. Before Obama Care, that was ten percent. In order to pass Obama Care, the Democrats agreed to the change in order to sweeten the deal for Republicans who were cost conscious. In truth, it seems for that moment on, Congress seemed to agree that the elderly are the surplus population, and to restate Dickens, "they should die and deplete the surplus population.'

I should point out, that when we hear the noise that Social Security is going Bankrupt. That is not so much true, a small increase in Social Security withholding's fixes the Social Security fund. Perhaps raising the minimum wage helps. What is true, is that the costs of Medicare are really large.

A Congress that is largely elected by donations from rich citizens, depend on those rich citizens getting money from their investment in drug companies.

Let us realize some of the gaming going on. Medical Doctors offices ask for a large amount for the doctors time and services. That dollar number is actually to try to negotiate a slightly better deal for the amount the doc gets paid, not to get that whole amount. As a Doctor told me during the 1990's, that patient who pays the most for health care is the one who has no insurance at all. Anyone with Insurance has a negotiated deal with doctors, clinics, hospitals, and pays part of the price. The second bad part of people without insurance, people wait until a problem is too painful, or makes their life too dysfunctional to continue. Which clogs the ER's with problems people should had solved in an orderly way at Clinics, private doctors offices. ER prices become raised because a lot of people, seeing those huge ER bills, just never pay any of it. Plus ER's need to accommodate all the ordinary problems while keeping enough resources for real Emergencies. One of the great improvements in Medicine is what ER's can do today. By any standard, ER's do real miracles every day. When I was a child they stitched up wounds fixed broken bones, and admitted people upstairs.

There are some funny things about how Insurance, surrounding Medicare has changed. My costs became twenty percent. The charity hospital system I go to has a system to write off that twenty percent. One of my providers is a DME (code for Durable Medical Equipment - provider) who provides the parts for my 'Sleep Apnea' Treatment, also writes off the twenty percent.

Obamacare came with a thing called "Expanded Medicaid" Notice the difference on the end of the word, caid, not care. This is a program which would have paid for a lot of the costs for Diabetics, and the extra price of Insulin.

That state I live in, Texas, refused Expanded Medicaid. Also the state passed a law that made it illegal for any group to give information, advice about which Obamacare plans might be the most useful for someone. That is criminal law, not politics, as the price for giving advice was, the State Attorney General promised, to put people in jail for giving information or advice.

Still, more to the confusion. When I applied for all the Benefits the state of Texas had available for me, I filled out a form for SNAP (used to be Food Stamps) now works off a card (like a bank card) which entitles me to get food at a grocery store. I think it started below twenty dollars, but it triggered an automatic application for a Federal Benefit called "Extra Help" Which was a Federal Benefit program to help pay for some things, one being my Part D Deductible, or most of it. As of this year, for a Prescription drug that is Generic, I pay seven, eight dollars, for a Patent drug, it is now about ten dollars. For Over the Counter Items, like aspirin vitamins, and so on, things my doctor recommends I take, I have to pay myself. That is a lot more money than prescriptions, unless I get sicker.

There are other programs, which likely people have not heard of, which will help pay some of their Medical/Insurance costs. Which can be applied for.

There are several things to keep in mind. Some programs are applied through on the Medicare Site, some through their respective states. A I was speaking to a woman who had worked for the state offices for years who said, "Apply for all the benefits you can, you can not know which ones you actually are entitled to."

When I said, ".... but the state website said, " She laughed, "The Website is a work in progress . . . "

My advice, Be good natured. Be patient. They have to work with a lot of people. All those workers for state offices actually tried to help me to find a way to document my qualifying for some benefit. Realize the text you read on government websites documents is not just government-speak. it is a language where the words do not apply in the way you would think they refer too, apply in consequences. Usually written by groups of lawyers skilled in obfuscation. No ordinary person could understand what these words mean.

Apply.. Be honest. I gotta warn you. State programs, Federal or for your state, have what I call a "Death Penalty,'

If you say or appear to imply any threat, You will be disqualified from all government benefits for all the rest of your life. Throughout the entire United States. It is like the second grader who took his cap pistol to school to show another kid, and by the rule, was banned from the school for all the rest of his life. Perhaps his siblings as well.

To put it a better way. Some years ago I was on public housing, as I was going through the yearly qualification, the worker told me about another client. A woman who had two children, she was employed worked one and half jobs, as well as taking care of her elementary age children. The worker said, I liked her, I was like a friend to her. When the woman was filling out her yearly qualification form that paid for sixty percent of her apartment cost. One little problem, one of the birth dates for one of her kids was written down incorrectly. The worker had copies of birth certificates, had previous forms with the correct date. The rules was to call the Mother, confirm the correct date, the worker crosses over the wrong date, writes in the correct one, initials it. Problem was Mom, being a bit of jokester, finishes the conversation with, "I am going to k**l you." The worker said, "All our calls are on tape. By Law I have to report it anyway. If I don't report it. I could lose my job and my pension if I don't report. I have over fourteen years doing this. I hate doing it. My report will disqualify her from all public housing, public health care, Snap Benefits, all public assistance for all the rest of her life in the entirety of the US. Even if you think she deserved, her kids don't deserve it.

When applying for public benefits, watch every thing you say. If you even repeated that story the worker is likely compelled to turn it in as a veiled threat.

Zero Tolerance rules.

At the same time, the public housing worker had the case loads of four others, who had quit because of the amount of overwork because of case load, and the state had put a hiring freeze on.

The Build Back Better bill, which is hung up in the US Senate by one vote, has in it a provision for Medicare to negotiate drug prices.

Over the Counter Insulin being cheaper is from signed by Donald Trump. Keep in mind he did not sign the reduction in Insulin Prices within a short time after he took office. Trump reduced Insulin price as part of running for re-election.

Finding the right Part D provider, or a better Medicare advantage plan? Really is asking me to game the best plan for me against a lot of professional statisticians with computers. Also my guessing what diseases I will develop in the next year, while the plans may drop coverage for something that I know I already have.

This system is supposed to offer the advantage of Free Market Capitalism in regarding to our health care. It is like, if your kid falls out a tree and breaks his arm. You don't say, next week I will survey all the clinics in driving distance to see which one has the best price. You will take your kid to the quickest place you think is competent, like the most expensive, an ER. Because he is in pain. Free Market concepts do not apply to any of these conversations, but Insurance Companies must make a profit. Suppliers of medical services must make a profit.

One of the more interesting books which is about this concept is the fictional novel by Robin Cook, "Viral."
 

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It is important to choose the right plan to ensure that you are adequately covered. To determine what type of plan is best for you, there are a few things that you will need to consider. First, consider your medical needs. If you have a chronic condition or are prone to getting sick, then it may be wise for you to choose an insurance plan with more comprehensive coverage.
 

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Hi Nancy, welcome to the forum. If you would, please start a thread in the new members introductory forum, here is a link to it. We would like to get to know you better.
 

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OMG, I am working with an agent to find an affordable health care plan for next year, and what I'm hearing is horrific. Thought plans were going to be cheaper this year. The plan I had last year for $65 a month is now $256 per month. Many of the companies are NOT COVERING NOVOLOG!! I use Novolog in my pump, and that's all I've ever used. If they do cover insulin, there is a huge deductible applied ONLY to insulin. Are they trying to kill all of us off? Please forgive the caps and exclamation marks; I just got off the phone with her. And I thought I saw something as I was logging in which said they're not covering Eli Lilly insulins either? Susan
My neighbor went from the quick pens to the Walmart insulin and she says she does better on it. It's $25 of vial.
 

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Thanks for all the responses; I haven't been on the site since I posted. foodaholic, I'm "lucky enough" to live in Texas too (heavy sarcasm), and am so irritated with Texas' ignorant governor and attorney general that I want to move out of state; I'm embarrassed to say I'm from the state which I believe I heard was 50th out of all 50 states in terms of healthcare. I ended up going with the best plan I could afford (UHC), which is a HMO. I've never had an HMO, and to make it more interesting, my PCP was an app called Galileo (my friend and I start singing the Queen song every time I mentioned it - am trying to keep my sense of humor). I quickly started yelling at Galileo because I never knew who was asking me for my personal information (a MD, a NP, a medical student, a non-medical person off the street) - there was no way of knowing because no one ever signed their names. Crazy! I finally got them to give me a referral to a live PCP I've seen in the past (think they were glad to get rid of me), but there are no appointments available for the next three months, and I am lucky enough to have the same endocrinologist, whom I was told can do a pre-authorization form for my new pump, but no one really knows. No one has ever heard of an insulin pump or a CGM or an infusion set and none of it is on the formulary, but I have the same DME provider, so they help a little. I have the MiniMed 630G and have had it for four years, so it expires in May and I'll need another one. But that's for another post.

Right now the problem is that Novolog is not on the formulary, so I got Humalog at my last refill and it's not working well at lowering my bgl's. I've been running in the 2-300s for the past two days (no ketones) and even got a couple of HI scores on my CGM, and I'm having to dose myself with syringes to try to get to a normal bgl, but I'm doing it over and over and over... I've always had fairly tight control; A1C was 6.8 last August, but last December it was 7.4 and will probably be worse now, and I've gained over 25 lbs since the pandemic started. Will see the damage when I get bloodwork done next month before my appointment, but I will call my endo Monday morning to get her opinion about dosing. I just read an article which said both Novolog and Humalog are fast-acting and they're basically the same, but not so for me. Has anyone else had the same problem with Humalog? Thanks.
 

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No experience with Humalog (not an insulin user). But I do have experience (successfully) challenging formulary. You need a cognizant (or "cognizant-adjacent") doctor as an ally. The most recent time I did it was with an NP (lower stakes that time but still...). Do you have records from your CGM showing that your BG is harder to manage with Humalog?
 

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No experience with Humalog (not an insulin user). But I do have experience (successfully) challenging formulary. You need a cognizant (or "cognizant-adjacent") doctor as an ally. The most recent time I did it was with an NP (lower stakes that time but still...). Do you have records from your CGM showing that your BG is harder to manage with Humalog?
Yes, I have tons of records from my CGM showing extremely high BGs; when I go to my endo I will bring it with me. They always download it into their system. And thank you Steve for the suggestion. I will ask my endo to do a "pre-authorization" or whatever they call it when they're requesting something outside the formulary. Great idea!! Her nurse can do that at the same time they're requesting a replacement insulin pump for me.
 

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Diabetes certainly has no cure on the horizon, and the quality of food intake has a big influence. Actually modern medicine is part of the problem and offers only short term remission. It is one of the reasons why many people ended up here on the forum, it wasn't working and they weren't satisfied with the answers they were getting. Following the dietary recommendations is doing Type 2's no favors and most meds have more risks associated with them than benefits.
 

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Discussion Starter · #16 ·
I’ve been on my 2022 HMO plan with UHC for almost eight months, and after all the whining, yelling (at the app which subbed for my PCP) and complaining, I got a referral to see a live PCP. I asked my endo to write a pre-auth for the Novolog and UHC gave it to me with no problems; my co-pay for 2 vials per month is only $25!
And when my Medtronic pump expired in May, she wrote another pre-auth for a pump and now I’m wearing a Tandem t-slim X2 with a Dexcom G6 CGM. I’m paying off the pump and Tandem supplies by the month, and my previous DME company ships my Dexcom supplies monthly. All good, right?

I received a 2-hour training from Tandem and used a YouTube video to help me change my infusion set the first time. But the second time I thought , “I got this” and did it myself. Long story short, my BGLs were high all day and by the next night it increased to 556 with moderate ketones. Called my endo and she called in a Rx for Tresiba pens, pen needles and syringes which totaled almost $150. My diabetes educator left a text stating she also had problems with the reservoirs at first (she’s Type 1). I am posting this hoping to be a great example of what NOT TO DO! All day yesterday and today my bgl’s have been in range, but I could have gone into ketoacidosis. Someone is definitely watching over me!
 

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Hi shrink111, glad things worked out for you. Not meaning to take us off the thread topic but what did you find to be the issue with the infusion set?
 
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