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Tuesday, October 28, 2014

Blue Cross Blue Shield of Illinois changes coverage of insulin! Imagine that.

So I got this wonderful gem in the mail last night.

You really really have to love it when an insurance giant like Blue Cross Blue Shield of Illinois decides that it can force you to use which ever insulin they want.  NOT what your DOCTOR thinks is right for you but what they decide they want to cover.  Starting Jan 1 members who are currently taking Humalog or Humulin will be required to go through prior authorization before the drug will be covered at the non-preferred benefit level.  Your doctor will need to submit a request for coverage.

WHAT. A. JOKE.  They use to cover them both equally, what happened?!



Luckily I JUST switched to Novolog but if I had not I personally do not feel like I should be pushed by an insurance company to switch the type of insulin I am on.  Read the bottom line: Most brands of human insulin work nearly the same.  They all work to lower your blood sugar.  Starting January 1, 2015 if you decide to start using a preferred insulin - you should ask your doctor first.  (REALLY?  Because the last time I checked we are allowed to just change our own prescriptions without telling our doctor?)  What the freaking heck?!

THEN it goes on to state about the preferred test strips also!  I have been using Bayer CONTOUR test strips for several years now, thankfully I dont have to change AGAIN!  BUT the kicker is the back of this letter!

Members who are currently using non-preferred test strips will need to go through step therapy.  This means that non-preferred test strips will not be covered unless you try the preferred strip first.  If you and your doctor decide the preferred strip is not right for you, your doctor should submit a prior authorization request for the non-preferred test stip.  If the request is approved, the test strips will be covered at the non-preferred benefit level. (Good luck getting it approved, I have tried this several times and finally gave up)

I know that this shouldnt technically have much effect on people with Diabetes but to have your insurance company make these sort of decisions about our Diabetes medications and treatments really quite frankly pisses me off and it pisses off almost everyone with Diabetes.  MAYBE these insurance companies should get together and force the pharmaceutical companies to lower their costs.  I mean come on 3 bottles of Humalog was around 650/mo before insurance for me.   It does not need to cost that dang much!  Say hey Mr. Billionaire we arent going to cover your insulin AT ALL unless you lower the cost down to 100/bottle or whatever.  

How do you all feel about your insurance companies dictating what insulin you take and what test strips you can use?  I flat out cannot use any other brand of test strip, they just are not covered AT. ALL. I do know this has been going on for many years as I have had to switch several times so I know that this has nothing to do with the ACA, so please do not assume I am blaming that or attributing it to the new health care laws.



5 comments:

  1. Wow! Can't believe they have the audacity to suggest this, well not even suggest but dictate(?)! I haven't experience with insurance companies since i'm from the UK however recently my needles have been changed, by the GP (who I don't know or have ever met) without my consent... after apparently being 'reviewed'. Without my consent! I know this is an old post however you've given me something to write about :)

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    1. Lizbetic, it happens all the time. Here in the US insurance companies are always dictating what they will or won't cover and switch preferred brands of insulin or test strips all the time. We just switched insurance companies at my work and they also "prefer" Novolog. Now I have to switch test strips again because the new company won't pay for Bayer, they prefer One Touch, so I am going to finally use the Verio IQ meter I got with my t:slim insulin pump. Its just a big giant nightmare to be Diabetic and live in the US.

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  2. I hate letters like this. They are such headaches! It's crazy all the hoops we have to jump through just to STAY ALIVE, and they have no CLUE! "Prior authorization is required for high risk drugs that can be misused"...what a JOKE! If Novolog, Apidra, and Humalog all work the same, they should either all require PA or all be covered. I personally hate the health insurance dictatorship that is existent in the US. Patients have the right to choose which medication they want to use. Insurance companies should not have a say in the matter because they are not personally involved in the patients' health care. They are just employed to help cover the costs!!

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  3. Does anyone know if any lawsuits in place for this? I am trying to fight this right now.

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  4. Good comments , I am thankful for the info ! Does someone know if I might be able to get access to a fillable a form copy to use ?

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