[Diabetes-Talk] Questions regarding insurance, and insulin pens

Mon Dec 2 21:39:16 UTC 2019

Terry,

I don't have answers for you, but generally, if you have both Medicaid and
Medicare, what one doesn't cover, the other will, give or take. I could be
completely wrong, but usually the more providers you have access too, the
more coverage you have. I haven't been on Medicaid for years, but when I
was, it covered certain things that Medicare doesn't, like birth control
  and Medicare helped fill in gaps with Medicaid. My point being, it might
be a good idea for your boyfriend to have both Medicare and Medicaid if he
qualifies. Sorry you're not getting answers you want/need. Insulin costs are
off the charts right now with no end in sight. Federally, nothing is being
done, but Colorado as a state has passed legislation allowing diabetics to
not have to pay over a certain amount for insulin, and it's very affordable.
I don't recall all the details, but it's a pretty progressive and awesome
piece of legislation I hope other states model.

Bridgit

-----Original Message-----
From: Diabetes-Talk <diabetes-talk-bounces at nfbnet.org> On Behalf Of Terri
Stimmel via Diabetes-Talk
Sent: Monday, December 2, 2019 3:22 PM
To: Diabetes Talk for the Blind <diabetes-talk at nfbnet.org>
Cc: Terri Stimmel <icecreamlover76 at outlook.com>
Subject: [Diabetes-Talk] Questions regarding insurance, and insulin pens

Hello everyone,

I don't know if anyone here will have any thoughts for me. What I have to
ask is rather complicated. I am hoping though that some of you might
understand this, and might have some advice. Or at least know where to
direct us.

Ok, my boyfriend has type II diabetes. He receives SSDI, and is on Medicare.
We live in the state of Missouri.

Right now, he is not on Medicaide, because the last time he applied, his
spend down amount was going to be around $600, or 700. So he decided to not
get the Medicaide, as that would have been about half his income.

well right now he is trying to decide as to whether or not he should stay
with the drug coverage plan he has. Which I believe is Signa Health Spring,
RX. He goes through a broker to try and decide what plans might be best for
him. He has had to use different insulins over the last couple of years, due
to the price. He wants to stick with the insulin pens, because these work
best for him. Due to his limited vision, and other things.

However, the lady who has been helping him to figure out if he should stay
with what he has, is telling him that nobody will cover the current
short-acting insulin he is taking. I doubt I will spell this correctly. 
But it's, Epedra. The only reason he is currently on this is, because his
doctor's office was able to somehow get him in to a patient assistance
program. This covered that medication, and Lantice.

Well, he has looked at Novolog, and Humalog to see if he could possibly take
1 of these, and maybe go back on Triceba for his long-lasting insulin. while
he could get the Triceba for a reasonable price in the beginning, that's not
at all how it is for the short-lasting pens. And apparently, according to
the information we were given, there are only 3 short-acting insulins that
come in the pre-filled pens.

Anyway, with any of these 3, they seem to be anywhere from $700, to maybe
$300. I might not be remembering this exactly right. But this would be the
sort of prices we would deal with, until he reached the doughnut hole, as
some call it. Also, he could get a low premium cost, but have a high
deductible.

As you can imagine, we don't know what to do. He feels at a loss. He needs
the insulin. His diabetes isn't real well managed as it is. He is
considering seeing if he could go back to using viles, and just getting help
keeping syrenges full. But we don't know if this would be better, or
cheaper. Although a nurse at his doctor's office did say that the pens are
more expensive.

Does anyone else deal with all this? How do you all manage the cost of your
medications, especially the insulin pens?

He does take other medications as well. But these are pretty affordable.

Any thoughts and suggestions would be very much appreciated. Sorry for all
the mis-spelled words. I hope you all will get what I am attempting to say.

Thank you,

Terri

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