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12 Responses

  1. Joe
    Joe December 12, 2013 at 4:29 am | | Reply

    In my less than humble opinion, it looks like Oregon is hoping to make “Type 2″ diabetes go away.

    1. Mary Dexter
      Mary Dexter December 12, 2013 at 4:53 am | | Reply

      Unfortunately, the way in which Type 2 patients will “go away” is they will pass away.

  2. Scott S
    Scott S December 12, 2013 at 6:34 am | | Reply

    The notion of “clinically equivalent” is not the same as a generic is with the original, innovator medicine. In the case of insulin, its a biologic and different master cell banks are used, in some cases a different vector (such as using bacteria instead of yeast to culture the biologic) is used, which means the products can seldom (if ever) be switched unit-for-unit, hence the patient shoulders a degree of burden for each switch in formulary to save shareholders of the pharmacy benefits manager (PBM) money (let’s face it, these decisions are primarily about income for the company, not necessarily providing healthcare) when formularies change. For more than a decade, patients were routinely switched from Lilly insulins to Novo Nordisk insulins, but in recent years, Lilly has been much more aggressive on price, and has actually landed itself on a number of insurance company formularies. However, in extreme cases, the manufacturers will play stupid pricing games such as offering a great price for the first few years, and then try to raise the prices by 75% or even 100% more the next year, and the payers (insurance companies) appropriately determine to put the medicine up on an request for proposal (RFP) and get bids. This raises the possibility that patients can (and some HAVE) been switched from Lilly Humalog to Novo Nordisk Novolog and back to Lilly Humalog in the span of a few years (trust me, I’ve lived through it).

    Keep in mind that individual state laws come into play here, too. For example, some states like New York, Connecticut, and Massachusetts have mandatory coverage obligations (hence premiums in those states are higher, too). However, the specific rules governing insurance vary in every state, with some states having rules that insurance companies must comply with, while others are a free-for-all for the companies with little regulation to protect patients. Navigating state rules is often an exercise in frustration; the rules are often not easy to understand and finding anyone who understands them who can help patients is difficult if not impossible. Doctors may be the best helpers in this regard since they (or their staff) deal with this all the time, but be sure to schedule extra time so they (or their staff) can help out with the specifics of your state. The take-away is that patients must be their own advocates, but do your homework and understand what options are available to you, and then, pursue it.

    As the former insurance company former Vice President of corporate communications at CIGNA, who in June 2009, testified against the HMO industry in the U.S. Senate as a whistleblower, has gone on record as saying:

    “It’s to the insurers’ advantage for it to be complicated and confusing and hard to deal with insurance companies. They profit as a result of the confusion.”

    Mr. Potter wrote a book in November 2010 entitled “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans” details much of the industry’s deceitful tactics, putting them in historical context by drawing parallels to the tobacco industry and the history of manipulative public relations.

  3. Dan
    Dan December 12, 2013 at 6:46 am | | Reply

    Hi Mike,
    A good article. Now the real question is what is the reasoning for the implementation of these changes. As an example, the local drug store gave me the retail prices for the current three fast acting insulin: Humalog is $188.99, NovoLog is $205.99, and Apidra is $185.99. As a historical point, it is my understanding that Humalog is the oldest product of the three choices. There is one final fact to consider. Should an appeal process fail and we elect to pay the retail price: It will not be included in the deductible totals for our drug purchases. Ohm btw I have used all three of the fact acting insulin and have better control with Apidra. As always have a great day.
    Dan

  4. Candace
    Candace December 12, 2013 at 7:42 am | | Reply

    My husband and two of our three kids are T1s. We use Express Scripts for our prescriptions (not by choice) and I received the dreaded “you must switch from Novolog to Humalog” letter. Actually, I received two of them. Our 6 year old is only on Levemir at the moment, so I didn’t receive one for him. I realize that both drugs are in the same class, but they are NOT the same thing. Novolog peaks at 52 minutes and Humalog peaks at 75 minutes. Some people also find they need to increase their insulin intake with Humalog as Novolog is also about 10% stronger. I see a lot of the numbers I trust (ICRs, CFs) changing because of the switch. I actually called Express Scripts and told them I felt like they needed to explain to me how much money this change would save them as it was going to be making my job harder. If they would have messed with my beloved One Touch test strips, I might have gone crazy. I trust those strips to give me numbers I dose insulin off of. HUGE deal.

  5. tmana
    tmana December 12, 2013 at 6:07 pm | | Reply

    The CVS/Caremark plan I’ve just moved on to states it will ONLY pay for Accu-Chek. It won’t even cover my Freestyle Lite strips on Tier 3. As a result, I will continue to purchase from third-party vendors at my own expense.

  6. Nancy
    Nancy December 13, 2013 at 7:06 am | | Reply

    I am on Medicare with supplemental coverage. When I first went on Medicare I could no longer buy my pump supplies from Medtronic. I was directed to an “approved” supplier. Then I was told I wouldn’t be able to use the Bayer meter that links with my pump bc Bayer testing strips were too expensive & would not be covered. I have recently received a Nova Max Link meter & strips as a replacement.
    I also can’t help but wonder if there is actually someone sitting in an office some where reviewing the 30 day bg log I am required to submit every 90 days as proof that after 35 yrs of being a diabetic I in fact still have diabetes, & therefore they still need to determine medical necessity.

  7. StephenS
    StephenS December 13, 2013 at 7:16 am | | Reply

    Mike, thanks for covering this topic. I’ve received my letter too, and I’m not happy at all about it. I keep wondering when companies are going to realize that overall savings happen when long-term outcomes are considered. Probably when bonuses are based on patient’s health, rather than next quarter’s earnings release. That would be nice, wouldn’t it?

  8. Brad
    Brad December 13, 2013 at 9:52 am | | Reply

    Mike, I received a letter from CVS this week stating that my Bayer strips won’t be covered next year, which really upset me because I really love my Contour Next USB meter, and have just within the past two weeks started to sync it with Glooko. I finally found a meter & log that WORKS for me! I am going to fight the switch for sure!

  9. Lee
    Lee December 13, 2013 at 11:11 am | | Reply

    I find it extremely curious that the author does not mention the Affordabel Care Act or Obamacare anywhere in this article. Its omission speaks volumes, to me anyway.

  10. Gail
    Gail December 18, 2013 at 9:00 am | | Reply

    There’s so much to be outraged (mad) about regarding increased obstacles that must be overcome to keep yourself (diabetic) healthy, but I wanted to mention something comments did not seem to address, those of us who pay cash out-of-pocket (self employed, too young for Medicare, not disabled or eligible (or non-existent) for some state insurance plan…The cash price for insulin + strips over past year has skyrocketed! E.G. Lantus insulin I paid $120 for last year now is as high as $235.00 bottle! In just past month, one pharmacy jumped (cash) price for Lantus bottle $23.00 more! Same goes for strips I use (for years), jumped up to $165.00 for 100 strips. So in addition to all the other outrageous issues with healthcare, (E.G. Insurance companies taking away your choices, increasing deductibles + co-pays, etc. and ObamaCare failures + inadequate state-run insurance programs, etc. THOSE OF US stuck with paying out-of-pocket SOON (unless very rich) will no longer be able to afford any care or supplies=DEAD or will develop serious complications that could have been avoided. The possible solutions and adverse outcomes are complex, but at moment the only immediate solution I can think of is to move somewhere else outside USA (like Canada) where “all are entitled to basic medical care” and prices are restrained (kept lower) by government interventions (negotiations). So sad, that so many more are faced daily with difficult decisions such as do I pay my rent/mortgage and eat or use that money to buy insulin and diabetic supplies…

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