The Dreaded Formulary Change

Levemir and Apidra pensEvery year, I cringe when the packet comes with my plan’s changes for the upcoming year. Late yesterday afternoon, I went over for my mail and my insurance stuff was there. It was not good. After first looking at the part that had all the $$$ increases that I can’t afford, I pulled out the formulary booklet to look at that. I was only on the very first drug when everything came to a screeching halt. Apidra will not be covered in 2012. Only a little over a week after finding out there will be an Apidra SoloSTAR shortage and worrying about how I will survive a couple months without it, I am now being told I can’t have it period.

I would like to say that I felt like someone put a gun to my head, but putting a gun to my head would be too easy. I have neuropathy, both peripheral and autonomic. I have gastroparesis. Apidra is out of my system in 2 ½ hours. It is the best insulin that I have used. I can take a shot of Apidra every hour to keep my blood sugar stable after eating. I can’t do that with Novolog or Humalog. In the almost 3 ½ years that I have been using Apidra, I have managed to keep my A1cs in the 5s other than one 6.1 and the 6.1 was because of all the pump problems I had. I was never able to do that with the other insulins. I have fought so hard to keep my blood sugar under control and try to keep the complications I have at bay. Now I am basically being told you get to die but you have to die a very slow painful death from neuropathy.

Needless to say, I have been doing a lot of crying and praying since yesterday. If I want to continue to use Apidra, it will cost me $90 a month. I don’t have $90 to spend on insulin along with the all the other co-pays for drugs, test strips, doctors, lab fees and everything I need just to stay alive. I am already on a bare bones budget. I am on disability so it isn’t like I can go out and get a part-time job to help tide me over.

My plan is a Medicare Advantage plan. I went to the website to see what else is available in my area and my choices are pretty limited. You can put in your drug list and that narrows down the choices even further. Most of the doctors I use, I could care less about but I do have two that I would like to keep. Of course, one of the plans that did have Apidra doesn’t have the doctor I use for my foot – he is the best doctor that I have ever had and considering all the other idiots I have seen, I don’t want to give up a doctor that I actually trust. I am basically screwed no matter which way I look at it.

This morning I called my plan’s customer service to find out how I can file an exception to try and get Apidra. His first response was that my doctor has to do it but their website said that I could also do myself. If my doctor would do it, I would have a snowball’s chance in h**l in having that go thru. Now I have to wait for the pharmacy department to call me back. I will start working on writing up why I need Apidra as opposed to the insulin they will actually pay for. I will continue to pray that I am able to continue to get it – it is literally a death sentence for me if I don’t.
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4 thoughts on “The Dreaded Formulary Change

  1. Kelly – I would be feeling the same way as you are with that news. I really REALLY don’t get American health care system at times – I know Americans have tried to explain it to me – but I still don’t get it . Here in Canada, with a doctors approval, you will get approved on drugs that aren’t covered by our individual provinces (every province e.g. state has different ways of handling things). I had to when I went onto Levemir here in Quebec – but I believe now – you don’t have to – but can’t say that for sure.

    Hoping that things come out okay in the end – keep us posted – and if all else fails – we’ll put our heads together to figure out how to keep you in good health with the products you NEED to stay alive and healthy!!!

    • Thank you Anna! I know other countries have their little quirks too – it is harder for you guys to pumps than it is for us. Hopefully I can get it approved, One of the drugs that I take for asthma isn’t covered either, but that one, I am not as worried about.

      • It’s not really harder for us to get pumps here in Canada – we’re just limited to certain ones unlike USA – as well – if you have medical insurance thru’ your workplace – “generally” they will cover the pump purchase, etc. (mine was 80% – 100% for supplies). There are about 4 provinces now in Canada that cover pump coverage for kids under 18 with T1 diabetes (Ontario so far is only one I believe that covers ALL age groups). Quebec, where I live, just passed pump coverage for under 18 – and I’ve been writing to my Prime Minster of Quebec and provincial parliament members to allow ALL ages to be covered – for those who aren’t as lucky as others to have medical coverage thru’ work.

        I have a friend in Germany as well where her country has pump program similar to Canada BUT she maybe losing her pump since her A1C is high & you have to keep your A1C within a certain number in order to stay on the pump. It maybe the same rules here for the provinces that have pump program as well. The pump is not the “fixer upper” for all patients who use it – some think it’ll make things better – but not always.

        I know when I retire – depending on private insurance – I may not be able to afford a pump if the province does not help with keeping it. Again, I’m lucky, can control my diabetes with both MDI (multiple doseage injections aka poor mans pump ) as I was doing this 40 years prior to going onto the pump 4 years ago.

        Okay – I’m shutting my big mouth up here – taking over your post on a subject that deserves a separate discussion!!! Main thing is to get you sorted out with keeping your current drugs available to you!!!

      • Honestly Anna, you can rattle as much and about whatever you want! I don’t mind! But there is a chance you can lose your pump when you retire. Medicare does cover pumps here for Type 1s when they retire – at least right now. It is the Type 2s that lose them here, so you would be safe. I read Barb’s blog at Diabetes Advocacy and she is worried about what will happen to her son when he turns 18 because her province won’t cover them. I guess that is why I figured they were harder to get in Canada. I guess know matter where you go, you could be a group with a problem.

        I am not worried about the pump coverage for me since I do better on MDI. I do know some people seem to do better on them. I know you like yours, so I hope that you get to keep it if you want to keep using it!

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