Apidra and Medicare: Good News!

Apidra and LevemirLast week after a reader contacted me that Apidra was not coming up on the Medicare search tool, I contacted Sanofi-Aventis. I came home Friday to find an email with some good news. Apparently, Medicare made a mistake in not including Apidra in the search tool. Most Medicare plans will still cover Apidra. Unfortunately, because the search tool will not help you, you have to go to each available plan’s website (or call them) to find out whether or not they will cover Apidra. The person at Sanofi also told me that if it is not coming up on the plan’s list, to call them to make sure because they might not have the latest available updates on the website.

My pharmacy was closed when we got back from Pittsburgh Friday evening, so I gave my two prescriptions to my mother to pick up. Saturday morning, I logged into my plan’s website to see if the Dakin’s solution would be covered – the wound center told me that it might not be covered. I noticed that they had the 2013 formulary up so I looked to see if Apidra was on there and it wasn’t. I then looked at one of the other plans in my area and they did have it.

My first thought was to just switch plans – Apidra is the key to my being able to manage my blood sugar with gastroparesis. The plan I like is accepted by a lot of doctors so that is a plus for that. I can also go see a specialist without getting a referral from my PCP – another big plus. When I decided to go to the wound center, I called and made an appointment without having to go thru my PCP to do that. I have had insurance plans that you need a referral first and it slows down the process of getting treatment fast when you need it. I did that with a foot ulcer once and had to have the PCP look at it before I could go to the podiatrist. Then when I got to the podiatrist, the referral was only for him to look at it, not to treat it. We had to wait to get the referral to allow him to treat it. He wasn’t very happy and neither was I!

I believe that I have a good chance at winning an appeal to get Apidra covered because of my gastroparesis. Everyone told me that I could not get a CGMS thru Medicare and I did. I still hear that all the time – they won’t’ cover it if you don’t fight for it. I am going to stick with my plan and fight to get Apidra covered. Then I will have the best of both worlds!


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