Does Insurance Cover Insulin

Soaring Insulin Prices Prompt Insurance Shift

Since 2002, the cost of insulin has increased by almost 200 percent, according to a new study.Video provided by Newsy Newslook Corrections and clarifications:This story has been updated to reflect fact that Basaglar can’t be used in an insulin pump. Many parents of diabetic children and adults suffering with type 1 or type 2 diabetes are bracing for changes in insurance coverage of their insulin next year, as prices of the vital medication continue to soar. Higher insurance deductibles and changes in the prescription brands covered by some insurers are raising concerns among some people with diabetes. CVS Caremark, a pharmacy benefit manager (PBM), will no longer cover the insulin brand Lantus in favor of a new biosimilar version, Basaglar. Biosimilars are considered the generic versions of "biologic" drugs that are based on natural sources. The company also announced a program last week to further keep diabetes costs down, following a similar move in August by competitor Express Scripts. Diabetes is an epidemic in the United States, affecting nearly 10% of the population or about 29 million people, according to the Centers for Disease Control and Prevention. Of those, more than 8 million people are undiagnosed. Type 1 diabetes — often still called juvenile diabetes — can occur when people are children or adults. Type 2 diabetes is becoming more common with the increase in obesity and sedentary behavior. Prices for Humalog and many insulin brands have increased from about $300 to $500 between January 2013 to October 2016, according to drug discount search company GoodRx. Lantus increased about 60% — from $240 to $380 — in the same time period, GoodRx says. (Photo: T1D Exchange) "It’s definitely unfortunate prices are going up so much and impacting the people Continue reading >>

Is My Test, Item, Or Service Covered?

How often is it covered? Medicare Part B (Medical Insurance) doesn’t cover insulin (unless use of an insulin pump is medically necessary), insulin pens, syringes, needles, alcohol swabs, or gauze. Medicare prescription drug coverage (Part D) may cover insulin and certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs. If you use an external insulin pump, insulin and the pump may be covered as durable medical equipment (DME). However, suppliers of insulin pumps may not necessarily provide insulin. For more information, see durable medical equipment. Your costs in Original Medicare You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the Medicare-approved amount, and the Part B deductible applies). You pay 100% for syringes and needles, unless you have Part D. To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like: Other insurance you may have How much your doctor charges Whether your doctor accepts assignment The type of facility The location where you get your test, item, or service Continue reading >>

Prepare Your Patients For An Insulin Change For 2017

Mo st insurance plans will be dropping Lantus from formularies. Guest Post by David Kliff, Diabetic Investor Sometimes I’m amazed at how oblivious some people in this wacky world can be. Actually, I should say it really doesn’t amaze me given this is the wacky world of diabetes, which is full of clueless opinions. I mention this after some conversations on the nature of the insulin market. Yes, people are beginning to wake up to the fact (yes, those damn pesky facts again), that insulins have become a commodity. This is particularly true with long-acting insulins, of which there are now 5, one being a biosimilar. Lilly has the biosimilar, Basaglar, which is winning the war that counts: formulary position. Lantus, the current leader, isn’t just losing the war, it’s losing by a mile. Starting next year, when formulary changes go into full effect, Basaglar will become the long-acting insulin of choice. Not because it’s any better than Lantus — it isn’t. It’s the same as Lantus, only cheaper — which is exactly the point. Still, many seem to believe there will be pushback from physicians. Why would they switch any patient from Lantus to Basaglar, especially when Lantus works so well? First, as much as I hate to state the obvious, it really won’t be left up to the physician. It will be the payor and formulary position that wins, not the opinion of the physician. Think about the discussion a physician would have with a Lantus-using patient after these formulary changes take place. “Mr./Ms. Patient, you know I would like to keep you on Lantus. It’s been a great drug that has worked very well for you. Now I could keep you on Lantus, but there is a slight problem: your insurance company no longer covers Lantus. You can stay on Lantus, but I must warn you t Continue reading >>

Insurers Heavily Restrict Diabetes Coverage In 2017

Dear Betics, Nothing makes me madder than having to arduously fight the insurance bureaucracy to stay alive. And the NPR report I read today has my heart racing with indignant rage on behalf of diabetics everywhere who KNOW what a struggle it is to cry, beg and plead with the insurance company in an effort to coerce them into doing the very thing they’re charged with doing: keeping you alive and well. If you have diabetes, you probably (like me) burst into tears at least three times per year after ending a call with a customer service representative who insists your life-saving diabetes treatment isn’t covered by insurance. Before you continue reading, get your game face on, because this is going to piss you off. In 2017, diabetics who get their meds through CVS Caremark or Express Scripts are in for some blood boiling adjustments to diabetes (and other) drug coverage. NPR’s got the full story, and you can read it here. For my part, I’ll summarize the CVS diabetes drug denial list for 2017 (because it’s bigger than the Express Scripts list), and discuss why denying people the drugs they need to stay alive is so awful. Both companies are choosing to remove brand name drugs from their formulary and instead are choosing to cover generic versions. Fine. We’re all accustomed to that. That isn’t news. Substituting generic for brand name happens ALL the time. I’m not upset about that. Here’s what I AM upset about: the prescription insurers are choosing to replace some of your current meds with biosimilar medications (this happens from time to time with all insurers, but not to this degree). Replacing a drug with a biosimilar is NOT the same thing as replacing a brand name drug with a generic drug that has the exact same ingredients. In this particular con Continue reading >>

Diabetes: Should I Get An Insulin Pump?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Get the facts Key points to remember An insulin pump can free you from a strict regimen of meals, sleep, and exercise, because you can program it to match your changing schedule. After you learn how to work with a pump, it can make living with diabetes easier. But it takes some time and effort to learn how to use the pump to keep it working properly and to control your diabetes. Using a pump includes checking your blood sugar many times a day and carefully counting the grams of carbohydrate that you eat. Using an insulin pump can keep your blood sugar at a more constant level so that you don't have as many big swings in your levels. People who use pumps have fewer problems with very low blood sugar. Many insurance companies cover the cost of insulin pumps, but they have strict guidelines that you will have to follow before they will pay. Continue reading >>

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage State Laws and Programs Diabetes Health Coverage: State Laws and Programs This is a policymaker and consumer guide to state insurance mandated coverage, Medicaid coverage and state-sponsored diabetes programs. It was published 2011and updated material was added January 2016 All state law diabetes mandates and minimum coverage requirements for state-regulated health insurance policies. The tables include the enacted state laws passedsince the firstmandates inCalifornia (1981) and New York (1993). Use links below to go directly to state-based information: State Medicaid diabetes coverage terms and conditions. All Children's Health Insurance Program (CHIP) diabetes coverage. Contact information and an overview of federal funding provided by the Centers for Disease Control and Prevention (CDC) to state-sponsored diabetes prevention and control programs (DPCPs). DPCPs represent the front line in battling diabetes in most states. An overview of other state activities and initiatives, such as creation of diabetes coordinator positions in the executive branch to fight diabetes. Federal Health Reform.The federal Affordable Care Act (ACA) signed March 2010, has led to changed and expanded coverage termed "EssentialHealth Benefits." Newly Released: NCSL Survey:Diabetes Drug coverage: A new survey of2016 Insurance Plans in 50 states, examining 1) patient access to the scores of diabetes drug treatments and2) results in the 46 states with laws mandating or offering diabetes coverage. NCSL original research, published summer 2016. [Read the report] December 2015: " Diabetes: Addressing the Costs; A 50-State Budget Survey for FY 2014 ." NCSL released its latest diabetes report, taking a closer look at programs and budget appropriations that play a role in con Continue reading >>

Health Insurance And Diabetes

Almost everyone with diabetes has a run in with health insurance concerns at one time or another. A quick search of "diabetes" and "insurance" brings up hundreds of forum topics with people talking about their insurance woes. Most people with diabetes either have insurance that won't cover enough of their diabetes needs, like test strips, labs, and doctor's visits or don't have insurance to help at all. If you have insurance, how do you get them to give you the coverage you want and need? If you don't have insurance what other options do you have? There are a couple of things you can do to help insurance maneuvering go smoother and we’ve listed some of them below. We’ve also included some helpful links for further reading. Know your Insurance Your physician and diabetes healthcare team will help determine what you need for good control. Be sure to obtain any referrals that may be needed to see specialists, such as an endocrinologists or internist or diabetes educator who specializes in glucose control and handling of diabetes complications. From their suggestions, you want to check with your insurance company to see what they cover, which brands they cover, and what amounts they cover. Find out if you have to visit certain pharmacies for your supplies. Your copay may be lower if you order your medications and supplies by mail. You should ask about test strips, insulin, medications, lancets, syringes, insulin pumps, continuous glucose monitors and any other supplies your team suggests. Also, ask if they reimburse for cash purchases from companies that don't accept insurance payment. Most insurance companies cover insulin pumps and supplies. The pump companies will help you through the insurance process if you contact them. Visit our Current Insulin Pumps page for lin Continue reading >>