A Boomer Lifestyle Blog

Sunday, May 19, 2019

Will the Insulin Problems Never End?

I received a copy of my monthly statement from the Medicare Drug Insurer last night.  I had just looked online last week when I pulled that snafu and ran out of Novolin-R late in the evening and had to go to Walgreens for an expensive refill.

I didn't look at the total of the amount Medicare had paid, and only looked to see the extra $100+ Walgreens had charged over the price at Walmart.  Truthfully though, I'm extremely lucky to be able to get one of the original insulin drugs over the counter at Walmart.  They have some kind of deal with the manufacturer of Novolin-R.  Once again, you have to know this to get the deal.  My doctor said Novolin-R is not nearly as good as the one she would like me to take, but understands that I am caught between a rock and a hard place.  I only wish the other drug, for which there is no generic, of course, was equally available.



So I decided to give the statement a good read.  As my doctor has been increasing the amount of insulin I take every 3-4 months, it had been on my mind that this would affect the bottom line of my insurance coverage before I reached the dreaded Gap period.

You heard this coming, right?  With my next refill of Toujeo which charges Medicare $1560 for 54 days, I will reach my Gap period.  The normal coverage period ends at $3,820 in drug expenses and the Gap period lasts until $5,100 has been incurred.  If you know Medicare coverage, they have a fancy formula for what they pay and what you pay while in the Gap period. I tried to figure out what it would be: 70% of the negotiated price, less 5% paid by Medicare, then 25% paid by me???  Too complicated for this old brain to figure out.

The only good thing is that with the price of my insulin I should get through the Gap period faster than most.

Tut.  Tut.  Tut.  In what world does this make sense.

On the other hand, my friend's mother has Alzheimer's.  She is living with my friend and her husband and trying to run away daily and becoming frightened over so many things.

There you go.  There is always someone who has it worse.






10 comments:

  1. I'm so sorry you have to deal with all this, Barbara. No fun. You've got a good attitude though, and for that I applaud you. Hugs, Nancy

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  2. I'm not sure where you live and how close you are to the Canadian border, but our news reports that lots of American diabetics are coming to Canada to buy insulin because it's a lot cheaper here than in the US.

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    1. I'm all the way down in Texas but I have been reading news articles about Americans going to Canada for insulin. Mexico would be closer for me but if I crossed the border the orange idiot might not let me back in. It's a ridiculous situation and I wish I had known before I retired how my diabetes would deteriorate and how much the drugs would go up. Best laid plans of mice and men ...

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  3. I am so blessed to have retired from the government and have my insurance with them. No gap. But this year we are well on our way to reaching our catastrophic deductible. I never did understand why that gap thing is there. Makes no sense to me.

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  4. Oh my! I don’t understand the coverage or gap business. I sounds inadequate for your needs.. I hope it all works out for you, Barbara.

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  5. Hi, Barbara! After you commented on my post, I had to come check you out in return. I read clear back to January! Now I'm YOUR newest follower. :)

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  6. I have never reached the gap period of insurance coverage for medicine, but have had to pay way too much for drugs, even with my 'full' coverage. I heard about Good Rx, a program which is totally free, and which provided much better coverage for my most expensive prescription than my insurance does. The program lets you print a coupon or download it to your phone. The coupon is good at several places, but not everywhere. In my area the discounts are available at Costco, WalMart, Target, Walgreens, CVS and HyVee grocery stores. There are other free discount prescription services besides Good Rx, it's just the one I happen to be familiar with. You can do an internet search and find others. My quick check for Novolin-R shows that Walgreens sells it for $28.38 a vial with the coupon. What you need may be different from what I searched for, but you can get an idea of the discount available at a pharmacy that will gladly charge you so much more than that if you don't happen to know to search for help. I always thought that insurance was to help us save money. With drugs, that is NOT the case. Good luck!

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  7. I remember my husband getting to that gap period. I didn't really understand it then either.

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  8. OMG this is just so awful Barb. Why on earth do we allow big pharma to do this to us? I'm so sorry.
    Yes, some Alzheimer patients do get scared of everything and run away. My neighbors mom would just go out walking in her nightgown. One day my husband saw her and ran up to her and asked if she'd like some company on her walk. It was 6:30am! She said yes, and put her arm through my husbands and just held him like her prom date. It was actually cute. He turned her around and walked her home all while chatting like this was normal. Because we knew the daughter he walked into the house with her. The daughter had just called the police and was so happy to see her mother as you would imagine. At night she would have to lock her in her room and if she woke up and couldn't get out she would scream and scream she was being held hostage. It was so awful for both of these poor women.

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  9. It is sickening what pharmaceuticals are getting for life needed drugs. How do they sleep at night? That Good RX Peg mentioned is worth looking into. I save with each prescription at Walmart using the free card I got from my Dr. They print out on the sheet how much you save. My Sotalol which is normally $48 was only $23.95 Worth a try.

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