The last time I updated about my diabetes was in August. A lot has happened since then, so I decided to update y’all. I started taking Novolog using a prefilled pen type of injector after my August visit with the endocrinologist. It was easy enough to get used to, and it worked well in keeping my blood sugar under control. Then, in November, I entered into the “Medicare Gap”. For those of you who do not know what that is, I’ll try to explain.
This is from Senior65.com:
In 2015, if your Medicare Part D drug plan has a coverage gap once you and your insurance provider have paid $2,960 toward your covered drugs and you exit it at $4,700. Here is what you’ll owe for generics and your plan’s covered brand name drugs during the donut-hole:
Generic costs: 65%
Brand name costs: 45%
My insulin was going to cost me over $300 for each prescription for the month of December. I was panicking because I really didn’t know where almost $700 was going to come from to pay for my medications. I went to the Haralson County Department of Family and Children’s Services, which is the agency I needed to apply for the “Extra Help” that is available to some people who are having problems paying for their medications through Medicare. I did not qualify for that extra help. The next step was to apply for “financial assistance” from the manufacturers of the two forms of insulin I take. I did not qualify for that either, because I have insurance. Catch 22, eh?
Next, I asked my primary care doctor if she had any samples she could offer me so that I could make it to January, when I would be out of the gap purely because it was new year. She told me that she was no longer able to dispense medication samples due (I think, see note) to a provision of the Affordable Healthcare Act (Obamacare). This provision mandates that in order for rural healthcare providers to dispense samples of medications to their patients, they must keep a record of what medications they gave out, and they must call each patient who is using sample medications every day for five consecutive days to ask the patient if they are having any problems with those medications. In order to do the required patient contact and associated reporting, my doctor would have had to hire someone specifically to take care of making the calls, entering the data into the computer, and fill out out reports to comply with the mandate. Because hiring another person for her practice would be financially draining she opted to not give out medication samples. (note: I googled my brains out trying to find information to back this up but was unable to find anything. Next time I talk to my doctor, I will ask where to find information about this.)
My endocrinologist is in another county and city that is not considered to be rural, so I went to his office next and requested samples that would be enough to get through December. Because so many of his patients are on medicare, and are all in “the donut hole”, they were completely out of samples. I understand that. I am not the only person who was floating in this boat. So, at this point, I had exhausted all of my options for getting any financial help or free samples of my medication. I ended up doing without one of my insulin prescriptions for three weeks simply because I could not afford it.
I had a regular appointment with my endocrinologist the first week of January. Amazingly, my hbA1C was 6.1. The doctor remarked that I was the first patient he had seen that day with a normal A1C. I then had a discussion with him about the unaffordability of the medications he had prescribed for me, and I asked if there was a cheaper option I could take. That is when he told me that Wal-Mart has their own brand of insulin, both the long acting and the fast acting types, and that I could get them without a prescription at the Wal-Mart pharmacy for about $25 each. He told me which one of their brands was equivalent to the meds I take, and how to take each one. That was a real relief to me, because I would be going into the medicare gap this year in April, making my insulin just plain unaffordable for more than 7 months.
The price of the two vials I need every month of insulin, one of each type, plus the syringes I need to be able to give myself the injections, is $62.64. If I were to go through my insurance company and get to get the pre-filled pens that my doctor prescribed for me to begin with, the cost would be $90–two $45 co-pays. And, it would throw me into the “gap” starting in April, making all of my medications more expensive until November, when I would have paid enough out of pocket to come out of the gap. What I don’t understand is why I had to go through all of the steps I went through, and do without my medication for almost a month, before I got the information I needed. Why would my doctor not tell me about a less expensive brand of medication that works just as well? I already know the answer, but I still had to ask it here, just to provoke people to think about what they are doing.
Now, my advice to any of you who have gotten this far reading about my medical hassles, is to 1) Tell your doctor you can’t afford the medication he has prescribed, and 2) ask your doctor if there is a more inexpensive medication that will work just as well for you. You are your own best advocate–open your mouth and speak up for yourself.