Diabetes.Blog.com

1 - I will start this new forum with Amylin's page on insurance coverage and help paying for Byetta with the Patient Assistance Program:

http://www.byetta.com/patient/byetta_insurance_coverage_141.jsp?reqNavId=4.2 (Comment this)

2 - My bg testing is not totally covered by my insurance company. I'm sure many have found this as well. If I want to test 4 x a day or more in order to determine which foods/carbs work for me - I will have to purchase test strips and or lancets on my own. They seem to cover 2x a day. Why is it if they want us to stay healthy and not cause them MORE outlay of money when and if we have major complications they can't see the benefit of paying UP FRONT for more testing strips and lancets. Just drives me crazy and needed to vent!!

Byetta 5mg 2x, Fortamet 1000 2x, Amaryl 1g 1x, Testing 4+ x per day! (Comment this)

3 - Judy, What does the prescription from your doc say? My doc prescribed 4-6 per day and I don't have a problem with my insurance. Without those specific directions, I wasn't able to get near that number. (Comment this)

4 - Thanks for the heads up Pat, I'm going to request a mail order prescription from him tomorrow and will specify that I want that ON the prescription. Maybe I'll get lucky and it will make a difference in what they give me!!

Judy (Comment this)

5 - I told my doctor that I go through 200 strips in 30 days so she made the prescription for that amount.

Still waiting for the word on the byetta going through. I have only one week left on the pen and am just doing 1 shot a day at dinner to make it last.
Just cannot afford to pay for it out of pocket anymore (Comment this)

6 - GOOD luck on getting the byetta through. I am running out of test strips as we speak.. For my monitor 100 strips is 90 dollars. That's insane. I am picking up the new prescription from him tomorrow and hoping the insurance co. picks it up. The insurance companies want us to be healthy - they want us to stay well or it costs them more money but yet they arent willing to pay upfront to make it happen. Somebody explain insanity? (Comment this)

7 - Judy
Look up your meter for there website. Many of them will provide free strips if you met certain guidelines. I was able to get 100 free strips to tied me over when I had no money to have my script refilled (Comment this)

8 - Judy Byetta5 2x, Fortamet1000 2x, Amaryl 1g 1x,

if you hav a walmart close to you, go and purchase their Relion Ultima meter for $8.88 and 100 strips is around 42 dollars - that is the on I use and have two of them. Now with my insurance covering I pay 42 for 200

I ditches the very pricey ones as I feel that the cost of the strips is outrageous (Comment this)

9 - I have two of the bayer meters and another one that I am not sure of the name but only that the strips are more costly than I want to pay! (Comment this)

10 - DianeW,

Have you tried the Onetouch?

With my insurance I get 300 for a copay of $50.00

http://www.lifescan.com/professionals/products/pharmacy/#Site%20Map

Uses OneTouch® Ultra® Test Strips, covered by more health plans at the lowest co-pay than any other test strip.
 (Comment this)

11 - Angela in Iowa type 2 11-05, Byetta 10, 2 x day, Metformin ER, 1x day, Diagnosed type 2 11-2005,

one similar in every way made by the same company but sold under Leader brand for select pharmacies. Too many dud strips and the strips came in a canister which I do not like.
The Relion ultima are individually wrapped and I never have any dud strips (Comment this)

12 - DianeW,
Thanks for the info
Just did a google search on Relion Ultima and you can get them at Walmart also (Comment this)

13 - still in limbo with the danged insurance coverage on my byetta!

Looks like I might be going to symlin and novolog

what fun!!!!! (Comment this)

14 - its final, I will be starting symlin this weekend as my insurance will not cover byetta and each and every time I need to refill they will do the very same things as they are currently doing.
I did not have insurance before and paid on my own for byetta. But now with the cost of my insurance at around $430.00 a month I cannot afford to buy on my own as the price at the pharmacy I use is 275.00 per pen.

Just hoping that the symlin will be as effective as the byetta. (Comment this)

15 - DIANEW: I'm sorry we are going to lose you on the Byetta forum, but I'm going to keep fingers crossed that the Symlin does just as well for you...or better! Insurance companies - -Grrrr! (Comment this)

16 - thanks!
I love the byetta but unfortunately there is nothing I can do short of just buying it out of pocket - soooo I guess I will see what symlin will do for me.
I have lost a total of 40 pounds with the byetta and feel great. Just hate having to change what is working so well for me at this point.
The stress I have been through from the insurance company is huge so am opting for the path of least resistance as i do not want to go through this each month.
Funny thing is that with novolog and symlin they will be paying more than with just the byetta - go figure! (Comment this)

17 - Lillie T2,99,byetta10,glyburide 2.5,NPH Insulin,The way Byetta has started helping me so well I will try out of pocket for as long as I can last. I too have the Relion meter and strips to have as a second monitor because you do like to keep track of your glucoses but if you test more than twice a day medicare which I have will not send extra. I want to get in shape to enjoy my retirement. Had to retire early due to joint and feet pain, hard due continue working the hospital floors. Good Luck all (Comment this)

18 - Kmart and lower priced meds.
I just contacted my Local K-Mart Pharmacy and was told they will match Walmart's $4.00 Program.

For me this means I can get 3 months of Metformin for $15.00 much cheaper than using my Insurance which would have been $75.00.
I was told all you need to do is to tell K-Mart you wan them to match Walmart on the pricing (Comment this)

19 - Angela in Iowa type 2 11-05, Byetta 10, 2 x day, Metformin ER, 1x day, Diagnosed type 2 11-2005,

That would be only for the generic drug plan and in monthly quantities of 30 for each prescription on the list.

I get my meformin from Walmart and since I get 90 tabs a month it is more than the $4.00

 (Comment this)

20 - DianeW, t2-2003, Symlin 20u 8-2007, Metformin 850 X3, levemir 20u, novolog,,DianeW,

I picked up mine yesterday and yes they are generic but that is all I have ever used.
I got them cheaper than I was expecting,$11.00 for 3 months worth that is about $3.66 a month.
They also gave me a coupon for a free FreStyle Meter which I am going to see if I like any better than the one touch.

 (Comment this)

21 - Targets list of $4.00 Generic Perscription Meds

http://sites.target.com/images/pharmacy/TargetPharmacy4DollarCategories.pdf?ref=sc_iw_r_1_0_1Cat (Comment this)

22 - K-Mart's Generics Formulary list at the link provided below.

https://pharmacy.kmartcorp.com/documents/90%20Day%20Generics%20Formulary%20Sheet%20July%202007.pdf
 (Comment this)

23 - Has anyone done a cost comparison of Januvia? I heard it is quite costly and every penny counts! (Comment this)

24 - Hi there, Gary in IN here... I just wondered, I am not ready yet but does anyone know if there is a supplemental insurance for medicare out there that accepts diabetic people???? My good health insurance runs out in a few years and I was just thinking ahead, I know medicare does not come near to covereing everything. I know that life insurance is impossible to get once you are diagnosed, I just wondered about the supplemental insurance.....
thanks for any help any of you can offer....
GK in wonderfully cool IN (Comment this)

25 - Guides to Finding Health Insurance Coverage in Your State:
I just found this site it has alot of helpful information

http://covertheuninsured.org/stateguides/
CoverTheUninsured.org
 (Comment this)

26 - Cover The Uninsured website

http://covertheuninsured.org/stateguides/


CoverTheUninsured.org


 (Comment this)

27 - C. PHILLIPS: The first thing to do is ask your doctor to file an appeal with the insurance company and to ask if he can get you started with some free samples. Often, the doctor's explanation of why you need Byetta is all that is needed for coverage, and some people have gotten 3 or 4 months worth of free samples. If that doesn't work, try filing for patient assistance. Start here:
Insurance Coverage and Byetta. (Comment this)

28 - Does anyone deal with medicare? I just started on medicare on January first. I called to get an explanation of the part B coverage of test strips. On line and in the book I was sent I read that test strips are covered but there may be restrictions on ammounts etc., etc. with no definition of what those restrictions are. When I called tonight I was told they would decide when they process the prescription. I have an additional plan that that covers presciptions and should make up any difference, I hope. What limits have you all found with medicare? Brands, number of tests etc.? I use a One Touch Ultra 2. (Comment this)

29 - Medicare B covers all your diabetic needs without a charge to you....test strips, batteries, everything. Your RX plan will not be involved in this. (Comment this)

30 - Angel Food ministries
Ok al I got permission form Dr. Bill to post This I know it will be of help to others.

This is not a commercial site it is a way for those of us on a limited income to help stretch our food dollars allowing more money available for other things such as Med's

As you can see they take Food Stamps EBT so they are approved by the government

I get over 70 dollars of GOOD food for 30 dollars and they also have other packages available.

Please check out the site as I think it is wonderful

http://www.angelfoodministries.com/menu.asp

ANYONE can Participate it is open to all no income guidelines no membership fees or any other fees are involved Here is the Frequently asked Questions page

http://www.angelfoodministries.com/faq.asp

 (Comment this)

31 - Angel Food ministries
Ok all I got permission form Dr. Bill to post This I know it will be of help to others.

This is not a commercial site it is a way for those of us on a limited income to help stretch our food dollars allowing more money available for other things such as Med's

As you can see they take Food Stamps EBT so they are approved by the government

I get over 70 dollars of GOOD food for 30 dollars and they also have other packages available.

Please check out the site as I think it is wonderful

http://www.angelfoodministries.com/menu.asp

ANYONE can Participate it is open to all no income guidelines no membership fees or any other fees are involved Here is the Frequently asked Questions page

http://www.angelfoodministries.com/faq.asp

 (Comment this)

32 - Amo from Humble, TX
I have a basic insurance and it does not cover teh test strips. I use one touch Ultra smart test strips. If you know any place I can buy for cheaper price let me know.So far Ebay was my best place to shop for it. Since I do not have a good insurance to cover my cost for the diabetes I'M I am planning a fund rise yearly for my diabetes. Can you send me some ideas about my fundrise?
thank you
masong01@yahoo.com
 (Comment this)

33 - taulandi,

Hi what can I take for type 1 cure?
 (Comment this)

34 - Angela in Iowa type 2 11-05, Byetta 10, 2 x day, Metformin ER, 1x day, Diagnosed type 2 11-2005,

Hi Angela you got a good insurance policy. My insuarence does not cover the test strips and I got $50.00 a month for the insulin (Comment this)

35 - Aggie and Taulandi: There is, of course, no cure for diabetes. If that were true, it would be major headline news everywhere in the world. Don't be scammed. There are no miracles, just schemes to make you throw away your money and hurt you with false hope. (Comment this)

36 - I am still unemployed going on 5 months now and if not for the free clinic and Partnership for Prescription Assistance and one touch I would have no meds.

Partnership for Prescription Assistance and One Touch

I applied through my free clinic pharmacy for help with Byetta I was aproved for 6 months free of Byetta. Do not hesitate to use this service.
Partnership for Prescription Assistance also helps with other prescriptions.
https://www.pparx.org/Intro.php

Also I attended a Diabetes Conference here in DM Iowa and spoke with the One Touch Rep He and my PA at the free clinic spoke and I was able to recieve a nice supply of test strips.
Don't be afraid to ask for assistance if you need it.
 (Comment this)

37 - Susan: I just want to say I don't blame you for being angry. So much about medical treatment nowadays is controlled by insurance companies, and often their decisions make no longterm sense. I remember several people on the blog with insurance denials and other issues. In many cases, appeals by their doctors did the trick. So don't give up. Your doctor may indeed be able to fight this successfully. We've seen it happen. (Comment this)

38 - Toneylee is correct; it's worth fighting! See a commentary I wrote on my other blog: Responding to an insurance company's denial.
 (Comment this)

39 - Bill the diabetesdoc, my issue is not that the insurance company is refusing to pay for Byetta but that they seem to have taken it upon themselves to tell me what dose to take. I have been on the 5 for over a year with another insurance company and now the new one is telling me I will get 1 five pen and then the following month 1 ten pen and then will evaluate again. I do plan to discuss this with my doctor but what has made me so angry is that I don't see why the insurance company has the authority to make the decision how much to take.

As far as insurance companies denying payment, which hasn't been done in my case, I was informed a long time ago by someone who worked for an insurance company that often they deny things with the hope that no one will object and they can save themselves money that way. I was advised to always question and appeal the decisions if they are not favorable because usually the companies will change their minds when they know people are willing to fight for what they think is right. (Comment this)

40 - toneylee in va, I plan to look into my problem further but the saving grace is that it won't be terrible if I have to go to the 10 pen even though it is something I hadn't wanted to do yet. As I've mentioned before I felt as long as I was doing OK on the 5 I wanted to stay there and then have the option to move to to the 10 dose if and when I felt it was needed. My gripe really is that I don't think insurance companies should have all the power they do but of course there is nothing that can be done about that. (Comment this)

41 - Susan: I do understand why you are angry at their interference. But it seems to me that it can become a Paying for Diabetes issue when the insurance company decides what the dosage should be and for how long. That is where I hope your doctor will fight it. To me, this is the same thing as denying coverage (proper coverage, determined by your doctor). Right in the Prescribing Information on the Byetta web site, it says: "Based on clinical response, the dose of BYETTA can be
increased to 10 mcg twice daily after 1 month of therapy."

Note that it doesn't say MUST be, but CAN be. It is up to your doctor and your "clinical response". I hope he/she will use that in talking to the insurance company.

Yeah, it probably would be fine for you to go to the 10. Just, it should be your decision, not theirs. (Comment this)

42 - toneylee in va, I agree with you that going on the ten pen should be my decision but I might have
gotten upset over nothing although I'm still not sure. I called the mail order pharmacy to try to get some information and was told that their records indicate that the review committee has allowed me to receive a 3 month supply of Byetta 5 mcg with 3 refills. I then asked why the letter I got from the insurance company said otherwise and they didn't know anything about such a letter. They had no copy of it. So I am waiting to receive the order which will still take a few days before it is processed and will see how it was filled. I didn't want to call the insurance company(yet)about the letter because it might be a mistake since the insurance company seemed so sure I will get the 3 month supply of the 5 pens so I will deal with it when I have more information and see what I am sent. If it isn't right I will take it up with them at that time. (Comment this)

43 - I am a Benefits Coordinator for my employer. I have two employees who are on Byetta. We have BCBS health insurance with PrimeMail as the Pharmacy manager. Is it common practice for health insurances to only cover the Byetta pen needles, when the employee orders insulin? These employees when they just order the Byetta they have two separate copays 1 for the Byetta and 1 for the short pen needles. When they order their insulin, they have one copay for the insulin and one copay for the Byetta all needles included. My employees say to me if there is another way to administer it they would. Is there another way to administer Byetta to save the extra copay? Another comment is they some times order the insulin, which they do not need and goes bad just to get free needles. To me this poor pharmacy management on BCBS part. Thanks for a wealth of information, and a great Blog!! (Comment this)

44 - BENEFITS COORDINATOR, hi, I see you already found your way over here. I don't know about what is done with insulin and the needles as far as payment goes but with Byetta needles there is a separate co-payment for Byetta and the needles with BCBS and Cigna. Depending on the exact plan people have (as you know it can differ from company to company) for some there is no charge for needles but I have BCBS now and am charged $40 each for Byetta and the needles for a 3 month supply. Some people pay a lot less on their plans and I assume others pay more.

When I recently spoke to a rep at the pharmacy that I have to use for BCBS(Express Scripts)he asked why I needed needles for Byetta because it comes in a pen. I had to explain that needles are needed for the pen so I think that there might be other kinds of pens that don't require a new needle for each injection but Byetta only comes one way. Also depending on the state where people live an Rx is not always needed for needles and some stores like K-Mart, Wal-Mart, Target or Price Club may sell them for very nominal amounts of money. I think what I pay is a lot for the needles but I am happy with the co-pay for Byetta.

Being that you are a benefits coordinator you could call the pharmacy and ask them about the situation your employees are finding with the needles. They are usually very willing to answer questions if they can although sometimes they just don't know the answer because it isn't written in their book or notes that they look up. If that happens just ask to speak to a supervisor who may know more if you are lucky.

 (Comment this)

45 - Thanks Susan! PrimeMail BC/BS Mail Order Pharmacy is inconsistent in their answers and dispensing the Byetta along with other diabetic supplies. My example is that when my employees order insulin $20.00 copay they get their insulin needles free and their Byetta needles free. They only pay copays for the Byetta and the insulin. All needles are free. If they order only the Byetta, they pay a copay for each the needles and the Byetta. If they order just needles, they pay a copay for the needles. They end up stockpiling insulin that goes to waste just to get the needles for free. I am just trying to figure out if it is BC/BS being tight/stingy with the Byetta needles or there are other health insurance plans out there who pay differently. I need to know if precedents have been set. Have I read correctly that there are different sized Byetta needles? My employees just feel that they are getting took by having to pay two copays for the Byetta to include the needles. It would be like getting an inhaler without the mouthpiece on it. How would you use it? It should be all one price everything included. (Comment this)

46 - BENEFITS COORDINATOR,BENEFITS COORDINATOR, yes, there are different size needles for Byetta pens. I use the BD brand ultra fine III mini needle which is recommended for children and small adults neither of which I am but that is what my doctor gave me to use and said it is OK although some people would not agree and feel a larger person with more fat on them should use a longer needle. My needle is 5 mm or 3/16" and 31 gauge. The ultra fine III short pen needle considered appropriate for most people is 8 mm or 5/16" 31 gauge. There is also a ultra fine original needle for people with arthritis or diminished manual dexterity or use it for insulin and that is 12.7 mm or 1/2" 29 gauge. This info comes with a package insert in the needle box. I had question the mail order pharmacy about using other brands which might be cheaper but they didn't know anything about other brands and were too lazy to look it up for me but I plan to find out more about it when I get the chance.

I think something is wrong with how meds/testing supplies are dispensed but it all comes down to the insurance companies making more money and charging us more for them. They have the advantage over us unfortunately. (Comment this)

47 - BENEFITS COORDINATOR, I have UHC for my insurance company and I have always paid a separate co-pay for my pens and needles. I used Novolog(insulin)pens for several years before starting Byetta so I've been paying a double co-pay for 4-5 years now. The needles are the same for the Novolog pen and the Byetta pen. I find it interesting that BCBS would send free needles when ordering both insulin/Byetta together when using both together is considered off label. I don't see the savings though if they are paying two copays, one for byetta, one for insulin(which you say may not be used) and getting free needles or just paying a copay for Byetta and another for the needles. Not all insulin is available in pens so do the others who use vials/syringes also get their syringes free when they order their insulin?

Are your employees drs writing the needles on the same prescription as the byetta/insulin or are they getting separate prescriptions for the needles? (Comment this)

48 - Thanks Geri & Susan! From my understanding from my employees they order their injectible insulin and their Byetta at the same time, and their needles for their injectible insulin and short pen needles are FREE! They pay $100 for a three month supply of Byetta and $70 for their three month supply of insulin. The needles are just thrown in. If they just order insulin needles they have to pay $27.05 for a 90 day supply,because they have a stockpile of insulin. If they order just a 90 day supply of Byetta (with out any additional insulin), they pay $100 for a 90 day supply and have to pay $47.05 for the 90 day supply of short pen needles. I will have to ask what the doctor's are writing on the scripts. (Comment this)

49 - BENEFITS COORDINATOR, I don't understand why there would be no co-pay for needles whether they are written on the same Rx as Byetta or insulin but if they are free it is a good deal. Much depends on the specific plan a person has and just because people have the same insurance company it does not mean their coverage is the same. Some people pay lower premiums and therefore have a higher co-pay whereas those with a higher premium sometimes have a lower co-pay.

I was told today that Walmart has its own mini needles and my guess is that they are cheaper than a regular brand like BD. Perhaps it would be cheaper for some of your employees to pay out of pocket for the needles and not put it through insurance. If they have a doctor's Rx they can take it to any store and get a price check on it and it may very well cost them less that way. (Comment this)

50 -

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