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| "Starting January 1, 2016, your Cigna plan won't cover the medications listed below. This means that if you continue to use any of these medications past January 1, 2016, you'll have to pay the full cost of the medication." |
Now I’m sure you have no idea what this means to me, so let me try to explain it to you. Pretend you’re going to buy a new pair of shoes. And you are told that shoes now only come in size 5 or size 9. And your foot? It is a size 7. Oh, but don’t worry, it’s all still shoes! Look at all these people happily walking around in size 5 and size 9 shoes with no problems whatsoever.
Ridiculous, right? Those happy people clearly have size 5 or size 9 feet. But you don’t. Those sizes won’t work for you. Sure, you can cram your foot in a size 5 and walk around, but soon you’ll be dealing with blisters and bleeding and foot cramps to start, and it will only get worse from there. Or you can slip right into the size 9 and then trip and fall and lose the shoes. Neither are an actual solution for your body.
This whole analogy sounds preposterous, right? That’s because it is. And so is your letter. Apidra is my size 7. Humalog and Novolog are my size 5 and 9. I’ve tried them. They are not a solution for my body.
I will fight for my size 7 shoes.
So sorry Karen! Fighting insurance companies is never fun.
ReplyDeleteCigna is also my insurer, and while I don't have your battle to fight, all my prescriptions will double in price in 2016. In addition to my deductible, out of pocket max, and coinsurance - all doubling.
Thank you Affordable Care Act.
The ACA might make insurance affordable for some who could not afford it before, but it makes it much less affordable for me and my family. Simply to purchase to medicine I need to stay alive from day to day.
The health care system in America is still not fixed.
I don't feel the ACA has much to do with this. Before it was passed, insurance companies still had preferred drugs and made us (well, at least me for certain) use one brand and not another.
DeleteIt's also been my experience that if your Dr pushes the issue, they will give the authorization for the one you want (need). That's how I got the test steps I wanted
That stinks, and it's the kind of thing I've had to endure the last several years. Thankfully humalog and novolog work fine for me. Best of luck with your appeal. Sometimes your state Attorney General can be useful in these situations.
ReplyDeleteKaren,
ReplyDeleteI do not know how, but can i help? Can I send a note to Cigna on you behalf? I knwo this will not help, but I want to try to do something. I do not appreciate my friends getting pushed around like this. Grrr.
rick
Thank you for being such a great friend. I'm going to start by having my endo send a letter. If that doesn't work, I'll pull out the big guns (aka:you!!).
DeleteOh Karen, I feel your pain and I hope your endo's letter will do the trick with Cigna. We have Aetna and recently my 16 y.o. T1D reached the "lifetime cap" for Levemir and Novolog...um, how can you impose a lifetime cap on something that SUSTAINS life? It's just crazy making!
ReplyDeleteWhy can't companies understand that we need choices, and to borrow your analogy, one size does not fit all?
ReplyDeleteNot sure if your state has an insurance commissioner, but if it does (like mine does), it might be helpful to complain there too. They're much more likely to want to help someone local as opposed to a corporate entity that might be from somewhere else.
I totally feel your pain on this Karen! Express Scripts did something similar in 2015, however you can only get size 5 (Humalog) covered without prior authorization. I hope that your endo will do what's necessary to get you your size 7! I guess I wear a size 5 shoe and size 7 insulin, huh?
ReplyDeleteWhen my endo was on vacation my Apidra was denied and her sub just wrote a script for Humalog for me, no call, no notice, nothing. All of a sudden I has a prescription for an insulin I don't take from a doctor I don't know.
Grrr. This upsets me. It's madness. All the hoop jumping just to get the care you need makes me crazy. So sorry this is happening.
ReplyDeleteHi Karen-
ReplyDeleteI am writing a profile on you and this blog for www.holisticpain.com, and I would like to use a picture of you. Can I use the one in your profile, or do you have another you would prefer? They need to be 670x670, minimum, and we are happy to give photo credit in the blog.
I tried to mail you through this blog but was not able to. Thanks for your help!
Suzannah
Hi Karen,
ReplyDeleteI had to fight my insurance company to let me use Apidra too instead of Novolog. I tried Novolog and told my doctor it wasn't working for me. I know and trust Apidra, so she helped me fight my insurance. Turns out, it was on the formulary through Edgepark and now my insurance covers it with no problems. I've been able to get my last few prescriptions of it for free! However, my insurance company is going out of business next year, so I'm preparing to fight again if my new insurance doesn't cover it. Preferred medications are ridiculous. Insurance companies have no idea what their patients need. Fight for your insulin! You're one of the only people who can. And see if your doctor can give you free samples of Apidra if you ever need them.
Best wishes!
Rachel