Educating and Advocating for Ourselves

Type 2 Diabetes Blog

Educating and Advocating for Ourselves

Managing diabetes is a constant battle. The struggle can be with carbs, attitude, willpower, stigma, depression, exercise, sleep, stress, etc. You know the drill.

But sometimes the battle can be with your insurance company.

I’m 56 years old, self-employed, and clearly, I have a pre-existing condition. I had a wonderful Anthem health care plan in 2017 through the Affordable Care Act. Victoza cost me about $80 for a 90-day supply. Not ideal, but manageable.

Then Anthem drops out of the Virginia exchange due to uncertainty about the ACA’s future and I was forced to select a new carrier in 2018. I did my due diligence before I picked a plan to make sure my medications were covered. Imagine my surprise when my first bill came from the new mail-order pharmacy (are you sitting down?) - $2,400. That is NOT a typo. Two-thousand four hundred dollars for 90 days’ worth of a single medication.

I will say the new insurance company’s pharmacists worked with me to try and reduce the cost. They checked to see if it would be cheaper if I got the prescription filled at a local drug store. Nope. They investigated whether the manufacturer (Novo Nordisk) offered a discount program. Yes. Yay! Oh, wait. The insurance company no longer honored it. Boo.

I mentioned this insanity to my doctor and he said I could switch to Ozempic. Because it was a new medication, there was a discount plan and my cost would be about $25 per month. Great! He sent in the prescription and I went to pick it up. $3,100. Wait, what? What happened to the discount? Oh, that price was with the discount. What happened to the $25 price? Well, since my insurance doesn’t cover Ozempic, my discount is off the list price. Uh, no thanks.

Then the pharmacist said if my doctor called the insurance company and said that Ozempic was medically necessary, the cost would come way down. My doctor called. The insurance company politely ignored his argument. Declined.

My husband and I were planning a trip to Canada. I asked my doctor if he would give me a hard-copy of my Victoza prescription because I had heard medications were cheaper in Canada. He did. I went to a Canadian pharmacy. If my doctor had been on the magic border area license list, my price would have been $1,031.95 in Canadian dollars (or about $786.35). But he wasn’t, so it wasn’t. Brilliant plan foiled.

It’s time to look into other options. I’ve had great success with Victoza and I don’t really want to switch. I’ll start by Googling my insurance company’s policy on medications. Then I’ll call the Health Advocate at Novo Nordisk to see if they have any advice.

The battle continues. Stay tuned.